side effects and toxicity

Question 1

What is an important effect of antibiotic therapy?

Answer 1

Clostridium difficile

Question 2

Which group of drugs are most commonly associated with allergic reactions?

Answer 2

Beta lactams (penicilllins and cephalosporins)

Question 3

What is an extreme effect of immediate hypersensitivity?

Answer 3

Anaphylactic shock

Question 4

What is anaphylactic shock characterised by?

Answer 4

Itching, urticarial (hives), nausea, vomiting, wheezing and shock

Question 5

What is delayed hypersensitivity?

Answer 5

A reaction which may take hours or days to develop and can have an immune complex or cell mediated mechanism.

Question 6

What is the most common type of side effect from antibiotics?

Answer 6

Gastro-intestinal

Question 7

How is C. difficile associated diarrhoea, C. difficile infection or the more serious pseudomembranous colitis diagnosed microbiologically?

Answer 7

Detection of toxin in stool by enzyme immunoassay

Question 8

How is CDI treated?

Answer 8

With oral metronidazole or oral vancomycin. Other antibiotic treatment is discontinued if clinically appropriate and infection control measures put in place

Question 9

What is the main reason for the increase in CDI over recent years?

Answer 9

Over-use of broad spectrum antibiotics

Question 10

What side effect may be caused by therapy with broad spectrum penicillins or cephalosporins giving overgrowth of resistant organisms?

Answer 10

Thrush (oral/vaginal candidiasis)

Question 11

Which drugs are associated with hepatotoxicity?

Answer 11

tetracycline and the anti-tuberculous drugs isoniazid
rifampicin
flucloaxillin

Question 12

With which drugs is nephrotoxicity more commonly seen?

Answer 12

aminoglycosides

vancomycin

Question 13

What are the four types of neurological toxicity?

Answer 13

Ototoxicity - ear damage
Optic neuropathy - optic nerve damage
Encephalopathy and convulsions - brain damage
Peripheral neuropathy - nerve damage

Question 14

What type of neurological toxicity may follow aminoglycoside or vancomycin use?

Answer 14

ototoxicity

Question 15

What type of neurological toxicity may follow ethambutol (an anti-tuberculosis drug) use?

Answer 15

optic neuropathy

Question 16

What type of neurological toxicity may result from high dose penicillin and cepharosporin use or with aciclovar especially if the dose in not reduced with renal impairment?

Answer 16

encephalopathy and convulsions

Question 17

What type of neurological toxicity may result from metronidazole and nitrofurantoin? Also isoniazid

Answer 17

peripheral neuropathy

Question 18

In what two ways might antimicrobials have a toxic effect on the bone marrow? (haematological toxicity)

Answer 18

selective depression of one cell line

unselective depression of al bone marrow elements

Question 19

Which three groups of people should particular care be exercised when administering antimicrobials?

Answer 19

those of extreme age
pregnant women
patients with liver or renal insufficiency