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.► FARMACOLOGIA CLÍNICA - JP > Side Effect > Flashcards

Side Effect Flashcards

1
Q

Macrolides side effect

A

1) GIT disturbance
2) thrombophlebitis
3) ototoxicity
4) hepatotoxicity (c&a better tolerated)
5) QT prolongation

Allergic can cause fever rash eosinophilia

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2
Q

Beta lactam side effect

A

1) hypersensitivity
2) bone marrow suppression (reversible)
3) seizure
4) hepatotoxicity
5) GI disturbance

All reversible

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3
Q

Penicillin 2 DDI

A

W oral contraceptives (decrease contractive level)

  • bacteria cannot hydrolyse conjugated hormones

W probenecid
( accumulate BL; block secretion at renal tubular cells)

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4
Q

Cephalosporin SE

A

Hypersensitivity: rash, pruritus, fever
Anorexia, nausea, flatulence
Supra infection: ceftriaxone, cefoperazone and cefotetan may cause bleeding tendencies
Taking cefotetan and alcohol may cause serious disulfiram like reaction

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5
Q

Cephalosporins DDI

A

Cephalosporins + warfarin can increase warfarin effects
l reduce the absorption of vitamin K in the body.
l Long-term use (more than 10 days) of antibiotics may result in vitamin K deficiency because these drugs kill not only harmful bacteria but also beneficial, vitamin K- activating bacteria

Increase the anticoagulant effect of warfarin

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6
Q

Monobactam se

A

Side effects of monobactams
1. Very well-tolerated
2. No IgE-mediated cross-allergenicity with penicillins
3. Hematologic, GI, nephrotoxic or neurotoxic reactions are rare

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7
Q

Carbapenam DDI

A

Valproate + Meropenem can decrease valproate levels (may apply to all carbapenems); AVOID CONCOMITANT USE

  1. Decreased absorption of VPA secondary to inhibition of intestinal transporters by carbapenems;
  2. Decreased enterohepatic recirculation of VPA due to decreased gut bacterial beta-glucuronidase, which may be disrupted due the broad-spectrum activity of carbapenems;
  3. Increased distribution of VPA into erythrocytes; and
  4. Disruption of the normal metabolism of VPA
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8
Q

Glycopeptide SE

A
  1. Dermatological rash; haemotologic (neutropenia and thrombocytopenia with prolonged therapy (reversible)
  2. Thrombophlebitis, fever, chills (10%)
  3. “Red-neck” or “Red man syndrome”
    (rash above the nipple line due to histamine release when vancomycin is infused too rapidly). Give antihistamine or prolong infusion time.
  4. Increased nephrotoxicity and ototoxicity when vancomycin is used with aminoglycoside
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9
Q

Glycopeptide DDI

A

Aminoglycoside

Polymyxin

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10
Q

Daptomycin SE

A

Myopathy (muscle weakness due to dysfunction of muscle fibre)
Monitoring of weekly creatinine phosphokinase levels recommended

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11
Q

Daotomycin DDI

A

Statin

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12
Q

Polymyxin SE

A

Adverse effects of Polymyxins
1. Polymyxin B applied to intact or denuded skin or mucous membranes produces no systemic reactions and almost complete lack of absorption.
2. Nephrotoxic: avoid aminoglycosides or other nephrotoxins.
3. Interfere with neurotransmission at the neuromuscular
junction, resulting in muscle weakness and apnea.
4. Other neurological reactions include paresthesias, vertigo, and slurred speech.

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13
Q

Polymyxin DDI

A

Avoid amioglycoside
Vancomycin

Not w neuromuscular blocker

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14
Q

Aminoglycoside SE

A

1) ototoxicity
Associated with excessively high peak concentration on in conventional onal dosing
• Auditory and vestibular damage – Auditory- High frequency hearing loss
first
– Vestibular – affect balance, nausea, vomiting ng, ver=go
• May be reversible/ irreversible

  1. Nephrotoxicity
    • Reported up to 20%
    • Due to uptake into proximal renal tubular epithelial cells • A saturable process
    Risk factors:
    Trough conc >2-3 mg/L for gentamicin, tobramycin, netilmicin and >10mg/L for amikacin
    – Prolonged duration on of therapy (>10-14 days) – Advance age
    – Concomitant nephrotoxins (vancomycin) – Sepsis
    – Gentamicin/ Amikacin > tobramycin • Reversible

