68 entries across all three Exam 1 decks, each citing its slide, grouped by the system the effect hits. Companion to the contraindications and indications charts.
| Drug or class | Side effects | Monitoring & what to watch | System | Source |
|---|---|---|---|---|
| Aminopenicillins ampicillin, amoxicillin | Hepatic dysfunction, hepatitis, jaundice with raised AST, ALT, bilirubin and alkaline phosphatase. C. difficile infection. Stevens-Johnson syndrome and toxic epidermal necrolysis. Interstitial nephritis, hematuria, crystalluria. Anemia and thrombocytopenia. | Monitor liver enzymes and bilirubin; watch for rash progressing to blistering. | Multi-system | L1 slide 21 |
| Penicillins — class | Hypersensitivity reaction, rash and diarrhea. | Monitor renal and hepatic function and platelets; dosing frequency drops with renal impairment. | Allergy | L1 slide 22 |
| Piperacillin/tazobactam Zosyn | Hypersensitivity reaction, rash and diarrhea. | Monitor for signs and symptoms of anaphylaxis, renal function and full blood count. | Allergy | L1 slide 28 |
| Nafcillin, oxacillin, dicloxacillin | Monitored for hepatic rather than renal toxicity — the exception in the beta-lactams. | Monitor hepatic function and full blood count, plus signs and symptoms of anaphylaxis. Dosing considerations are hepatic function. | Hepatic | L1 slide 26 |
| Aztreonam monobactam | Diarrhea. | Monitor liver function and signs or symptoms of anaphylaxis; dosing consideration is renal. | Gastrointestinal / Hepatic | L1 slide 41 |
| Cephalosporins — class | Signs and symptoms of allergic reaction; nausea, vomiting and diarrhea. | Penicillin cross-sensitivity is approximately less than 1%. Mostly renally eliminated. | Allergy | L1 slide 30 |
| Carbapenems imipenem especially | SEIZURES — specifically with imipenem. | Monitor renal and hepatic function, full blood count for bleeding, and signs of anaphylaxis. | Neurologic | L1 slide 44 |
| Vancomycin | “Red Man Syndrome” as an infusion reaction, with fever, chills and phlebitis. Ototoxicity and nephrotoxicity. | Requires therapeutic drug monitoring. Trough drawn 15–30 minutes before the next dose, around the 3rd or 4th dose. Random levels in unstable or severe renal impairment. | Infusion / Renal / Ear | L1 slide 51 |
| Macrolides erythromycin, clarithromycin, azithromycin | Nausea, diarrhea, abdominal pain — more with erythromycin and especially in children and young adults, because it stimulates motility. Cholestatic hepatitis (rare, more with estolate). Transient hearing loss with large intravenous doses or renal insufficiency. QT prolongation and Torsades de pointes. | Worse with class Ia and III antiarrhythmics and electrolyte abnormalities. Check the ECG (electrocardiogram) risk before adding. | Gastrointestinal / Cardiac | L1 slide 57 |
| Tetracyclines doxycycline, minocycline | Photosensitivity. Discoloration of teeth — doxycycline more than the others. Depression of skeletal growth. | Must be renally dose adjusted. Counsel on sun protection and on separating doses from iron, calcium and dairy. | Skin / Teeth / Bone | L1 slide 63 |
| Tigecycline Tygacil | Vomiting, nausea, diarrhea and fever. | Dosing consideration is hepatic dysfunction, not renal — the opposite of most of this lecture. | Gastrointestinal | L1 slide 66 |
| Aminoglycosides gentamicin, tobramycin, amikacin | Renal toxicity and ototoxicity. | Renally adjusted, and requires therapeutic drug monitoring: peaks 30 minutes after the end of the infusion, troughs 15–30 minutes before the next dose, around the 3rd or 4th dose. | Renal / Ear | L1 slide 68 |
| Linezolid Zyvox | Thrombocytopenia. Serotonin syndrome with SSRIs, tyramine-containing foods and pseudoephedrine. | Check the medication list for serotonergic agents before starting; watch the platelet count. | Hematologic / Neurologic | L1 slide 71 |
| Fluoroquinolones class | Tendonitis and Achilles tendon rupture. QT prolongation and Torsades de Pointes. Photosensitivity. Peripheral neuropathies. Central nervous system toxicity — dizziness, insomnia, somnolence. | Caution under 18 years. Inhibits CYP1A2; complexes with cations; renally eliminated. | Musculoskeletal / Cardiac / Neurologic | L1 slide 79 |
