9-11 Fluoroquinolones and Metronidazole Flashcards
[Fluoroquinolones]
A: MOA (2)
B:
- Rapid or slower acting?
- Time or Concentration Dependent?
- Bacteriostatic or BacteriCIDAL
[Fluoroquinolones]
A: MOA= Inhibits DNA synthesis by inhibiting
1) [DNA Gyrase Topoisomerase 2] in [gram negative] –>Excess supercoiling —> No DNA Replication
2) [Topoisomerase 4] in [Gram POSITIVE] –> NO SEPRATION of daughter cells during division
B: RAPID-Concentration Dependent BacteriCIDAL activity
[Fluoroquinolones]
A: [Mechanism of Resistance] (3)
A2: Which mechanism is the most common?
B: Cross-resistance between FQs?
C: Examples (3)
C2: Which is older?
[Fluoroquinolones]
A: [Mechanism of Resistance] = Bacteria may have:
1. [Chromosomally-mediated Altered Target Sites] = MOST IMPORTANT AND MOST COMMON
- [Plasma mediated Active Efflux Pumps]
- ## DEC Cell Wall permeabilityB: YES, There is Cross-resistance between FQs
C: Examples
- Levofloxacin
- Moxifloxacin
- Ciprofloxacin = OLDER and less respiratory activity
[Fluoroquinolones]
B: [Gram negative bacteria]: (2)
B2:Compare the efficacy of the 3 Fluoroquinolones for [Gram negative bacteria]
C:Moxifloxacin can NOT be used to treat which [Gram negative bacteria]?
[Fluoroquinolones]
A: [Gram POSITIVE bacteria]
1. MssA
2. Streptococcus pneumoniae (INCLUDING PRSP)
——————————————————————————
B: [Gram negative bacteria]:
1. Enterobacteriaceae FAMILY
2. Pseudomonas Aeruginosa [CAN NOT USE MOXIFLOXACIN]
B2:[CIPRO = LEVO > moxi]
C:[Pseudomonas Aeruginosa]
[Fluoroquinolones]
A: Anaerobes:
1) _______ does have some activity with [B.Fragilis]
B: Atypical Bacteria: All FQs have ____(Great/mild) activity with Atypical Bacteria: (4)
C:[_____ and _____ also treat [Bacillus Anthracis]
[Fluoroquinolones]
A: Anaerobes:
1) MOXIFLOXACIN does have some activity with [Bacteroides Fragilis]
B: Atypical Bacteria: (All FQs have GREAT activity with Atypical Bacteria)
1) Legionella
2) Chlamydia Species
3) Mycoplasma
4) [Ureaplasma urealyticum]
C: [Cipro and Levo] also treat [Bacillus Anthracis]
Which two Fluoroquinolones do you give to treat [Mycobacterium Tuberculosis]?
Levo and Moxi
- Fluoroquinolones have ______[Bad/Good] Bioavailability PO and are distributed to:
- lung
- bone
- [Urinary Tract] / Prostate = _____ and _____
- CSF = _____ - How are Fluoroquinolones Eliminated? (2)
- Adverse Effects (6)
- Fluoroquinolones have GOOD Bioavailability PO and are distributed to
- lung
- bone
- [Urinary Tract] / Prostate = Cipro and Levo
- CSF = Moxi - Fluoroquinolones are RENAL ELIMINATED but
- MOXI is HEPATIC ELIMINATED.
