Side effects

of the Drugs included in CAT1

Pharma 232 . 1427-H

 

Chemotherapeutic Drugs:

1. Sulfonamides:

 

  1. Hypersesitivity reactions
  2. Gastric Upset
  3. Crystalluria . so, it should be given with large amount of water
  4. Haematuria , Renal Obstruction
  5. Allergic nephritis
  6. Haemolytic Anemia   (in patient with G6PDD)
  7. Aplastic Anemia , Thrombocytopenia
  8. Kernictrus : in new born (because they cross placenta)

 

 

2. Co-trimethoxazole

  1. Megaloblastic Anemia
  2. Leukopenia
  3. Granulocytopenia
  4. Plus the A.Es. of Sulphonamides

 

3. Beta-Lactam Antibiotics:

 

A-    Penicillins:

1.      Hypersensitivity: from Skin rash to Anaphylactic Shock.

2.      High dose in Renal failure patients may case Seizure.

3.      Neutropenia with Naficillin

4.      Hepatitis with  Oxicillin

5.      Nephritis  with   Methicillin

6.      Pseudomonous colitis  with    Most of broad spectrum Penicillins

7.      Secondary infection  e.g. Vginal Candiasis

8.      Skin Rash with  Ampicillin & Amoxicillin

 

B- Cephalosporines

  1. Hypersensitivity reactions :

§         Anaphylaxis

§         Bronchospasm

§         Urticaria

§         Maculopopular rash

  1. Nephrotoxicity  with  Cephradine
  2. Thombophlibities   in  I.V. administration
  3. Superinfection  (Monilia infection)
  4. Diarrhea with   Cefoperazone  & Oral Cephalosporines
  5. Bleeding disorders  with

o Cephamandol

o Moxalactam

o Cephoperazone      all of them have MethylTetrazole Ring

  1. Disulfiriam – like reaction if administrated with Alcohol

o Cephamandol

o Moxalactam

o Cephoperazone                      

 

C- Carbapenems

Imipenem

§         N , V , D

§         Allergy (especially in patient with to penicillins)

§         Seizures if given in high level especially in cases of Renal Failure

Meropenem

Causes less Seizures

 

D- Monobactam

o       Similar to other Beta-lactam

o       Increase Hepatic enzyme (TransAminase)

o       Allergic reaction

 

1- Macrolides:

 

A- Erythromycin

1.      Gastric upset (Orally!)

2.      Anorexia , D , V

3.      Liver Toxicity:

Especially with Estolate preparation. Produce Acute cholestatic Hepatitis

4.      Drug-drug interaction as it’s Cyt P450 inhibitor

5.      Hypersensitivity

B- Azithromycin

1.      Gastric upset but less frequently than Erythromyicin

2.      Secondary infection

3.      Fungal over growth

4.      Hypersensitivity, but not anaphylactic shock

5.      Liver affection

C-    ClarithroMycin

Gastric upset (less freq. than Erythro.)

Hypersensitivity reaction

More Expensive than Erythromycin

 

2- TetraCycline

1.      I.M. à Pain , Local inflammation , I.V.  à Thrombophlibites

2.      Gastric upset: N,V,D     .  Superadded infection

3.      Damaging bone, teeth in newborn  (intra-uterine teratogenicity)

4.      Yellowish -Brown discoloration in 3-4 ys children , also, dental caries deformity m osteomalisia

5.      Liver, kidney toxicity

6.      PhotoSensetivity esp. in fair-skin people ( Demeclocyclin is the most)

7.      Vestibular reaction :  Dizzness, Vertigo, Nosia, Vomitting  (Doxycyclin , Menocyclin)

8.      Fanconi-Syndrome: if taken after expired date :      

o       Nosia ,Vomitting

o       PolyUria

o       Polydepsia

o       Kidney damage

Note: all broad spectrum Antibiotics affect Normal flora & cause PseudoMembranous EnteroColitis

w! can cause sever Watery Diarrhea & could be Fatal

 

 

 