| Clindamycin Cleocin | Clostridium difficile and pseudomembranous colitis — the reaction this drug is known for. Also rash, neutropenia and thrombocytopenia. | New diarrhea on clindamycin is C. difficile until proven otherwise. | Gastrointestinal / Hematologic | L1 slide 81 |
| Trimethoprim/sulfamethoxazole Septra, Bactrim | Hypersensitivity — rash, Stevens-Johnson syndrome, toxic epidermal necrolysis. Blood dyscrasias — thrombocytopenia, agranulocytosis, megaloblastic anemia. Hepatotoxicity and hyperbilirubinemia. Nausea, vomiting, diarrhea, anorexia. | Interactions matter as much as the toxicity: raises phenytoin, rifampin, digoxin; reduces renal clearance of methotrexate (pancytopenia); hypoglycemia with sulfonylureas; significantly increases INR (international normalized ratio) with warfarin. | Skin / Hematologic / Hepatic | L1 slide 85 |
| Metronidazole Flagyl | Disulfiram-like reaction with ethanol. Headache, nausea and vomiting. | The alcohol counseling is the whole of the patient education for this drug. | Gastrointestinal | L1 slide 86 |
| Polymyxin B and E | BLACK BOX WARNINGS for nephrotoxicity, neurotoxicity and neuromuscular blockade. | Three black boxes on one slide — the most heavily warned agent in the lecture. | Renal / Neurologic | L1 slide 88 |
| Drug or class | Side effects | Monitoring & what to watch | System | Source |
|---|---|---|---|---|
| Amphotericin B | Fever and chills from interleukin-1 and tumor necrosis factor. Side effects limit treatment. | Pre-treat with paracetamol, antihistamines and corticosteroids. | Infusion | L1 slide 98 |
| Amphotericin B | Electrolyte abnormalities — hypokalemia and hypomagnesemia. Hypotension. Uremia in 80% with decreased filtration. Renal tubule damage. | Hydrate with normal saline for the renal tubule damage. Lipid formulations cost 20–50 times more but have reduced toxicity. | Renal / Electrolyte | L1 slide 99 |
| Flucytosine Ancobon | Bone marrow suppression. Hepatotoxicity. Gastrointestinal disturbance and rash. | Available orally only. | Hematologic / Hepatic | L1 slide 101 |
| Ketoconazole | Nausea, vomiting and anorexia. | Inhibits CYP3A4 — significant drug interactions, which is a large part of why it is now rarely used. | Gastrointestinal | L1 slide 103 |
| Posaconazole Noxafil | QT prolongation, fever, diarrhea, hypokalemia, hypomagnesemia and thrombocytopenia. | Same electrolyte pattern as amphotericin — check potassium and magnesium. | Cardiac / Electrolyte | L1 slide 105 |
| Voriconazole Vfend | Effects on vision in 30%, plus liver and renal effects. Teratogenic in animals. | The intravenous vehicle cyclodextrin accumulates in renal failure — a reason to switch to oral. | Ocular / Hepatic / Renal | L1 slide 107 |
| Echinocandins caspofungin, micafungin, anidulafungin | Tachycardia, headache, insomnia, hypokalemia, hypomagnesemia and blood dyscrasias. | The best-tolerated systemic antifungal class in the deck. | Cardiac / Electrolyte | L1 slide 109 |
| Griseofulvin | Headache in 15%, mental confusion, fatigue and blurred vision. | Induces CYP1A2 and CYP2C9 — an inducer, where most antifungals here are inhibitors. | Neurologic / Ocular | L1 slide 111 |
| Drug or class | Side effects | Monitoring & what to watch | System | Source |
|---|---|---|---|---|
| Benzoyl peroxide | Bleaches hair, clothes. Skin and mucous membrane irritation. | Start at 2.5% once daily and build up as tolerated. | Skin | L2 slide 21 |
| Azelaic acid Azelex | Mild skin irritation and dryness. Hypopigmentation. | Improves over 6 to 8 weeks with continuous therapy — tell the patient not to quit at week two. | Skin | L2 slide 22 |
| Topical retinoids | Erythema, desquamation, burning and stinging — these decrease with time and with the use of emollients. Photosensitivity and severe sunburn. | Warning them the irritation settles is what keeps them on the drug. | Skin | L2 slide 24 |
| Isotretinoin Accutane | Retinoid dermatitis — erythema, pruritus, scaling. Photophobia. Arthralgia, headaches, alopecia, brittle nails. Increased serum lipids. | Monitor for signs of developing depression — the one that changes management. | Skin / Multi-system | L2 slide 27 |
