Infections ADRs Flashcards
Penicillins
* Type of abx
* 4 categories of penicillins and examples
* ADRs
Beta-lactams
* Natural penicillins (penicillin G/ V)
* Penicillinase resistant penicillins (cloxacillin)
* Aminopenicillins (ampicillin, amoxicillin, amoxicillin + clavulanic acid/ augmentin, ampicillin + sulbactam)
* Anti-pseudomonal penicillins (peperacillin, piperacillin + taxobactam)
ADRs
* Allergy/ Hypersensitivity
* GI symptoms: nausea, vomiting, diarrhoea, CDAC
* Neurotoxicity: convulsions, coma occur at very high doses/ in toxic accumulation due to renal failure
Cephalosporins
* Type of abx
* 5 generations and examples
* ADRs
Beta lactams
* 1st gen: cefazolin (IV, IM, eyedrop), cephalexin (PO)
* 2nd gen: cefuroxime (PO)
* 3rd gen: ceftriaxone, ceftazidime (both IV, IM)
* 4th gen: cefepime (IV, IM)
* 5th gen: ceftaroline, ceftobiprole (IV, IM)
ADRs
* Hypersensitivity/ cross-allergy w penicillins
* GI symptoms: nausea, vomiting, diarrhoea, CDAD
Carbapenems
* Type of abx
* Examples
* ADRs
Beta lactams: Imipenem + cilastatin, meropenem, ertapenem
ADRs
* Hypersensitivity/ cross-allergy with penicillins
* GI symptoms: nausea, vomiting, diarrhoea, CDAD
* Neurotoxicity
Monobactam
* Type of abx
* Example
* ADRs
* DDIs
Beta lactam: aztreonam
ADRs
* Occasional skin rashes and elevated transaminase
* Generally well-tolerated, little/no cross allergy with penicillins
Vancomycin
* Type of abx
* ADRs
Glycopeptide
ADRs
* Thrombophlebitis
* Red-man syndrome
* Nephrotoxicity
* Ototoxicity
Tetracycline + Glycylcycline
* Type of abx
* Examples
* ADRs
* DDIs
* C/Is
Tetracyclines: tetracycline, doxycycline, minocycline
Glycylcycline: tigecycline
ADRs
* Gastric discomfort
* Yellow discolouration and hypoplasia of teeth, temporary growth stunt
* Hepatotoxicity
* Phototoxicity
* Vestibular dysfunction: dizziness, vertigo, tinnitus (esp minocycline)
* Renal SEs in patients with pre-existing renal disease (less with doxycycline)
* Fungal or bacterial superinfection: due to prolonged use, includes CDAD
- Food-drug interaction: avoid administration w dairy products (calcium) or other substances that contain divalent and trivalent cations (Mg/Al antacids, Fe supplements)
DDIs
* ↑effects of oral sulfonylureas → hypoglycemia
* ↑effects of digoxin, lithium, theophylline (have narrow therapeutic indices) → toxicity
* ↑effects of warfarin, downward dose adjustment of anticoagulants needed
* ↓effects of oral contraceptives
C/Is: Pregnant/ breast-feeding women, children <8yo
Aminoglycosides
* Type of abx
* Examples
* ADRs
* C/Is or cautions
Aminoglycosides:
ADRs
* Ototoxicity
* Nephrotoxicity
* Neuromuscular paralysis
* Hypersensitivity: skin rash, contact dermatitis (topical neomycin)
C/Is
* Myasthenia gravis
* Neomycin (most toxic): intestinal obstruction, ulcerative GI disease, hx of hypersensitivity to aminoglycosides
Pregnancy: cat D
Macrolides
* Type of abx
* Examples
* ADRs
* DDIs
Protein Synthesis Inhibitors (50S): erythromycin, clarithromycin, azithromycin
ADRs
* GI discomfort
* Hepatotoxicity
* Ototoxicity
* Prolongation of QTc interval
DDI: CYP450 inhibitor
Pregnancy: erythromycin and azithromycin are cat B, clarithromycin is cat C
Lincomycin
* Type of abx
* Example
* ADRs
* C/Is
Protein synthesis inhibitors (50S): Clindamycin
ADRs
* GI discomfort
* Skin rash
C/Is: CDAC (resistant to clindamycin), pseudomembranous. ulcerative colitis
Oxazolidione
* Type of abx
* Example
* ADRs
* C/Is
Protein synthesis inhibitor (50S): Linezolid
ADRs
* GI discomfort
* Thrombocytopenia
* Serotonin syndrome
