Antimicrobials: Adverse Reactions

Question 2

Prototypical Penicillins

Answer 2

Hypersensitivity, Hemolytic Anemia.

Question 3

Extended Spectrum Penicillins

Answer 3

Hypersensitivity, Rash, Pseudomembranous colitis

Question 4

Penicillinase Resistant Penicillins

Answer 4

Hypersensitivity, Methicillin = interstitial nephritis

Question 5

Anti-Pseuodomonal Penicillin

Answer 5

Hypersensitivity

Question 6

Penicillin + ß lactamase inhibitor. Sulbactam is another inhibitor.

Answer 6

Hypersensitivity

Question 7

Cephalosporins: Penicillinase resistant

Answer 7

Cross-reaction with PCN allergy, hypersensitivity, vitamin K deficiency, DDI with warfarin, increases nephrotox of Aminoglycosides, disulfiram-like rxn with EtOH, superinfections

Question 8

Carbapenems. Beta lactamase resistant.

Answer 8

GI Upset: Nausea, Vomiting, Diarrhea. Skin rash. Seizures possible at high doses. Because significant toxicity use as last resort.

Question 9

Monobactams

Answer 9

Usually non toxic and well tolerated. Occasional GI upset.

Question 10

Vancomycin

Answer 10

Common: Chills, Fever, Rash, Most Severe: Ototoxic, Nephrotoxic >> Routine Cp monitoring, Thrombophlebitis (NOT)

Question 11

Macrolides. MacroLungs

Answer 11

N/V/D, acute cholestatic hepatitis, eosinophilia, skin rashes, prolonged QT interval. Most severe: CYP450 inhibition (except Az) - increase [theophyllines] + [oral anticoagulants]

Question 12

Lincomycin

Answer 12

Severe diarrhea, fever. Pseudomembranous colitis

Question 13

Streptogramins

Answer 13

Infusion related pain and phlebitis, inhibits CYP3A4, significant DDIs possible

Question 14

Oxazolidinones

Answer 14

Well tolerated, minor GI, HA, rash, rare thrombocytopenia, weak MAO inhibitor

Question 15

Tetracylines

Answer 15

• N/V/D. Bone & tooth abnormal dvlpmnt, & fungal superinfections,
• cannot be taken w/antacids or milk or iron-containing substances
  
  • & DDI w/metal cations, milk, Fe b/c inhibits absorbtion in gut.
• DDI w/inducers.
• Teratogen.
• photosensitivity.

Question 16

Aminoglycosides

Answer 16

Nephrotoxicity esp w/ cephalosporins, Ototoxicity esp w/ loop diuretics, Teratogen = Routine monitoring of Cp (NOT)

Question 17

Metronidazole

Answer 17

Disulfuram-like with EtOH = nausea, HA, metallic taste. No drinking allowed on the train, if you eat the train like king kong, will get metallic taste in mouth

Question 18

Fluoroquinolones

Answer 18

GI upset, Superinfection, HA, Dizziness, rash, tendonitis/rupture.

Kids: myalgias.

Contraindicated in pregnancy and children under 12.

Don’t take with antacids.

Question 19

Sulfonamides

Answer 19

• Moderately safe, renal damage “crystallura”
• hemolysis if G6Pd (hemolytic anemia)
• kernicterus in infants
• hypersensitivity rxns (fever, rash)
• DDIs with displacement of other compounds from albumin (warfarin),
• GI upset, contraindicated in pregnancy.
• Trimethorpin causes serious marrow issues.
• nephrotox

Question 20

Nitrofurantoin

Answer 20

GI upset (A/N/V/D), hypersensitivity (hemolytic anemia), neuropathies.

Question 21

Antituberculuar Agents (Rifampin)

Answer 21

Red/orange body fluids, anorexia, N/V, diarrhea, rash, hypersensitivity, fever, HA, drowsiness, minor hepatotoxicity/jaundice, DDI by inducing CYP450