Side effects

Question 1

Amphotericin B Deoxycholate

Answer 1

BW: do NOT exceed 1.5 mg/kg/day because of cardiopulmonary arrest

SE: infusion related rxn (fever, HA, malaise, rigors), decreased K, decreased Mg, NEPHROTOXICITY

*compatible with D5W only

*requires premedication to prevent infusion rxn:
- APAP, NSAID
-Benadryl, Hydrocortisone
-NS bolus to help with nephrotoxicity
- maybe meperidine to decrease rigors

Question 2

Amphotericin B + Digoxin is a high risk of what?

Answer 2

Hypokalemia

Question 3

Liposomal Amphotericin B (AmBisone

Answer 3

BW: cardiopulmonary arrst and death
SE: infusion rxn, nephrotoxicity (less likely), hypokalemia, hypomagnesia

Question 4

Liposomal Amp B + Tacrolimus would be a higher risk of what?

Answer 4

Nephrotoxicity

Question 5

Flucytosine (prodrug of fluoruracil)

Answer 5

mainly used for crypto!

MYELOSUPPRESSION
nephrotoxicity
hepatoxicity
hypokalemia
hypoglycemia

Question 6

Common side effects for Azole antifungals

Answer 6

increased LFTs
QTc prolongation
DRUG INTERACTIONS

all IV to PO is 1:1

Question 7

Fluconazole (Diflucan)

Answer 7

increased LFTs
QTc prolongation
DRUG INTERACTIONS

not recommended in pregnancy

penetrates into the CNS really well!!!! meningitis treatment :)

RENAL DOSING: CrCl < 50 decrease dose by 50%

Question 8

Ketoconazole (Nizoral A-D)

Answer 8

increased LFTs - HEPATOTOXICITY = death
QTc prolongation
DRUG INTERACTIONS

Question 9

Voriconazole (Vfend)

Answer 9

CI: coadministration with CYP inducers (barbituates, carbamazepine, efavirenz, quinidine, rifampin, ritonavir, sirolimus, St John’s Wart)

Warning: HEPATOTOXICITY, Phototoxicity, QTc

SE: visual changes, nephrotoxicity, CNS toxicity (hallucinations)

** good CNS penetration

Question 10

Posaconazole (Noxafil)

Answer 10

CI: coadministration with some CYP inducers

Warning: QTc prolongation - correct Ca, K, Mg

Question 11

Posaconazole + Vincristine creates increase risk of what?

Answer 11

Neurotoxicity (seizures, peripheral neuropathy, SIADH, parlytic ileus)

Question 12

What azoles cause increase in INR?

Answer 12

Fluconazole + Voriconazole

Question 13

Isavuconazoium (Isavuconazole)

Answer 13

CI: Use with CYP inducers or inhibitors
**Teratogenic
QTc prolongation
increased LFTs

Question 14

Caspofungin (Cancidas)

Answer 14

mainly used for more coverage of Candida species, only IV

Warning: Histamine related symptoms (pruritis, rash, swelling, hypotension)

SE: increased LFTs, HA, hypotension, hyperglycemia

Question 15

Micafungin (Mycamine)

Answer 15

mainly used for more coverage of Candida species, only IV

Warning: histamine related rxn (pruritus, rash, hypotension, swelling)

SE: increased LFTs, HA, hypotension, hyperglycemia

Question 16

Nystatin

Answer 16

SE: N/V/D, stomach pain
- very low systemic risk due to low GI absorption

Question 17

Terbinafine (Lamisil AT)

Answer 17

Warning: Hepatotoxicity , SJS, hematologic
SE: HA, increased LFT

Question 18

Griseofulvin

Answer 18

CI: PREGNANCY
SE: photosensitivity, increased LFTs

Question 19

Which antifungals have photosensitivity?

Answer 19

Griseofulvin
Voriconazole

Question 20

Which anti-fungals have renal dose adjustments?