| Topical corticosteroids | Local: skin atrophy, acne, rosacea, allergic dermatitis (the last related to the vehicle). Systemic: adrenal suppression, infections, hyperglycemia, glaucoma, cataracts, and growth retardation in children. | Risk scales with potency, duration, area covered and occlusiveness — ointment > cream > lotion. | Skin / Endocrine / Ocular | L2 slide 38 |
| Tacrolimus, pimecrolimus | Burning sensation. Possible cancer risk. | Use a high-SPF (sun protection factor) sunscreen. Avoid in immunosuppressed patients. | Skin | L2 slide 43 |
| Topical azoles clotrimazole, miconazole, sertaconazole | Local irritation. | Treatment is prolonged, 2 to 3 weeks — the irritation has to be tolerable for that long. | Skin | L2 slide 51 |
| Topical allylamines naftifine, terbinafine | Local irritation — the only adverse reaction the deck records for the topical form. | No systemic contraindication is given for this class. | Skin | L2 slide 53 |
| Topical acyclovir, penciclovir | Local irritation. | Used for recurrent orolabial herpes simplex. | Skin | L2 slide 56 |
| Bacitracin | Allergic dermatitis, rarely. No systemic toxicity. | The safest topical antibiotic on the slide — a useful contrast with neomycin. | Skin | L2 slide 46 |
| Neomycin | Frequently causes sensitization. Can have systemic accumulation. | This is why a patient using triple antibiotic ointment can develop a contact dermatitis over the wound. | Skin | L2 slide 49 |
| Polymyxin B topical | Allergic reactions are uncommon, but high doses on open wounds or denuded skin risk neurotoxicity and nephrotoxicity. | The intact-skin restriction is the point. | Skin / Renal | L2 slide 48 |
| Imiquimod Aldara | Skin irritation in virtually all patients — edema, vesicles, erosions, ulcers. | The degree of inflammation parallels efficacy, so the reaction is a sign it is working. Say so before they stop using it. | Skin | L2 slide 57 |
| Drug or class | Side effects | Monitoring & what to watch | System | Source |
|---|---|---|---|---|
| Bethanechol Urecholine | Sweating, salivation, flushing, decreased blood pressure, nausea, abdominal pain, diarrhea and bronchospasm. | This is the muscarinic excess pattern — it recurs for every cholinergic agonist in the lecture. | Cholinergic excess | L3 slide 31 |
| Physostigmine Antilirium | Convulsions at high doses. Bradycardia and decreased cardiac output. Paralysis of skeletal muscle from acetylcholine accumulation. | The only one in the class with convulsions listed — it is the one that enters the central nervous system. | Neurologic / Cardiac | L3 slide 37 |
| Neostigmine, pyridostigmine | Salivation, flushing, decreased blood pressure, nausea, abdominal pain, diarrhea, bronchospasm. | Identical profile for both agents — the deck repeats the list verbatim. | Cholinergic excess | L3 slide 39 |
| Donepezil, rivastigmine, galantamine | Gastrointestinal distress. | The limiting side effect of the Alzheimer agents. | Gastrointestinal | L3 slide 40 |
| Organophosphates AChE inhibitor toxicity | Toxicity shows as nicotinic OR muscarinic signs and symptoms. These agents are commonly used as agricultural insecticides, and also for suicidal or homicidal purposes. | Pralidoxime (Protopam) reactivates inhibited acetylcholinesterase — but it does not penetrate the central nervous system and cannot overcome reversible inhibitors such as physostigmine. | Cholinergic excess | L3 slide 42 |
| Atropine | Dry mouth, blurred vision, “sandy eyes”. Bradycardia at lower doses, tachycardia at higher doses. Urinary retention and constipation. Central nervous system — restlessness, confusion, hallucinations, delirium. | The dose-dependent heart rate reversal is the trap: low dose slows, high dose speeds. | Anticholinergic | L3 slide 52 |
| Succinylcholine | Malignant hyperthermia with halothane — muscular rigidity, metabolic acidosis, tachycardia, hyperpyrexia. Apnea with plasma cholinesterase deficiency. Hyperkalemia. | Treat malignant hyperthermia by rapid cooling and dantrolene (Dantrium), which blocks calcium release from the sarcoplasmic reticulum. | Muscle / Electrolyte | L3 slide 70 |
| Atracurium | Releases histamine — fall in blood pressure, flushing and bronchoconstriction. | Replaced by its isomer cisatracurium (Nimbex) because of fewer adverse effects. | Histamine | L3 slide 65 |
| Drug or class | Side effects | Monitoring & what to watch | System | Source |