* Irrversible peripheral neuropathic and optic neuritis after >28d of use
C/Is: tx of catheter-related bloodstream/ catheter-site infections
Fluoroquinolones
* Type of abx
* Examples
* ADRs
* FDIs / DDIs
* C/Is
DNA Gyrase/ Topoisomerase IV Inhibitor: ciprofloxacin, levofloxacin, moxifloxacin
ADRs
* GI disfomcort, risk of CDAC
* Dysglycemia
* Aortic dissections/ resupters/ tears
* Phototoxicity
* Tedonitis/ tendon rupture
* Prolongation of QTc interval
* Peripheral neuropathy
FDI: avoid taking tgt w calcium/ divalent cations, or dietary supplements containing iron/ zinc (decreases absorption)
Give 2hrs before or 6hrs after meals, best on empty stomach
DDI: increase serum levels of warfarin
C/Is: pregnancy, lactation, myasthenia gravis, G6PD deficiency, pts predisposed to arrhythmias/ taking other meds that cause QTc prolongation
Sulfonamides: Sulfamethaxozole
* Type of abx
* ADRs
* DDIs
* C/Is
Anti-folate agent
ADRs
* Crystalluria and nephrotoxicity
* Hypersensitivity: rashes, angioedema, Stevens Johnson Syndrome
* Hemolytic anemia/ thrombocytopenia in G6PD deficiency
* Kernicterus
DDI: warfarin (displace drug from albumin binding sites → transient ↑anticoagulant effect)
C/Is: G6PD deficiency, pregnancy, <2m
Trimethoprim
* Type of abx
* ADRs
* C/Is
Anti-folate drug
ADRs
* Folic acid deficiency: megablastic anaemia, leukopenia, granulocytopenia
C/Is: folate deficiency, pregnancy
Cotrimoxazole
* Type of abx
* ADRs
* C/Is
Anti-folate drug
ADRs
* Hypersensitivity
* GI discomfort
* Haemolytic anaemia in G6PD deficiency
* Folic acid deficiency
* Hyperkalemia
* SJS
C/Is: hypersensitivity to sulfonamides/ trimethoprim, G6PD deficiency, folate deficiency, pregnancy, infants <2m
Nitrofurantoin
* Type of abx
* ADRs
* C/Is
Urinary antiseptic
ADRs
* GI discomfort
* Colours urine brown
* Hypersensitivity
* Leukopenia/ haemolytic anaemia in G6PD deficiency
* Chlestatic jaundice, hepatocellular damage (rare)
* Pulmonary and hepatic toxicities, peripheral neuropathies in elderly
C/Is: G6PD deficiency, renal impairment (CrCl<40), pregnancy, infants <1m
Metronidazole
* Type of abx
* MoA
* Route of administration
* Coverage
* ADRs
* DDIs
* C/Is
* Other remarks (CSF penetration, administration)
Antiprotozoal agent
ADRs
* GI discomfort
* Unpleasant metallic taste
* Oral moniliasi (yeast infection in mouth)
* Convulsive seizures, optic and peripheral neuropathy (rare)
DDI: is a CYP inhibitor, potentiate effects of warfarin
C/Is: pregnancy
List some antimicrobials that should be avoided in patients with G6PD Deficiency.
Sulfonamides, co-trimoxazole, nitrofurantoin, fluoroquinolones
List some antimicrobials that are avoided in children.
Fluoroquinolones (arthropathy), tetracyclines (discolouration of teeth)
Which antimicrobials display cross-reactivity with penicillins?
Cephalosporins and carbapenems
List some antimicrobials that are safe to use in pregnancy.
Beta-lactams, macrolides, clindamycin, amphotericin B, cutaneous antifungals, anti-tuberculosis agents
List some antimicrobials that are generally cautioned or avoided in pregnancy.
co-trimoxazole, fluoroquinolones, tetracyclines
List some antimicrobials that do not achieve adequate CSF penetration, and hence are not used for CNS infections.
1st and 2nd gen cephalosporins, aminoglycosides, macrolides, clindamycin
List some antimicrobials that are used to treat CNS infections.
penicillins, ceftriaxone, cefepime, ceftazidime, meropenem, vancomycin
List some antimicrobials that are bactericidal.
beta-lactams, glycopeptides, aminoglycosides, fluoroquinolones, polymixins, lipopeptides
