Compared with most other cephalosporins, the administration of cefoperazone, or cefotetan is associated with a higher incidence of which of the following? (AIPG 2009)
|A||Acute heart failure|
|B||Acute renal failure|
|C||Bleeding tendencies in patients taking warfarin|
a. Cefmetazole and cefotetan, both second-generation cephalosporins, and cefoperazone (third generation) can interfere with hepatic vitamin K metabolism, leading to what amounts to a deficiency ot vitamin K-dependent clotting factor activity.
b. Because this is the general mechanism by which warfarin exerts its anticoagulant effects, combined use of one of these cephalosporins can cause further (and potentially dangerous) prolongations of the International Normalized Ratio (or prothrombin time); the clinical consequence can be spontaneous, prolonged, or excessive bleeding.
c. One should also be cautious when these cephalosporins are given to patients taking aspirin or other antiplatelet drugs (e.g., clopidogrel) or thrombolytics.
d. Although most cephalosporins are excreted unchanged by the kidneys, renal failure (especially severe and acute) seldom occurs with these or other cephalosporins.
e. There is no link between administration of even high doses of these cephalosporins (or others) with the development of acute heart failure. Hypertension (or other substantial changes of blood pressure) are not associated with cephalosporins, nor are these drugs ototoxic.
f. Although a history of severe allergic reactions to penicillins requires caution when considering a cephalosporin (indeed, cephalosporins should be avoided, if possible, in such patients), there is nothing unique about cefmetazole, cefoperazone, or cefotetan in this context. None of the cephalosporins are contraindicated for patients with mild allergic reactions due to penicillins.