Antimicrobials Flashcards
name the S/E of tetracyclines
epigastric distress (to drink plenty of fluids and avoid administration just before bed time), brown-yellow discolouration of teeth (+/- enamel hypoplasia, temporary stunting of growth) in children <8yo, photosensitivity +/- severe sunburn , superinfection with prolonged usage (CDAD when use > 2 months, oral thrush), nephrotoxicity and hepatotoxicity, vestibular dysfunction with tinnitus/ dizziness/vertigo (esp. for minocycline)
name the drug interactions for tetracyclines
trivalent/divalent cation containing products, incl. antacids and dairy products (reduce tetracyclines absorption), oral SU (hypoglycemia), digoxin / lithium / theophylline (toxicity), warfarin (bleeding), oral contraceptives (reduces its efficacy), penicillins (reduce its efficacy)
name the contraindications for tetracyclines
pregnancy (category D), lactation, children <8yo
name the S/E of aminoglycosides
ototoxicity (vestibular and auditory; elderly more susceptible and deafness may be irreversible), nephrotoxicity (elderly more susceptible), neuromuscular paralysis, hypersensitivity (rash + contact dermatitis for topically applied neomycin)
name the contraindications for aminoglycosides
renal impairment, hearing impairment, myasthenia gravis, pregnancy (category D), concomitant use with other nephrotoxic / ototoxic / neuromuscular blocking agnets, intestinal obstruction/ulcerative gastrointestinal disease (for neomycin only)
name the S/E of macrolides
gastric distress (more with erythromycin than clarithromycin and azithromycin), QTc prolongation, ototoxicity (high IV doses of erythromycin has been associated with transient deafness and azithromycin has been associated with irreversible hearing loss), hepatotoxicity (cholestatic jaundice)
name the contraindications of macrolides
use with caution in patients who have pro-arrythmic conditions, and hepatic dysfunction
name the drug interactions of macrolides
CYP450 inhibitor, thus potentiates the effect of digoxin, corticosteroids, warfarin (erythromycin and clarithromycin only)
name the S/E of clindamycin
gastric distress / vomiting / diarrhoea, skin rashes, CDAD (as C. difficile is alw resistant to clindamycin)
name the contraindications of clindamycin
patients with pseudomembranous colitis / ulcerative colitis
name the S/E of linezolid
bone marrow suppression, incl. thrombocytopenia for prolonged use (>10 days), serotonin syndrome (due to linezolid’s non-selective monamine oxidase inhibitory activity; may be precipitated by SSRI, MAOi, tyramine rich foods), gastrointestinal effects incl. nausea and diarrhoea, irreversible peripheral neuropathy and optic neuritis (causing blindness)
name the drug interactions of linezolid
contraindicated within 2 weeks use of MAOi, avoid concurrent administration with SSRI and avoid tyramine rich foods
name the S/E of fluoroquinolones
gastric distress incl. N/V/D, headache/lightheadedness/dizziness, dysglycemia, tendonitis/tendon rupture, aortic dissection/aortic aneurysm rupture, arthropathy in children <18yo, peripheral neuropathy, QTc prolongation, photosensitivity, increased risk of CDAD esp with ciprofloxacin
name the contraindications of fluoroquinolones
caution in patients with diabetes, elderly, CNS disorders e.g. epilepsy, aortic blockages / aneurysms / HTN / blood vessel disorders, patients with myasethensia gravis, pro-arrhythmic conditions, pregnancy, lactation, children <18yo, G6PD deficiency
name the drug interactions of fluoroquinolones
CYP450 inhibitor, hence potentiates the effects of cyclosporines, warfarin, digoxin, corticosteroids; avoid administration with polyvalent cations
name the S/E of co-trimoxazole
hypersensitivity from rash to angioedema and SJS, crystalluria +/- nephrotoxicity, N/V hence to take after food, photosensitivity, myelosupression due to folate acid deficiency (anemia, leukopenia, granulocytopenia, thrombocytopenia), hyperkalemia, hepatotoxicity
name the contraindications of co-trimoxazole
avoid in patients with hx of hypersensitivity to sulfa drugs, patients with folic acid deficiency, first / last trimester of pregnancy / when at term (due to folate acid deficiency + kernicterus), lactation (due to kernicterus), in infants <2 months old (due to kernicterus), avoid in G6PD deficiency
name the S/E of nitrofurantoin
hypersensitivity incl. fever and chills, gastric distress incl. N/V/D hence to take after food (also increases absorption), colours urine brown, headache, pulmonary toxicity (pulmonary fibrosis), hepatotoxicity (cholestatic jaundice and hepatocellular damage) and /or neuropathy (elderly are more susceptible, esp. if poor renal function and prolonged treatment duration), hemolytic anemia and other hematopoietic disturbances in patients with G6PD deficiency
name the contraindications of nitrofurantoin
patients with severe renal impairment (CrCL <30mL/min), G6PD deficiency, last trimester of pregnancy / at term / lactation / infant <2 months old (G6PD of infant unknown)
name the S/E of metronidazole
gastric distress incl. N/V/abdominal cramps, epigastric distress, metallic taste in mouth, oral yeast infection, nervous system effects incl. convulsive seizures, optic neuropathy, peripheral neuropathy (rare but neccesitates discontinuation of drug; to avoid alcohol)
name the contraindications of metronidazole
caution in severe hepatic dysfunction, avoid in first trimester of pregnancy (but category B for pregnancy)
name the S/E of penicillins
hypersensitivity, GI symptoms (N/V, CDAD), neurotoxicity (convulsions and coma)
name the S/E of cephalosporins
hypersensitivity, GI symptoms (V/D, CDAD)
name the S/E of carbapenems
hypersensitivity, GI symptoms (V/D, CDAD), neurotoxicity (seizures at high IV doses & in renally impaired)
name the S/E of aztreonam
generally well tolerated, but can cause occasional skin rashes and elevated transaminases
name the S/E of vancomycin
thrombophlebitis with fever and chills, red man syndrome +/- hypotension (can be prevented by prolonging infusion duration to 1-2h), nephrotoxicity, ototoxicity