3- Chloramphinicol

  1. Gastric upset
  2. Inhibits normal intestinal flora
  3. Bleedin, esp. by inhibiting Synthesis of Vit. K
  4. Superinfection or Secondary infectionà Enterocollitis
  5. Inhibit Cyto. P450   affects other drugs  (if taken with Warfarrin they can cause Bleeding)
  6. They Affect renal function
  7. Bone Marrow Suppression (Aplastic Anemia- Granulocytosis)
    • Affects WBC by Hypersensitivity reaction
  8. Optic Neuritis : by Hypersensitivity reaction  (treated by Vit. B6 , B12)
  9. Dermatitis : d.t. Hypersensitivity
  10. In Pregnant Women if given in 1st trimester it can accumulates in the fetus blood & causes :

GRAY BABY SYNDROME   Ss & Ss:

·        HyperThermia

·        Circulation Failure

·        Grayish in Color

·        Respiratory Failure, Shock, Collapse

4- AminoGlycosides

o Ototoxicity: (may cause deafness, Ask the patient to do Audiogram routinely)

o Nephrotoxicity

o NeuroMuscular Blocking (Curare Like Reaction) take care when you give Analgesic or muscle relaxant before operations

o Hypersensitvity , skin rash

o Headache   

5-FluoroQuinolones:

1.Orally à N, V, D

2.cross BBB à  Headache , dizziness , insomnia

3.Abnormal Liver function esp. with (Trova.)

4.4- Skin rash , Photosensitivity

5.Concomitant administration of  Theophyllin+ Quinolones=Toxic effect

May cause Seizure

6.Increase Q-T interval à Arrhythmia

7.Damage of growing cartilage à Arthropathy

 

 

Miscellaneous Antibiotics:

1-Poly Myxin:  Highly Nephrotoxic.

2-SpectinoMycin: pain at site of injection.

3-ClindaMycin

a. GIT upset (Diarrhea is common)

b. PsudoMembraneous colitis

c. HepatoToxicity

d. B.M. suppression

4- VancoMycin:

a. I.M. à irritation  , I.V. à ThromboPhlibites

b. Ototoxicity  or Nephrotoxicity are Uncommon but administration with another Otoxic or Nephrotoxic drug  (e.g. Aminoglycosides) increase the risk.

c. Red Man Syndrome d.t. Histamine release (can be prevented by prolong the infusion period or increase the interval between doses)

d. GIT upset

5- TeicoPlanin

6- Basitracin : Nephrotoxicity

 

Anti-Tuberculus Drugs

1st line:

1. INH:

§         Peripheral Neuritis

§         Hemolytic Anemia

§         Age dependent Hepatotoxicity (common after 50)

§         SLE-like Syndrome , Hypersensitivity , Rash

§         If given with Phenytoin : INH can decrease Ph. Metabolismà Ph. Toxicity

2. Rifampicin:

Ø      Harmless Orange or red colour change in Urine-Sweat-Tears-Contact lenses

Ø      Hypersensitivity , Rashes, Fever

Ø      ThromboCytoPenia

Ø      Nephritis

Ø      Liver: Hepatitis, Jaundice

Ø      Flu-like Syndrome

Ø      GIT upset

Ø      Enzyme inducerà drug-drug interaction

3.EthamButol:

o       Loss of visual acuity

o       Red-Green colour blindness

4.PyrazinAmide

Ø      HyperUricemia

Ø      Hepatotoxicity

Ø      N,V

Ø      Allergy

Ø      Artheralgia

 

5.StreptoMycin

v     Ototoxicity , Nephrotoxicty

v     NeuroMuscular Block = Curare-like actio

2nd line:

1.      EthionAmide:

v     Sever Gastric irritation

v     Neurologic manifestation

v     Hepatotoxicty

2.      CaprepMycin

o       Nephrotoxicty, Ototoxicity

o       Local pain

o       Sterile Abscess

3. Cycloserine

Neurotoxicity

4.Amikacin …

5 & 6. Ciprofloxacine and  Levofolxacin…

7 & 8.Rifabutin & Rifapentine….

9. PAS:

§         Gastric irritationà should be taken on full stomach

§         as Sulfonamide in causing:

§         CrystallUria

§         Stone Obstruction HeamtoUria

§         Hypersensitivity reaction, Urticaria, skin rash

 

Drugs Used in LEPROSY:

1-      Dapson 

à        Haemolytic Anemia

à        Erythema Leprosa Nodosa

à        MetHaemoGlubulinemia

à        GIT intolerance

à        fever

2-      Clofazimine

§         Discoloration:

o SkinàRed-Brown to black

o Urine àred

§         Gasric Upset

§         Eosenophilic Enteritis

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