Answer 20

Fluconazole

Question 21

Acyclovir (Zovirax)

Answer 21

SE: malaise, neutropenia, SEIZURES, crystal nephropathy (increased SCr and BUN), burning with topical formulations

Warning: renal impairment, elderly, and use with other nephrotoxic drugs; infuse over at least 1 hour

**dose with IBW

Question 22

Valacyclovir (Valtrex)

Answer 22

SE: malaise, HA, neutropenia, increased LFTs, increased seizures, nephrotoxicity

Question 23

Famiciclovir

Answer 23

Prodrug of Penciclovir
SE: malaise, HA, neutropenia, increased LFTs, increased seizures, nephrotoxicity

Question 24

Ganciclovir

Answer 24

BW: MYLEOSUPPRESSION, carcinogenic, teratogenic
SE: fever, thrombocytopenia, neutropenia, leukopenia, anemia, increased SCr, rare seizures, retinal detachment (CMV retinitis patients)

**use extracontraception 30 days after treatment

Question 25

Valganciclovir (Valcyte)

Answer 25

BW: MYLEOSUPPRESSION, carcinogenic, teratogenic SE: fever, thrombocytopenia, neutropenia, leukopenia, anemia, increased SCr, rare seizures, retinal detachment (CMV retinitis patients) ** use extra contraception for 30 days after treatment

Question 26

Foscarnet

Answer 26

Renal impairment, seizures from electrolyte imbalances decreased: K, Ca, Mg, Phos increased: Scr, BUN, QTc

Question 27

Osesltamivir (Tamiflu)

Answer 27

Warning: neuropsychiatric events (confusion, delirium, hallucination), SJS SE: HA, nausea, vomiting *** preferred neuraminidase inhibitor in pregnancy

Question 28

Sofosbuvir

Answer 28

Warning: serious BRADYCARDIA, do NOT use with amiodarone

Question 29

All DAA for HCV

Answer 29

BW: risk of reactivating HBV === test for HBV BEFORE DAA Warning: hypoglycemia when used with insulin or hypoglycemia drug SE: well tolerated, HA, fatigue, diarrhea, hypoglycemia CI: strong CYP3A4 inducers **most increase statin dose

Question 30

Epclusa

Answer 30

Velpatasvir Sofosbuvir - do NOT use with amiodarone PPI not recommented!!! decreases concentrations of Velpatasvir BW: HBV reactivation Warning: Hypoglycemia SE: fatigue, diarrhea VS - Victoria's Secret

Question 31

Mayvret

Answer 31

Glecaprevir Pibrentasvir PG CI: moderate to severe hepatic impairment or hx of hepatic decompensation Do NOT use with HIV protease inhibitors "navir" ***approved for 8 week course AND salvage therapy in select patients

Question 32

Ribavirin

Answer 32

BW: Teratogenic; not to be used at monotherapy , hemolytic anemia CI: PREGNANCY, CrCl < 50 mL/min SE: hemolytic anemia (can lead to MI), fatigue, hypothyroidism AVOID in pregancy and 6 months after DI: can increase the hepatotoxicity of NRTIs, Zidovudine can increase risk of severe anemia

Question 33

Interferon Alfa

Answer 33

BW: can exacerbate neuropsych, autoimmue, ischemis or infection disorders CI: neonates, autoimmune hepatitis, decompensated liver disease Warnings: neuropsych, cardiovascular, endocrine, cisual, pancreatic, myelosuppression, skin reactions SE: CNS effects, increased LFTs, myelosuppression Flu-like syndrome ---- pretreat with APAP + antihistamine

Question 34

All HBV NRTIs

Answer 34

BW: Lactic Acidosis and severe hepatomegaly with steatosis exacerbations of HBV SE: increased LFTs, nephrotoxicity DI: rilavirin can increase hepatotoxicity in NRTIs

Question 35

Viread

Answer 35

TDF Warning: renal toxicity, osteomalacia, decreased bone mineral density SE: renal impairment, decreased bone mineral density, increased LFTs and CPK

Question 36

Vemlidy

Answer 36

TAF SE: nausea, less renal impairment and bone toxicity, increased LFTs

Question 37

Baraclude

Answer 37

Entecavir SE: increased LFT, peripheral edema, nephrotoxicity, pyrexia, ascites

Question 38

Epivir HBV

Answer 38

Lamivudine contains lower dose for HBV than HIV SE: headache, N/V/D, increased LFTs Bactrim increased lamivudine