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PHRM 865 EXAM2 > Erdman FQ > Flashcards

Erdman FQ Flashcards

1
Q

MOA of Fluoroquinolones

A

inhibit DNA synthesis through binding to and inhibiting DNA topoisomerases

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2
Q

What are the 2 targets of FQs

A

DNA gyrase (topoII) and topoIV

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3
Q

What does inhibition of DNA gyrase do

A

prevents the relaxation of positively supercoiled DNA

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4
Q

What does inhibition of topo IV do

A

interferes with the separation of replicated DNA into daughter cells

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5
Q

DNA gyrase is the the main target for ________ bacteria

A

gram (-)

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6
Q

Topo IV is the main target for ______ bacteria

A

gram (+) (S. aureus)

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7
Q

FQs display ______ bactericidal activity

A

concentration-dependent

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8
Q

What are the 3 MOR for FQs

A

Alteration of binding site, increased efflux pump expression, alteration of cell wall permeability

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9
Q

True or False: cross-resistance is usually observed between FQs

A

True

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10
Q

Ciprofloxacin displays (good/poor) activity against gram (+) aerobes?

A

poor

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11
Q

Levo and Moxi display ______ activity against gram (+) aerobes compared to Cipro

A

enhanced

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12
Q

T/F: FQs are effective against MRSA

A

F - active against MSSA

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13
Q

What gram (+) aerobes do FQs cover

A

Group and viridans strep, enterococcus (limited)
Strep. pnuemoniae (including PRSP - not cipro)
MSSA

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14
Q

activity against enterobacteriaceae (H. influenzae, Neisseriam, M. catarrhalis)

A

cipro=levo activity but both > moxi

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15
Q

Which FQs have activity against Pseudomonas aeruginosa

A

Cipro and Levo

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16
Q

Which FQs have activity against anaerobes

A

Trova and Moxi - resistance is emerging for moxi

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17
Q

What FQs are active against atypical bacteria

A

most FQs are extremely active against legionella

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18
Q

What type of activity do FQs exhibit

A

rapid, concentration dependent bactericidal activity

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19
Q

T/F: FQs exhibit PAE against only gram(-) bacteria

A

False - display PAE against both gram (+) and (-) bacterial; (2hrs for gram (+), 2-4 for gram (-))

20
Q

How does oral bioavailability of cipro compare to moxi/levo

A

Cipro - 70-75% F
Moxi/Levo - >90%

very good oral bioavailability allows for early conversion to oral therapy

21
Q

how does food effect Tmax of FQs

A

coingestion with food delays peak serum concentrations

22
Q

FQs obtain therapeutic concentrations in which tissues

A

prostate, lung, bronchial mucosa, sputum, bone

23
Q

All FQs achieve high urinary concentrations and can be used to treat UTIs, except…?

A

Moxi and Gemi

24
Q

T/F: FQs achieve good CSF concentrations

A

False: achieve minimal penetration into CSF

25
Q

Which FQs need dose adjustments in renal insufficiency

A

Levo, oflox, gati, cipro, and gemi

26
Q

Which FQs are eliminated by both renal and hepatic mechanisms

A

Cipro and gemi

27
Q

Which FQs are eliminated by hepatic metabolism only

A

trova and moxi

28
Q

Which FQs are eliminated by renal elimination only

A

levo, oflox, and gati

29
Q

T/F: FQs must be supplemented after hemodialysis

A

False: they are not removed during hemodialysis

30
Q

What FQs are available in the USA

A 
Old FQs:
Ciprofloxacin
Norfloxacin
Ofloxacin
New FQs (respiratory FQs)
Levofloxacin
Moxifloxacin
Gemifloxacin
31
Q

Used to treat CAP (lower respiratory tract)

A

levo and moxi

32
Q

Used to treat upper respiratory tract infections; sinusitis

A

cipro, levo and moxi

33
Q

Used to treat bacteria exacerbations in cystic fibrosis (p. aeruginosa)

A

cipro

34
Q

Used to treat nosocomial pneumonia (Lower respiratory tract)

A

cipro and levo

35
Q

Used to treat UTIs (cystitis and pyelonephritis)

A

cipro and levo

36
Q

Used to treat chronic bacterial prostatitis

A

cipro and levo

37
Q

Used to treat osteomyelitis

A

cipro and levo

38
Q

Used to treat intraabdominal infections

A

cipro or levo WITH metronidazole

39
Q

Common SE of FQ use

A

gastrointestinal, neurologic, hepatotoxicity, phototoxicity, cardiac, articular damage, tendonitis (literally like everything ever)

40
Q

FQs carry a blackbox warning for?

A

peripheral neuropathy

41
Q

What is the cardiac concern with FQs

A

may prolong the QTc interval increasing risk of torsades

42
Q

Who should FQs be used with caution in (cardiac SE specific)

A

patients with hypokalemia, concomitant use of class III antiarrhythmics and preexisting QTc prolongation

43
Q

Why are FQs contraindicated in pediatric patients and warned to be avoided in pregnant patients

A

Articular damage

44
Q

who is most at risk for tendonitis and tendon rupture as a result of FQ use

A

patient >60yo
corticosteroid tx
transplant patients

  • avoid exercise which on tx -
45
Q

ALL oral FQs interact with?

A

ZICAM - Zinc, Iron, Ca, Al, Mg

take FQ 2 hrs before or 2-6 hours after

In the case of tube feedings - give FQ first and separate by several hours

46
Q

What drugs do FQs interact with

A

warfarin (most)

theophylline; cyclosporin (cipro only)

PHRM 865 EXAM2 (3 decks)

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