Side effects Flashcards
Amphotericin B Deoxycholate
BW: do NOT exceed 1.5 mg/kg/day because of cardiopulmonary arrest
SE: infusion related rxn (fever, HA, malaise, rigors), decreased K, decreased Mg, NEPHROTOXICITY
*compatible with D5W only
*requires premedication to prevent infusion rxn:
- APAP, NSAID
-Benadryl, Hydrocortisone
-NS bolus to help with nephrotoxicity
- maybe meperidine to decrease rigors
Amphotericin B + Digoxin is a high risk of what?
Hypokalemia
Liposomal Amphotericin B (AmBisone
BW: cardiopulmonary arrst and death
SE: infusion rxn, nephrotoxicity (less likely), hypokalemia, hypomagnesia
Liposomal Amp B + Tacrolimus would be a higher risk of what?
Nephrotoxicity
Flucytosine (prodrug of fluoruracil)
mainly used for crypto!
MYELOSUPPRESSION
nephrotoxicity
hepatoxicity
hypokalemia
hypoglycemia
Common side effects for Azole antifungals
increased LFTs
QTc prolongation
DRUG INTERACTIONS
all IV to PO is 1:1
Fluconazole (Diflucan)
increased LFTs
QTc prolongation
DRUG INTERACTIONS
not recommended in pregnancy
penetrates into the CNS really well!!!! meningitis treatment :)
RENAL DOSING: CrCl < 50 decrease dose by 50%
Ketoconazole (Nizoral A-D)
increased LFTs - HEPATOTOXICITY = death
QTc prolongation
DRUG INTERACTIONS
Voriconazole (Vfend)
CI: coadministration with CYP inducers (barbituates, carbamazepine, efavirenz, quinidine, rifampin, ritonavir, sirolimus, St John’s Wart)
Warning: HEPATOTOXICITY, Phototoxicity, QTc
SE: visual changes, nephrotoxicity, CNS toxicity (hallucinations)
** good CNS penetration
Posaconazole (Noxafil)
CI: coadministration with some CYP inducers
Warning: QTc prolongation - correct Ca, K, Mg
Posaconazole + Vincristine creates increase risk of what?
Neurotoxicity (seizures, peripheral neuropathy, SIADH, parlytic ileus)
What azoles cause increase in INR?
Fluconazole + Voriconazole
Isavuconazoium (Isavuconazole)
CI: Use with CYP inducers or inhibitors
**Teratogenic
QTc prolongation
increased LFTs
Caspofungin (Cancidas)
mainly used for more coverage of Candida species, only IV
Warning: Histamine related symptoms (pruritis, rash, swelling, hypotension)
SE: increased LFTs, HA, hypotension, hyperglycemia
Micafungin (Mycamine)
mainly used for more coverage of Candida species, only IV
Warning: histamine related rxn (pruritus, rash, hypotension, swelling)
SE: increased LFTs, HA, hypotension, hyperglycemia
Nystatin
SE: N/V/D, stomach pain
- very low systemic risk due to low GI absorption
Terbinafine (Lamisil AT)
Warning: Hepatotoxicity , SJS, hematologic
SE: HA, increased LFT
Griseofulvin
CI: PREGNANCY
SE: photosensitivity, increased LFTs
Which antifungals have photosensitivity?
Griseofulvin
Voriconazole
Which anti-fungals have renal dose adjustments?
Fluconazole
Acyclovir (Zovirax)
SE: malaise, neutropenia, SEIZURES, crystal nephropathy (increased SCr and BUN), burning with topical formulations
Warning: renal impairment, elderly, and use with other nephrotoxic drugs; infuse over at least 1 hour
**dose with IBW
Valacyclovir (Valtrex)
SE: malaise, HA, neutropenia, increased LFTs, increased seizures, nephrotoxicity
Famiciclovir
Prodrug of Penciclovir
SE: malaise, HA, neutropenia, increased LFTs, increased seizures, nephrotoxicity
Ganciclovir
BW: MYLEOSUPPRESSION, carcinogenic, teratogenic
SE: fever, thrombocytopenia, neutropenia, leukopenia, anemia, increased SCr, rare seizures, retinal detachment (CMV retinitis patients)
**use extracontraception 30 days after treatment
Valganciclovir (Valcyte)
BW: MYLEOSUPPRESSION, carcinogenic, teratogenic
SE: fever, thrombocytopenia, neutropenia, leukopenia, anemia, increased SCr, rare seizures, retinal detachment (CMV retinitis patients)
** use extra contraception for 30 days after treatment
Foscarnet
Renal impairment, seizures from electrolyte imbalances
decreased: K, Ca, Mg, Phos
increased: Scr, BUN, QTc
Osesltamivir (Tamiflu)
Warning: neuropsychiatric events (confusion, delirium, hallucination), SJS
SE: HA, nausea, vomiting
*** preferred neuraminidase inhibitor in pregnancy
Sofosbuvir
Warning: serious BRADYCARDIA, do NOT use with amiodarone
All DAA for HCV
BW: risk of reactivating HBV === test for HBV BEFORE DAA
Warning: hypoglycemia when used with insulin or hypoglycemia drug
SE: well tolerated, HA, fatigue, diarrhea, hypoglycemia
CI: strong CYP3A4 inducers
**most increase statin dose
Epclusa
Velpatasvir
Sofosbuvir - do NOT use with amiodarone
PPI not recommented!!! decreases concentrations of Velpatasvir
BW: HBV reactivation
Warning: Hypoglycemia
SE: fatigue, diarrhea
VS - Victoria’s Secret
Mayvret
Glecaprevir
Pibrentasvir
PG
CI: moderate to severe hepatic impairment or hx of hepatic decompensation
Do NOT use with HIV protease inhibitors “navir”
***approved for 8 week course AND salvage therapy in select patients
Ribavirin
BW: Teratogenic; not to be used at monotherapy , hemolytic anemia
CI: PREGNANCY, CrCl < 50 mL/min
SE: hemolytic anemia (can lead to MI), fatigue, hypothyroidism
AVOID in pregancy and 6 months after
DI: can increase the hepatotoxicity of NRTIs, Zidovudine can increase risk of severe anemia
Interferon Alfa
BW: can exacerbate neuropsych, autoimmue, ischemis or infection disorders
CI: neonates, autoimmune hepatitis, decompensated liver disease
Warnings: neuropsych, cardiovascular, endocrine, cisual, pancreatic, myelosuppression, skin reactions
SE: CNS effects, increased LFTs, myelosuppression
Flu-like syndrome —- pretreat with APAP + antihistamine
All HBV NRTIs
BW: Lactic Acidosis and severe hepatomegaly with steatosis
exacerbations of HBV
SE: increased LFTs, nephrotoxicity
DI: rilavirin can increase hepatotoxicity in NRTIs
Viread
TDF
Warning: renal toxicity, osteomalacia, decreased bone mineral density
SE: renal impairment, decreased bone mineral density, increased LFTs and CPK
Vemlidy
TAF
SE: nausea, less renal impairment and bone toxicity, increased LFTs
Baraclude
Entecavir
SE: increased LFT, peripheral edema, nephrotoxicity, pyrexia, ascites
Epivir HBV
Lamivudine
contains lower dose for HBV than HIV
SE: headache, N/V/D, increased LFTs
Bactrim increased lamivudine
