Exam 2 - Fluoroquinolones Spectrum/Clinical Use Flashcards
Describe the GP coverage trends between the newer and older FQs
cipro - poor coverage
new FQ ( levo, moxi, dela) - enhanced coverage
what GP are covered by FQs
PSSP
PRSP (except cipro)
MSSA
MRSA (only dela)
what GN are covered by FQs
Enterobacteriaceae
HENPECKSSS
Pseudomonas Aeruginosa
what FQs cover pseudomonas aeruginosa
cipro > levo > dela
what FQs do NOT cover pseudomonas aeruginosa
Moxi or gemi
what anaerobes do FQs cover
bacteroides fragilis (trova and moxi)
do FQs cover atypicals
YES
what atypicals do FQs cover?
Legionella
Chlamydia
Mycoplasma
Ureaplasma
what are the clinical uses for FQs
-Community-Acquired Pneumonia
-Acute exacerbations of bronchitis & sinusitis
-GN Nosocomial pneumonia
-GN UTIs (cystitis, pyelonephritis)
-Chronic bacteria prostatitis
-Skin infections
can pen allergies use FQs?
No
what is the moa for FQs
inhibit topoisomerase
what kind of killers are FQ
concentration dependent bactericidal
what is the mechanism of resistance against FQ
alteration in binding site
active efflux pump
alteration in cell wall permeability
cross-resistance between FQs
what are the FQs
levofloxacin
ciprofloxacin
moxifloxacin
delafloxacin
what is the fear with resistance of Staph A to FQs
Staph A only needs one mutation at the binding site to become resistant
what is the absorption profile for FQ
high oral absorption
dose cipro higher for PO
levo and moxi same dose IV and PO
can FQs access the CSF
no
what is the half life of ciprofloxacin
4 hours
how are FQ eliminated
renally
what FQs require renal dose adjustments
levo, cipro, dela
what FQ does not require renal dose adjustments
moxi
what FQ are removed during hemo
none
what are the major DDIs with FQ
cations
warfarin
theophylline and cyclosporine (cipro only)
what are the major adverse events of FQ
neurologic
hepatotoxicity (moxi)
cardiac
articular damage
tendon damage
who is at risk for cardiac toxicities for FQ
hypokalemia
amiodarone/sotalol
QTc Prolongation
who is at risk for articular damage for FQ
peds and pregnancy
who is risk for tendon damage for FQ
> 60 pts
steroids
transplant pts
*avoid exercise during therapy)