- FQ ADVERSE EFFECTS:
“FQ Head Gives me CHAP”
- hypOkalemia
- GI (including C.Diff Colitis)
- CNS
- Hepatotoxicity from MOXI
- [Articular Cartilage Damage] –> [Tendon rupture]
- [PROLONGED QTc INTERVAL–> Torsades]
Fluoroquinolones Clinical USES: Name the Abx most appropriate for each:
1) URI
2) [Comm.Acquired PNA]
3) [Hospital Acquired PNA] (2)
4) [Cystic Fibrosis Exacerbation]
5) UTI (2)
Fluoroquinolones Clinical USES:
1) URI = ALL
2) [Comm.Acquired PNA] = ALL BUT CIPRO due to poor [Gram POSITIVE coverage]
3) [Hospital Acquired PNA] = [Cipro + (Gram positive agent)] or Levo
4) [Cystic Fibrosis Exacerbation] = CIPRO
5) UTI = Cipro or Levo
A: Fluoroquinolones are CONTRAINDICATED in what demographic of people? (3)
B: What other groups are at high risk for [Articular Cartilage Damage] and Tendonitis (3)
A: CONTRAINDICATED
(xx) Pediatrics
(xx) Pregnant or [Breast Feeding] Women
(x) [Pt on Warfarin / Theophylline / Cyclosporine] - (Cipro Only)
B:
- Transplant pts
- [Pts over 60]
- [Pts on Corticosteroids]
A: All Oral Fluoroquinolones have IMPAIRED absorption and Clinical ______ when taken with [______ and ______ Cations] such as ______ (5)
A2: [Oral Fluoroquinolones] Must be given _____ hours _______ [Before/After] _____ and _____ Cations
A: All PO Fluoroquinolones have IMPAIRED absorption and Clinical Failure when taken with [Divalent and Trivalent Cations] such as [Magnesium / Zinc / Iron / Calcium / Aluminum].
A2: FQs Must be taken 3 hours BEFORE [Divalent and Trivalent Cation] ingestion
A: Metronidazole is a PRODRUG that’s active against AnAerobes, [microaerophilic bacteria] and Protozoa.
B: MOA= ______ tht Inhibits DNA synthesis based on presence of ______ in bacteria.
______ donate ______—> [bacterial DNA damage]. Metronidazole is then ______ recycled.
C:
- Concentration or Time -Dependent?
- Bacteriostatic or BacteriCIDAL?
D: [Mechanisms of Resistance] (2)
A: Metronidazole is a PRODRUG that’s active against AnAerobes, [microaerophilic bacteria] and Protozoa.
B: MOA= PRODRUG tht Inhibits DNA synthesis based on presence of [Ferredoxins] in bacteria. [Ferredoxins] donate electrons –> [bacterial DNA damage]. Metronidazole is then catalytically recycled.
C:
- Concentration -Dependent
- BacteriCIDAL
D: [Mechanisms of Resistance] = UNCOMMON
- Organisms that grow in O2 environments
- Bacteria with altered Ferredoxin levels
Metronidazole:
Anaerobic Bacteria (3)
Metronidazole:
“Brian Can Hear the METRO at night”
A: Anaerobic Bacteria
- Bacteroides SPECIES
- Clostridium SPECIES
- H.Pylori
METRONIDAZOLE
A: Routes of Administration (2)
A2: Can this abx penetrate CSF?
B: Elimination
B2: Half-Life
C: Is this abx removed during hemodialysis?
A: [Available IV and PO] and IS ABLE TO PENETRATE CSF
B: Hepatic Elimination
B2: Half-Life = [6-8 hours]
C: YES
Metronidazole: CLINICAL USES
- Anaerobic Infections (6)
B: What condition is Metronidazole the DRUG OF CHOICE for?
Metronidazole: CLINICAL USES
- Anaerobic Infections
- Intraabdominal
- [Skin and Soft tissue]
- diabetic foot and decubitus ulcer infections
- Pseudomembranous colitis due to C. difficile
- Brain Abscess / CNS
B: [PO/IV] Metronidazole is the DRUG OF CHOICE for MILD
to MODERATE c.dif disease
Metronidazole Adverse Effects:
A: GI (2)
B: CNS (2)
Metronidazole Adverse Effects:
A: GI
- Stomatitis
- Metallic Taste
B: CNS = MUST DISCONTIUE
- Peripheral neuropathy (occurs with more than 6 week use)
- Seizures
METRONIDAZOLE
C: Contraindicated (4)
D: What happens when a pt takes Metronidazole and Drinks EtOH?
E: Which abx when taken with Metronidazole will DEC Metronidazole EFFICACY?
METRONIDAZOLE
C: Contraindicated: [Pt taking PPEW]
(xxx) [Pregnant and [Breast Feeding] Women]
(xxx) [Pt taking PPEW] (Phenytoin / EtOH / Warfarin)
D: When taken with EtOH —> [Disulfiram rxn] —> SEVERE FLUSHING WITH N/V
E: Rifampin
