ID Contraindications

Question 1

Penicillins

Answer 1

• Penicillin-class allergy (i.e. hives, anaphylaxis)

* IgE-mediated cephalosporin allergy

Question 2

Augmentin/XR/ES

Answer 2

• Extended release tablet contraindicated in severe renal impairment (CrCl < 30 mL)

Question 3

Cephalosporins

Answer 3

• Severe penicillin-class allergy (i.e. hives, anaphylaxis)

Question 4

Ancef (cefazolin)

Answer 4

• Warnings/Precautions: may be associated with increased INR

Question 5

Carbapenems

Answer 5

• Severe allergic reaction to penicillins

Question 6

Macrolide

Answer 6

• Hypersensitivity

* *Precautions: Hepatic dysfunction

Question 7

Ketek (telithromycin)

Answer 7

• *Warnings/Precautions (medguide is required upon dispensing)

• Risk for QT interval prolongation
• Acute hepatic failure and severe injury reported
• Worsening of myasthenia gravis
• Rare incidence of serious visual disturbances
• Syncope

Question 8

Fluoroquinolones

Answer 8

• Children, adolescents or pregnant women
• Tendon abnormalities, permanent lesions in weightbearing joints
• Warning/ precaution: can cause hypo- or hyper- glycemia and increase risk of C.diff
• *Major Warnings / Precautions (Black Box):
- Tendonitis and tendon rupture (increase risk with elderly, solid organ transplant recipients, or concomitant corticosteroids)
- CNS effects: seizures, psychosis, elevated intracranial pressure
- Peripheral neuropathies

Question 9

Tetracyclines

Answer 9

• CI: Hypersensitivity, Pregnancy category D (avoid unless benefit > risk)
• Precaution: Children < 8 years of age (tooth discoloration), Impaired renal function

Question 10

Bactrim

Answer 10

• Avoid is patient is also taking warfarin

* If HAVE to be on both, make sure that pt will be monitored within 72 hours

Question 11

Macrobid / Macrodantin (nitrofurantoin)

Answer 11

• Precautions: Impaired renal function, Pulmonary concerns with long-term treatment
- Possibly ok to use in those with CrCl 30-60 mL/min
- Beers Criteria: avoid in those >= 65 w/ CrCl < 30 mL/min
• *Rare: peripheral and optic neuropathy; hepatic rxns

Question 12

Flagyl (metronidazole)

Answer 12

• Precautions: CNS effects, severe hepatic impairment

Question 13

Rifampin

Answer 13

• Warnings: potential for hepatotoxicity

Question 14

Vancocin (vancomycin)

Answer 14

• Precautions: Infusion reactions (red man syndrome), renal insufficiency

Question 15

Vibativ (telavancin)

Answer 15

• Warnings: Black box in pregnancy, QT prolongation, nephrotoxicity

Question 16

Cleocin (clindamycin)

Answer 16

• Precautions: can increase risk of pseudomembranous colitis (C. difficile)

Question 17

Zyvox (linezolid)

Answer 17

• CI in the use with SSRI’s; linezolid acts as a mild monoamine oxidase inhibitor

Question 18

Diflucan (fluconazole)

Answer 18

• *Use with warfarin; avoid or monitor closely

* Precaution: Liver function monitoring

Question 19

Sporanox (itraconazole)

Answer 19

• Contraindications / precautions: Use with quinidine / dofetilide; CHF; liver function monitoring
• *CONTRAINDICATED IN CHF acts like a negative inotrope

Question 20

Ketoconazole

Answer 20

• Contraindications / precautions: Hepatotoxicity - liver function monitoring

Question 21

Lamisil (terbinafine)

Answer 21

• Precautions: Skin reactions, pre-existing liver disease

Question 22

antivirals

Answer 22

• Contraindications / precautions: Renal disease, dehydration