ID: ABX adverse effects

Question 1

Fluoroquinolones

Answer 1

• generally well tolerated*
  but. .. when cmpared to other ABX:
• GI upset more common
• CNS: HA, dizziness, sleep issues are more common
• Incidence of C. Diff is more common
• small risk of photoxicity
• hypersensitivity
• dysglycemia: hyper or hypo

less common but severe:

• periph neuropathy
• QT»>
• possible increased risk of aortic dissection

BBW: Tendinopathy*****

Question 2

Sulfonamides

Answer 2

Metabolism of drug causes a metabolite that can lead to

• kidney stones
• renal damage

1. hypersensitivity–very common
2. Crystalluria—kidney stones
3. Hemolytic anemia
4. Kernicterus–bilirubin associated brain damage in newborns–sulfa drugs displace the bilirubin from binding sites
5. Inhibition of CYP P2C9–increases serum [ ] of drugs with same CYP—EX: warfarin, methotrexate, phenytoin

Question 3

Trimethoprim

Answer 3

• folic acid deficiency— to avoid this give concurrently with Leucovorin
• Hyperkalemia– be aware with concurrent use with other K+ sparing drugs (ACEI)

Question 4

Cotrimoxazole

Answer 4

• n/v
• skin rash
• hematologic toxicity
• hyperK

Question 5

Methenamine

Answer 5

GI upset***

Question 6

Nitrofurantoin

Answer 6

• N/v/d

- rare: drug induced liver injury, periph. neuropathy

Question 7

Rifampin

Answer 7

• metabolites can turn urine, tears, sweat orange/red
• flu like s/s
• hepatoxic

Question 8

Isoniazid

Answer 8

• potentially fatal hepatitis
• periphereal neuropathy/parethesia caused by peroxidase deficiency—— to prevent this give B6**
• Seizures=common

Inhibits B6
Neuropathy
Hepatits

Question 9

Pyrazinamide

Answer 9

• hepatitis and Hyperuricemia
• photosensitive dermatologic rash
• arthralgias

Question 10

Ethambutol

Answer 10

• optic neuritis–esp in PT with renal dz

- caution in gout bc it can elevate uric acid

Question 11

Dapsone

Answer 11

Severe hemolytic anemia esp in PT with G6PD*****

Peripheral neuropathy

Question 12

Tetracyclines

Answer 12

1. if allergic to one tetra… then allergic to all
2. Phototoxicty
3. GI discomfort
4. esophageal erosion avod b4 bed
5. Accumulation in bones/teeth
6. Hepatotoxicity is rare but fatal
7. nephrotoxicity
8. vertigo only with minocycline
9. Jarish-Herxheimer rxn with spirochete tx

Question 13

Tigecycline

Answer 13

• Similar to other tetracyclines EXCEPT:
• BBW for increased mortality……. so use this drug only when alternative treatments are not available
• coagulopathy
• Safety not established for PT <18YO

Question 14

Aminoglycosides (toxicity)

Answer 14

• ototoxicity–vestibular or cochlear damage
• nephrotoxicity– 10-20% pTs, mild-severe, reversible or irreversible
• paralysis from NMJ blockade: rare but serious with rapid increases in [ ] or in PT with Myasthenia gravis
• contact dermatitis— mostly with neomycin

Question 15

Macrolides

Answer 15

1. GI distress/motility
2. Cholestatic jaundice
3. Ototoxicity
4. Prolonged QTc

Question 16

Clindamycin

Answer 16

• PO use is limited due to diarrhea *****
• –diarrhea is possible up to 20%: Possible C. Diff/pseudomembranous colitis
• skin rash
• caution with neuromuscular blocking agents

Question 17

Quinupristin/Dalfopristin

Answer 17

• Venous irritation–>use central line*
• Hyperbilirubinemia
• Arthralgia/myalgia at high doses

Question 18

Linezolid and Tedizolid

Answer 18

1. MC: GI upset, HA, rash
2. Myelosuppression
3. Peripheral or otic neuropathy (can be irreversible)
4. Serotonin syndrome if given with SSRIs, SNRIs, MAOIs Bupropion
5. Lactic Acidosis with prolonged used*
   WHY WE WANT TO AVOID LONG TERM USE*****

Question 19

Chloramphenicol

Answer 19

1. blood dyscrasias and risk of irreversible bone marrow suppression** BBW for the bone marrow suppresion****
2. gray baby syndrome in neonates
3. many drug-drug interactions due to inhibition of liver metabolizers—warfarin, phenytoin

Question 20

Anti-staphylococcal penicillins

Answer 20

N/V/D
Neurotoxicity 
Acute interstitial nephritis---Methicillin 
Thrombocytopenia 
Neutropenia 
Methemoglobinemia

Question 21

Ampicillin

Answer 21

Skin rashes is common

Question 22

Penicillins

Answer 22

*gen well toleratd and safe vs other ABX

1. Hypersen
2. diarrhea
3. nephritis–methicillin
4. Neurotoxicity–can lower seizure threshold
5. hematologic–piperacillin, nafcillin, Pen G can cause decreased coagulation
   * ***monitor for cytopenias after prolonged tx

Question 23

First gen Cephalosporins

Answer 23

Hypersensitivity rxn 0-80% cross reactivity with PCNs

Question 24

Aztreonam

Answer 24

Cross-allergenicity with Ceftazidime

Question 25

Vancomycin

Answer 25

* Vancomycin flushing syndrome * thrombophlebitis * Nephrotoxicity

Question 26

Telavancin

Answer 26

nephrotoxicty teratogenicity coagulation disturbance prolonged QTc

Question 27

Daptomycin

Answer 27

Elevated transaminases Myalgia Rhabdomyolysis

Question 28

Fosfomycin

Answer 28

Diarrhea Vaginitis Nausea HA

Question 29

IV Polymyxin B

Answer 29

IV= high risk of nephrotoxicity and neurotoxicity

Question 30

trimethoprim-Sulfamethoxazole aka Co-trimoxazole

Answer 30

N/V Skin rash hematologic toxicity hyperK

Question 31

Methenamine

Answer 31

GI upset is MC

Question 32

Clofazimine

Answer 32

Photoxicity brownish/black skin discoloration during tx QT>>>> GI upset