important MHRA safety info Flashcards
(17 cards)
Aminoglycosides via injection
Ototoxicity (esp if mitochondrial mutations)- urgent treatment should not be delayed for genetic testing- but closely monitor renal and auditory function
Amikacin
pegylated/ lipsomal/ lipid-complex forms NOT INTERCHANGEABLE
Gentamicin
some batches contain higher levels of histamine from manufacturing process- be vigilant for signs of histamine related reaction
Streptomycin
side-effects increase after cumulative dose of 100g- should only be exceeded in exceptional circumstances
Erythromycin (3)
1) QT interval prolongation- caution needed with cardiac diseases or disturbances, should not be given if hx of interval prolongation/ ventricular arrhythmia
2) may interact with rivaroxaban to increase bleed risk
3) 2-3x increased risk of infantile hypertrophic pyloric stenosis (esp if used around 14days old)- monitor babies for irritability/ feeding difficulty
Benzylpenicillin sodium
Intrathecal injection not recommended
Flucloxacillin
Cholestatic jaundice and hepatitis may occur up to 2 months after stopped - do not use again if happened before, caution in hepatic impairment
Quinolones (5)
1) may induce convulsions
2) tendon damage and rupture
3) increased risk of aortic aneurysm and dissection
4) stop at first signs of tendon/ CNS damage as can be disabling if left
5) heart valve regurgitation
Co-trimoxazole
only consider in acute exacerbations of chronic bronchitis and UTIs when there is susceptibility and better action than one antibacterial alone
Linezolid (2)
1) Severe optic neuropathy if used >28days
2) Haematopoetic disorders - FBC every week- stop if myelosupression occurs
Amphotericin B
liposomal/ pegylated/ conventional are not interchangeable
Chloroquine (3)
1) ocular toxicity is unlikely unless dose exceeds 4mg/kg.day
2) Who used with macrolides in people with rheumatoid arthritis increased risk of cardiovascular events & mortality
3) rare suicidal behaviour risk
Quinine
dose dependent QT prolongation
COVID-19 antivirals
safety not established in pregnancy- report any inadvertent exposure to UKTIS
Direct acting antivirals for chronic hepatitis C (3)
1) Changes to the liver may affect efficacy of vitamin K antagonists- closely monitor INR
2) Can cause latent hep B reactivation- screen patients before treatment
3) May improve glucose metabolism in diabetics- can cause hypoglycaemia on current therapy (esp in first 3 mo)
Dolutegravir
neural tube defects risk is less than initially through- comparable to other HIV drugs
Elvitegravir boosted with cobicistat
mena exposure is lower during second and third trimester than postpartum (may lead to treatment failure)
