antibiotics and antifungal ADRs

Question 1

pencillin adrs

Answer 1

GI(N/V/D), hypersensitivity (rash to anaphylaxis), hematologic toxicity

Question 2

cephalosporin ADRs (including special one)

Answer 2

GI(N/V), hypersensitivity, hematologic toxicity, cefepime can cause neurotoxicity, ceftriaxone can cause biliary sludge especially in young children

Question 3

carbapenem adr

Answer 3

N/V/D, seizures (more in imipemen than the others)

Question 4

macrolide ADRs

Answer 4

N/V/D/heartburn
photosensitiivity rash and hyperpigmentation(mino>doxy>tige)
binding with multivalent cations(Al, Ca, Fe, Mg, Zn)
permanent teeth discoloration in kids under 8 (use doxycycline for less than 21 days is okay)
teeth staining and enamel hypoplasia to fetus/infant so avoid in pregnancy unless there is no other option

Question 5

macrolide ADR

Answer 5

GI, prolonged QTc, hepatotoxicity

Question 6

quinolone adr

Answer 6

Boxed warning of tendinitis and tendon rupture (more if above 60, take corticosteroids, and solid organ transplant patients and most commonly involves achilles tendon)
QTc prolongation (moxi>cipro/levo)
neurologic(dizzy, HA, insomnia, seizures)
drug interactions (multivalent cations) and warfarin (increase INR)

Question 7

sulfonamide ADR

Answer 7

dermatologic (rash and skin photosensitivity), pancytopenia (leukopenia, thrombocytopenia, hemolytic anemia and all dose dependent)
DDI with warfarin that increases INR

Question 8

lincosamide adr

Answer 8

N/V/D, BBW of colitis caused by C. diff

Question 9

nitroimidazole adr

Answer 9

peripheral neuropathy, metallic taste, avoid use with alcohol, DDI with warfarin that increases INR

Question 10

telavancin ADRs

Answer 10

BBW of preexisting renal impairment combined with telavancin for HAP/VAP can increase mortality risk vs vancomycin(use only when benefit outweighs the risk); increased risk of nephrotoxicity, make sure to test for pregnancy before starting; interferes with PT, aPTT, ACT, and INR tests(not with the actually coagulation itself)

Question 11

daptomycin adr

Answer 11

myopathy(rhabdomyolysis is rare), elevated creatine kinase (weekly monitoring recommended)

Question 12

adr of oxazolidinones

Answer 12

myelosuppression (generally reversible) and more common if therapy is more than 2 weeks (linezolid>tedizolid); peripheral neuropathy and optic neuropathy (irreversible) and more common if more than 4 weeks of therapy (about the same risk); weak and reversible MAO inhibitor so don’t take linezolid with SSRI/SNRI/TCAs but tedizolid has no limitation

Question 13

aminoglycoside adr

Answer 13

nephrotoxicity (more risk if old, dehydrated, ICU, pre-existing kidney disease, concomitant nephrotoxic drugs, MDD, high troughs, longer duration of therapy); ototoxicity (irreversible and depends on dose and duration of therapy)

Question 14

vancomycin adr

Answer 14

-nephrotoxicity (acute tubular necrosis with risk factors of high doses (at least 4 grams a day), concurrent ue of zosyn or aminoglycosides of other nephrotoxic drugs, history of CKD, and long-term therapy)
- red man syndrome (infusion-related reactions is like a rash that affects the head/face/neck/upper trunk and can treat with diphenhydramine and H2 antagonist and if you continue vanco then you can premedicate and infuse vanco at a slower rate)
- neutropenia

Question 15

nitrofurantoin adr

Answer 15

n/v, rash, pulmonary reactions

Question 16

polymixins adr

Answer 16

nephrotoxicity that is dose dependent, neurotoxicity that is reversible (signs of paresthesias, muscle weakness, peripheral neuropathy)

Question 17

amphotericin B adr

Answer 17

nephrotoxicity (secondary to direct vasoconstriction of afferent renal arterioles, dose-related, K and Mg wastine (replenish aggressively, and a saline bolus dose before administration); infusion related reactions (premedicate with APAP, benadryl, and/or meperidine)

Question 18

flucytosine adr

Answer 18

GI, bone marrow suppression, hepatotoxicity

Question 19

echinocandin adr

Answer 19

well-tolerated

Question 20

fluconazole adr

Answer 20

N/V, hepatotoxicity, alopecia(reversible)

Question 21

isavuconazole adr

Answer 21

N/V/D, hepatotoxicity, shortened QTc, infusion-related reactions, peripheral edema

Question 22

itraconazole adr

Answer 22

N/V/D especially with the solution, hepatotoxicity, QTc prolongation, peripheral edema (can’t use if heart failure - BBW), DDIs

Question 23

voriconazole adr

Answer 23

hepatotoxicity, qt prolongation, alopecia (reversible and more common in long term therapy), visual changes (blurred vision, vision change, and/or photophobia)(reversible); neurologic toxicity (confusion, hallucinations, agitation

Question 24

posaconazole adr

Answer 24

N/V/D, hepatotoxicity, peripheral edema, QT prolongation