Side effects for all drugs

Question 1

Penicillins 6

Answer 1

1.Hypersensitivity reactions
-(type I is IGE mediated and the immediate reaction that leads to itching and discomfort) (Type II is IGG or IGM mediated and is a delayed reaction that leads to rash and hives)
- Patients with penicillin allergy should not be given any other penicillin drugs and should be cautious of taking other b-lactam antibiotics

2.Neurologic: Direct toxic effect Happens to patients who are given large IV doses with renal insufficiency leads to confusion, jerking, seizures

3.Hematologic: Neutropenia, thrombocytopenia, anemia usually seen in patients on longer durations of therapy (usually >2 weeks) - it is reversible upon discontinuation

4.GI upset: Diarrhea, N/V, increased LFTs, C. Diff

5.Interstitial Nephritis: Immune mediated damage to renal tubules (hapten causes this) characterized by an abrupt increase in serum creatinine
- Methicillin has many reports of this and is why it is no longer used, also seen with Nafcillin
- can lead to renal failure

6. Others: Phlebitis, hypokalemia, sodium overload
   5

Question 2

Cephalosporins 4

Answer 2

1.Hypersenitivity reaction - Patients who had severe reaction to penicillin needed ICU admission should avoid ALL Cephelosporins those with other reaction and NO ICU admission should avoid Cephalopsorins with similar R1 chain

2.Hematologic - Anemia, Leukopenia, Thrombocytopenia

3.Gastrointestinal- increased bili (ceftriaxone), C. diff

4.other - IV calcium and ceftriaxone orecipitation(never mix the two), Nonconvulsive status epilepticus (can happen in those with renal insufficiency)

Question 3

Carbapenems 3

Answer 3

1.Hypersensitivtiy reaction - If patient has reaction to penicillin that requires ICU avoid Carbapenems if patient has other reaction and does not require ICU can use carbapenems with caution

2.Gastrointestinal - C. Diff

3.Central nervous system - confusion, dizziness, hallucinations, seizures
Risk factors for seizures include preexcisting CNS disorder, high doses, renal insufficiency

Question 4

Monobactams 2

Answer 4

1.Gastrointestinal- nausea, diarrhea

2.Hypersensitivity: No cross reactivity with penicillins, can be used in penicillin allergic patients

Question 5

FQ 6

Answer 5

1.Neurological - Peripheral neuropathy (BLACK BOX WARNING)

2.Cardiac toxicity - QTC prolongation (caution in those with hypokalemia, preexisting QT prolongation, concomitant anti-arrythmics (ex: Amiodarone))

3.Hepatotoxicity - LFT elevation, liver failure

4.Articular damage - contraindication in pediatric patient and avoid in pregnant or breast feeding women

5.Tendonitits and tendon rupture - especially in patients over 60 receiving corticosteroids

6.Gastrointestinal - N/V, Diarrhea, Dyspepsia

Question 6

Macrolides 3

Answer 6

1.Thrombophlebitis - IV erythro and azithro (Dilution of dose, slow administration, large vein)

2.QTC prolongation

3.Gastrointestinal - N/V, Diarrhea, Dyspepsia (can take with food to help)

Question 7

Vancomycin 5

Answer 7

1.Red man syndrome - related to rate of infusion time - Happens within 15 minutes of infusion (can give vancomycin again after this happens but would want to slow down infusion rate or give antihistamines before hand)
2. Nephrotoxicity - Risk factors: those with renal insufficiency, higher doses of vancomycin and higher concentrations, use other nephrotoxic drugs
3. Ototoxicity
4. Thrombophlebitis
5. Interstitial nephritis

Question 8

Synercid 2

Answer 8

1.Venous irritation/Phlebitis - Recommended to use a central vain when using synercid

2.Myalgias, arthralgias - extremely painful and no full explanation on why it happens

Question 9

Linezolid 3

Answer 9

1.GI -N/V/D

2.CNS- Headaches, peripheral and optic neuropathy

3.Thrombocytopenia or anemia - common in those on prolonged therapy >2 weeks once therapy is D/C it will return to normal

Question 10

Daptomycin k5

Answer 10

1.Myopathy and CPK elevation - patient will complain of weakness and pain in muscles

2.Acute eosinophilic pneumonia

3.Gastrointestinal

4.Headache

5.Injection site reactions
Rash

Question 11

Telavancin, Oritavancin, Dalbavancin

Answer 11

Televancin - Nephotoxicity (risk factors - renal insufficancy, older age, higher doses) , QTc prolongation, taste disturbances
All cause infusion related reactions, N/V/D,

Oritavancin and televancin are associated with red man syndrome

Question 12

Tetracycline and tetracycline analongs 3

Answer 12

GI - N/V/D

Dermatologic - Photosensitivity

Pregnancy category D - dont use during prego or lactation as well as for kids <8 as it can cause permanent discoloration of adult teeth (grey/blue color)

Question 13

TMP-SMX 4

Answer 13

Hematologic: leukopenia,thrombocytopenia

Hypersensitivity reactions: rash

Others: – crystalluria, hyperkalemia, increase creatinine

Pregnancy Category C - should NOT be used in pregnant women (especially during the third trimester or at term) or lactating women because it may cause kernicterus in the newborn due to bilirubin displacement from protein binding sites

Question 14

Polymixins 2

Answer 14

1.Nephrotoxicity
2.Neurotoxicity

Question 15

Clindamycin 2

Answer 15

GI - C. Diff n/v/d

Hepatotoxicity

Question 16

Metronidazole 3

Answer 16

Gastrointestinal - N/V/D, METALIC TASTE

Central nervous system - peripheral neuropathy

Mutagenicity and carcinogenicity
- Metronidazole may be teratogenic – should be avoided during the first trimester and during breastfeeding (Pregnancy Category B)

Question 17

Amino glycosides 3

Answer 17

Nephrotoxicity

Ototoxicity
- risk factors: prolonged use >2 weeks, presence of renal insufficiency, advanced age, concomitant use with Vancomycin, Loop diuretics (ototox-), Cisplatin(nephro-)

Neuromuscular blockade