|---|---|---|---|---|
| Epinephrine | Central nervous system — anxiety, fear, tension, headache, tremor. Cerebral hemorrhage from the rise in blood pressure. Cardiac arrhythmias. Pulmonary edema. | Oral is ineffective — inactivated by intestinal enzymes. Rapid onset, brief duration. | Cardiac / Neurologic | L3 slide 86 |
| Catecholamines — class epinephrine, norepinephrine, isoproterenol, dopamine | Anxiety, tremor and headache — central nervous system-like adverse effects despite poor penetration into the central nervous system, because they are too polar to enter it. | Rapidly inactivated by COMT postsynaptically and MAO intraneuronally, which is why they are infusions rather than tablets. | Neurologic | L3 slide 79 |
| Norepinephrine | Similar to epinephrine, plus extravasation causing blanching and sloughing of the skin from extreme vasoconstriction. | Treat extravasation with the alpha antagonist phentolamine. | Vascular | L3 slide 90 |
| Dopamine | Nausea, hypertension and arrhythmias. | Watch the rhythm as the rate climbs into the alpha-1 range. | Cardiac / Gastrointestinal | L3 slide 93 |
| Dobutamine | Increases atrioventricular conduction — caution in atrial fibrillation. Otherwise the same as epinephrine. | Tolerance may develop with prolonged use. | Cardiac | L3 slide 94 |
| Albuterol | Tremor, restlessness, apprehension and anxiety. | Beta-2 effects outside the lung — expected, not a reason to stop. | Neurologic | L3 slide 98 |
| Clonidine Catapres | Lethargy, sedation, constipation, xerostomia. Rebound hypertension with abrupt discontinuance. | The rebound is the one that is dangerous; the rest merely reduce adherence. | Neurologic / Cardiac | L3 slide 97 |
| Oxymetazoline Afrin | RHINITIS MEDICAMENTOSA — rebound congestion — if used longer than THREE DAYS. | The three-day limit is the entire safety message for this over-the-counter product. | Nasal | L3 slide 95 |
| Phenylephrine Neo-Synephrine | Induces REFLEX BRADYCARDIA as it raises systolic and diastolic blood pressure. | A pure alpha-1 agonist, so the slowing is a baroreceptor response rather than a direct cardiac effect. | Cardiovascular | L3 slide 96 |
| Amphetamine | Increases blood pressure (alpha-1), stimulates the heart (beta-1) and increases central nervous system activity. | Acts indirectly — blocks norepinephrine uptake and releases stored catecholamines. | Cardiac / Neurologic | L3 slide 100 |
| Tyramine | May cause serious vasopressor effects if the patient is taking a monoamine oxidase inhibitor. | Normally oxidized by MAO (monoamine oxidase) in the gastrointestinal tract; on an MAOI (monoamine oxidase inhibitor) it enters the nerve terminal and displaces stored norepinephrine. Found in fermented foods such as cheese and wine. | Cardiovascular | L3 slide 101 |
| Alpha-1 blockers prazosin, terazosin, doxazosin, tamsulosin, alfuzosin | Dizziness, lack of energy, nasal congestion, headache, drowsiness and orthostatic hypotension. | Combined with first-dose syncope, this is why the first dose is given at bedtime. | Cardiovascular | L3 slide 112 |
| Propranolol | Bronchoconstriction. Arrhythmias if stopped abruptly, from beta receptor up-regulation. Sexual impairment. Fasting hypoglycemia, increased LDL cholesterol, increased triglycerides. | The metabolic disturbances are easy to forget and easy to ask about. | Respiratory / Cardiac / Metabolic | L3 slide 117 |
| Propranolol central effects | Depression, dizziness, lethargy, fatigue, weakness, visual disturbances, hallucinations, short-term memory loss, emotional lability, vivid dreams including nightmares, and decreased performance. | Cimetidine, fluoxetine, paroxetine and ritonavir inhibit its metabolism; barbiturates, phenytoin and rifampin induce it. | Neurologic / Psychiatric | L3 slide 118 |
| Labetalol, carvedilol | Orthostatic hypotension due to alpha-1 blockade. | Both produce peripheral vasodilation, which is where the postural drop comes from. | Cardiovascular | L3 slide 122 |
| Nicotine | Increases blood pressure, heart rate, peristalsis and secretions; at higher doses blood pressure falls from ganglionic blockade and gastrointestinal and bladder activity ceases. | Biphasic — stimulation first, then paralysis of all ganglia. | Autonomic | L3 slide 59 |