3) neuromuscular blockage
Reversible with calcium gluconate

4) risk factor
Myasthenia gravis
HypoCa
HypoMg

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15
Q

Aminoglycoside DDI

A

Avoid polymyxin
Vancomycin
Not w CCB

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16
Q

Tetracycline SE

A 
GI disturbance 
Liver failure 
Vertigo 
Desorption in bone and teeth 
Photo toxicity

Avoid pregnancy

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17
Q

Drug to Avoid in pregnancy

A

Quinolones
Tetracycline

Metronidazole
Chloramphenicol
Aminoglycoside
Tetracycline

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18
Q

Aminoglycoside DDI

A
  1. amphotericin B,
  2. Vancomycin
  3. NSAIDs

Nephrotoxic
reduce renal blood flow by inhibiting prostaglandin production

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19
Q

Tetracycline DDI

A
  1. Phenytoin
  2. Carbamazepine
  3. Phenobarbitone
  4. Antacids

Hepatic enzyme inducers -shorten the plasma
half-life of doxycycline by 50%

Antacid Reduce absorption
Cations: Ca++, Fe++ and Al+++
- reduce the absorption of oral
tetracycline

20
Q

Tigecycline SE

A

Side effects of Tigecycline
1. Nausea, vomiting (20-30%)
2. Photosensitivity (uncommon)
3. Superinfection
4. Increase risk of mortality and treatment failure

21
Q

Tigecycline DDI

A

Warfarin increase R warfarin AUC 40% but don’t affect INR

22
Q

Macrolide DDI

A

Erythromycin
Clarithromycin

  1. Simvastatin
  2. Carbamazepine
  3. Cyclosporine
    Inhibition of CYP450 3A4
    Lead to increase level of these drugs
    *azithromycin: doesn’t inhibit CYP 450

Digoxin

By inactivating gastrointestinal bacteria thought to metabolize digoxin in the gut?
Increase digoxin conc by 2-4x can suffer digoxin-induced toxicity, including arrhythmias, anorexia, altered color vision, and mental change

23
Q

Clindamycin SE

A
  1. Hypersensitivity
  2. Gastrointestinal (most common)
    • Diarrhea and nausea
    • C difficile Pseudomembranous colitis
  3. Hepatotoxicity (rare)Are Adverse effects of Clindamycin
24
Q

Lincosamide DDI

A

Neuromuscular blocking agents

Clindamycin can inhibit neuromuscular transmission; therefore potentiate effects

25
Q

Linezolid SE

A
  1. GI intolerance (nausea, vomiting ng, diarrhoea)
  2. Myelosuppression (thrombocytopenia, anemia) Most oien with treatment duration of >2 weeks
    Increase risk in patients with renal failure, pre-existing myelosuppression, on drugs that can cause myelosuppression
    Reversible upon discontinuation
  3. Monoamine oxidase inhibition (Serotonin Syndrome ) Additive with other agents (MAOI, SSRI, etc)
  4. Peripheral and optic neuropathy
  5. Lactic acidosis
26
Q

Clinical implication linezolid

A

Weekly FBC, especially platelets

• BP
• Visual changes

27
Q

Linezolid DDI

A

monoamine oxidase inhibitors
1. SSRI
2. tyramine rich
food
3. adrenergic
agents

Reason: Monoamine oxidase inhibition (Serotonin Syndrome )

  1. Rifampicin
    Rifampicin induce CYP450 enzymes
    decrease linezolid AUC by 32%
28
Q

Macrolide clinical application

A

.1 Community-acquired pneumonia pertussis

2. Corynebacterial
3. chlamydial infection

29
Q

Lincosamide clinical applications

A
  1. Skin and soft tissue infections; anaerobic infections
  2. Prophylaxis against endocarditis prior to dental procedures in patients with valvular heart disease.
  3. Treat Pneumocystis jaroveci infection in HIV patients
30
Q

Oxazolidinone clinical application

A

Treatment of severe infections caused by Gram-positive bacteria that are resistant to other antibiotics.
Agst MRSA, VRE (equivalent to vancomycin but can be taken orally!)

