Antimicrobial chemotherapy - side effects and toxicity

Question 1

What group of drugs are most commonly associated with allergic reactions

Answer 1

B-lactams

Question 2

What are the two forms of hypersensitivity

Answer 2

immediate

delayed

Question 3

What is an immediate hypersensitivity and what is it mediated by

Answer 3

Anaphylactic shock mediated by IgE

Question 4

What is the mechanisms of a delayed hypersensitivity

Answer 4

immune complex or cell mediated

Question 5

What are the characterisations of delayed hypersensitivity

Answer 5

Drug rashes - restricted to the skin
Drug fever
serum sickness

Question 6

What are common gastrointestinal side effects associated with antimicrobial use

Answer 6

Nausea and vomiting

Question 7

What is an important side effect infection in antibiotic therapy

Answer 7

C.diff

Question 8

What side effect is associated with c.diff toxins

Answer 8

CDAD - diarrhoea

or an CDI infection psudomembranous colitis

Question 9

How does C.diff infection arise in antibiotic therapy

Answer 9

carried in the GI tract and overgrows normal flora during antibiotic therapy and produce toxins

Question 10

How is C.diff toxin detected

Answer 10

detection of toxin in stool by an enzyme immunoassay

Question 11

What is the treatment of a c.diff infection

Answer 11

oral metronidazole or vanomycin

other antimicrobial treatment is discontinued

Question 12

Antimicrobials cause side effect of thrush how

Answer 12

As suppress normal flora allowing overgrowth of yeast candida albicans

Question 13

What is the range of side effects of liver toxicity

Answer 13

elevated liver enzymes

severe hepatitis

Question 14

What drugs can cause hepatotoxicity

Answer 14

Tertracycline

flucloxacillin

Question 15

What groups of antibiotics cause nephrotoxicity (renal toxicity)

Answer 15

Aminoglycosides ( e.g gentamicin)
or vancomycin
Probably as both are toxic

Question 16

Both hepatotoxicity and nephrotoxicity are more common

Answer 16

with patients with pre-existing liver/renal diseases

Question 17

What are the four types of neurological toxicity

Answer 17

ototoxicity -damage to the ear
optic neuropathy - optic nerve damage
encephalopathy and convulsions - brain function
peripheral neuropathy - damaged nerves

Question 18

What antimicrobials cause ototoxicity

Answer 18

aminoglycosides

or vancomyosin

Question 19

what antimicrobials cause optic neuropathy

Answer 19

ethambutol - an antituberculous

Question 20

When does encephalopathy and convulsions occur

Answer 20

high dose penicillin and cephalosporin use

also with aciclovir

Question 21

what may produce a reversible peripheral neuropathy

Answer 21

metronidazole and nitrofurantonin

also as anti-tuberculous inhibits vitamin 6 inducing peripheral neuropathy

Question 22

What is heamatological toxicity

Answer 22

toxic effect on bone marrow

Question 23

What is the different forms of of heamatological toxicity

Answer 23

neutropenia - selective depression of all bone marrow

pancytopenia - un-selective depression of all bone marrow elements

Question 24

How does co-trimoxazole cause megaloblastic anaemia producing large bone marrow

Answer 24

As acts as a competitive inhibitor to folic acid

and the folic deficiency affects the bone marrow

Question 25

antimicrobials should only be used when and in what form

Answer 25

used when indicated

at minimum dose at the duration necessary to achieve efficacy

Question 26

What are the susceptible groups of antimicrobial therapy

Answer 26

extreme ages
pregnant women
patients with liver or renal insuffiency

Question 27

What does it mean when antibiotics have a low therapeutic margin

Answer 27

difference between an effective and a toxic dose is small

Question 28

Why should antibiotics with a low therapeutic margin be monitored

Answer 28

to ensure maximal efficacy and minimal toxicity