Erdman FQ

Question 1

MOA of Fluoroquinolones

Answer 1

inhibit DNA synthesis through binding to and inhibiting DNA topoisomerases

Question 2

What are the 2 targets of FQs

Answer 2

DNA gyrase (topoII) and topoIV

Question 3

What does inhibition of DNA gyrase do

Answer 3

prevents the relaxation of positively supercoiled DNA

Question 4

What does inhibition of topo IV do

Answer 4

interferes with the separation of replicated DNA into daughter cells

Question 5

DNA gyrase is the the main target for ________ bacteria

Answer 5

gram (-)

Question 6

Topo IV is the main target for ______ bacteria

Answer 6

gram (+) (S. aureus)

Question 7

FQs display ______ bactericidal activity

Answer 7

concentration-dependent

Question 8

What are the 3 MOR for FQs

Answer 8

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

Question 9

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

Answer 9

True

Question 10

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

Answer 10

poor

Question 11

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

Answer 11

enhanced

Question 12

T/F: FQs are effective against MRSA

Answer 12

F - active against MSSA

Question 13

What gram (+) aerobes do FQs cover

Answer 13

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

Question 14

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

Answer 14

cipro=levo activity but both > moxi

Question 15

Which FQs have activity against Pseudomonas aeruginosa

Answer 15

Cipro and Levo

Question 16

Which FQs have activity against anaerobes

Answer 16

Trova and Moxi - resistance is emerging for moxi

Question 17

What FQs are active against atypical bacteria

Answer 17

most FQs are extremely active against legionella

Question 18

What type of activity do FQs exhibit

Answer 18

rapid, concentration dependent bactericidal activity

Question 19

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

Answer 19

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

Question 20

How does oral bioavailability of cipro compare to moxi/levo

Answer 20

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

very good oral bioavailability allows for early conversion to oral therapy

Question 21

how does food effect Tmax of FQs

Answer 21

coingestion with food delays peak serum concentrations

Question 22

FQs obtain therapeutic concentrations in which tissues

Answer 22

prostate, lung, bronchial mucosa, sputum, bone

Question 23

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

Answer 23

Moxi and Gemi

Question 24

T/F: FQs achieve good CSF concentrations

Answer 24

False: achieve minimal penetration into CSF

Question 25

Which FQs need dose adjustments in renal insufficiency

Answer 25

Levo, oflox, gati, cipro, and gemi

Question 26

Which FQs are eliminated by both renal and hepatic mechanisms

Answer 26

Cipro and gemi

Question 27

Which FQs are eliminated by hepatic metabolism only

Answer 27

trova and moxi

Question 28

Which FQs are eliminated by renal elimination only

Answer 28

levo, oflox, and gati

Question 29

T/F: FQs must be supplemented after hemodialysis

Answer 29

False: they are not removed during hemodialysis

Question 30

What FQs are available in the USA

Answer 30

``` Old FQs: Ciprofloxacin Norfloxacin Ofloxacin New FQs (respiratory FQs) Levofloxacin Moxifloxacin Gemifloxacin ```

Question 31

Used to treat CAP (lower respiratory tract)

Answer 31

levo and moxi

Question 32

Used to treat upper respiratory tract infections; sinusitis

Answer 32

cipro, levo and moxi

Question 33

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

Answer 33

cipro

Question 34

Used to treat nosocomial pneumonia (Lower respiratory tract)

Answer 34

cipro and levo

Question 35

Used to treat UTIs (cystitis and pyelonephritis)

Answer 35

cipro and levo

Question 36

Used to treat chronic bacterial prostatitis

Answer 36

cipro and levo

Question 37

Used to treat osteomyelitis

Answer 37

cipro and levo

Question 38

Used to treat intraabdominal infections

Answer 38

cipro or levo WITH metronidazole

Question 39

Common SE of FQ use

Answer 39

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

Question 40

FQs carry a blackbox warning for?

Answer 40

peripheral neuropathy

Question 41

What is the cardiac concern with FQs

Answer 41

may prolong the QTc interval increasing risk of torsades

Question 42

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

Answer 42

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

Question 43

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

Answer 43

Articular damage

Question 44

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

Answer 44

patient >60yo corticosteroid tx transplant patients - avoid exercise which on tx -

Question 45

ALL oral FQs interact with?

Answer 45

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

Question 46

What drugs do FQs interact with

Answer 46

warfarin (most) | theophylline; cyclosporin (cipro only)