31
Q

Anti folate SE

A
  1. Gastrointestinal disturbances (common) - Nausea, vomiting, and diarrhea
  2. Hypersensitivity/ allergic reactions - due to the products of sulpha
  3. Photosensitivity
  4. Renal
    – False increase in creatinine (ave 18%) (common) – Nephrotoxicity, allergic nephritis
    – Crystalluria
  5. Hyperkalemia (with higher doses +/‐ renal impairment)
  6. Bone marrow suppression
    Megaloblastic anemia (Give folinic acid supplementation in special cases- pregnant, malnourished)
    May cause hemolytic reactions in G6PD patients Thrombocytopenia in high doses
32
Q

Sulphonamide clinical application

A
  1. Lower urinary tract infections
  2. Sulphadiazine+pyrimethamine: -1st line for toxoplasmosis
    -2nd line for malaria.
33
Q

Trimethoprim clinical application

A
  1. Lower urinary tract infection
  2. Prescribed to patients with sulfonamide allergy
34
Q

Cotrimoxazole clinical application

A
  1. Urinary tract infections
  2. P jaroveci pneumonia
  3. Toxoplasmosis
  4. Nocardiosis
35
Q

Cotrimoxazole DDI

A

Oral anticoagulants: Warfarin
Poss mechanisms: disrupts vitamin K synthesis; Enhance the antithrombotic effect

Methotrexate
Increase levels of methotrexate (by displacing warfarin/methotrexate from protein binding, decreased renal tubular elimination).

Hydantoin anticonvulsants: Phenytoin
Increase the half-life of phenytoin (by inhibiting its metabolism)

Sulfonylurea hypoglycemic agents
increase risk of hypoglycemia – monitor
– Poss mechanisms: protein binding displacement

2-4. Inhibit metabolism of drugs and displace bilirubin from albumin

36
Q

Floroquinolone SE

A
  1. Gastrointestinal disturbances (common)
    - Nausea, vomiting, diarrhea and dyspepsia
  2. Central Nervous systems
    - Headache, agitation, insomnia, dizziness, rarely, hallucinations and seizures (elderly)
  3. Hypersensitivity
  4. Cardiac
    QT interval prolongaJon; Moxi> cipro, levo
  5. Articular Damage
    Arthopathy including arJcular carJlage damage, arthralgias, and joint swelling
  6. Tendinitis and tendon rupture (black box warning)
  7. Alterations in blood glucose
37
Q

Nitrofurantoin SE

A
  1. GIT disturbances - the principal adverse effects
  2. Hypersensitivity reactions (occasional and reversible): skin rash, pneumonitis, chills and fever
  3. Pulmonary interstitial fibrosis with chronic use, especially in the elderly
  4. Blood dyscrasias – neutropenia; hemolysis in infants and G6PD-deficient subjects
    **Best to avoid use in pregnancy and the elderly
38
Q

Floroquinolone DDI

A

Divalent/trivalent cations (eg in antacid, enteral feeds, iron)
- Co‐administration reduce fluoroquinolone absorption
- Reduce fluoroquinolone conc > treatment failure
- Separate by at least 2‐4 hours

Warfarin:
increase anticoagulation effect

Drugs that can cause QTc prolongation (eg quinidine, procainamide, amiodarone
— increase QT risk

39
Q

Nitrofurantoin DDI

A

Antacid—–Reduce nitrofurantoin conc.

40
Q

Floroquinolone Clinical application

A
  1. Urinary tract infections
  2. Gastroenteritis
  3. Osteomyelitis
  4. Anthrax
  5. TB (2nd line)
41
Q

Nitrofurantoin uses

A
  1. Acute UTI
  2. Prophylaxis of lower UTI
    **Only approved for the treatment of urinary tract infections caused by microorganisms known to be susceptible to the drug
42
Q

Fosfomycin Clinical application

A
  1. Uncomplicated lower UTI
  2. Safe for use in pregnancy
43
Q

Metronidazole SE

A
  1. GI intolerance, metallic taste
  2. Headache
  3. Peripheral neuropathy
  4. Disulfiram-like reacJon with alcohol
  5. Encephalopathy, aseptic meningitis, optic neuropathy

Dry mouth

44
Q

Metronidazole DDI

A

Warfarin
Potentiate anticoagulant effect

Ethanol
Disulfiram like reaction

Lithium
Reduced Li renal elimination –> concentration

45
Q

Metronidazole clinical uses

A

Effective against amoebiasis, giardasis, anaerobic peritoneal infections (CDAD) and bacteremia, Helicobacter
pylori

46
Q

Polymyxin causes _______

A

Muscles weakness
Nephrotoxic

Do not affect ECG

47
Q

Fosfomycin SE

A

RHVIN

Rash 
HA
Nausea 
Rhinitis 
Vaginalis

.► FARMACOLOGIA CLÍNICA - JP (50 decks)

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