Fluoroquinolone's

Question 1

Fluoroquinolone’s should NOT be taken with:

Answer 1

Dairy, or oral supplements which contain Mag, zinc, calcium, or iron

Question 2

Is Ciprofloxacin part of the older or newer generation?

Answer 2

Older

Question 3

Which Fluoroquinole has significant activity against Staphylococcus, Enterococcus, and Streptococcus?

Answer 3

Levofloxacin

Question 4

Ciprofloxacin and Levofloxacin are the only two fluoroquinoles that have activity against this organism:

Answer 4

P. aeruginosa.

Question 5

Can ciprofloxacin & Levofloxacin cross the blood brain barrier?

Answer 5

Poorly in uninflammed meninges, but to a moderate extent under inflammation

Question 6

Does ciprofloxacin enter breast milk?

Answer 6

Yes

Question 7

What is the bioavailability of ciprofloxacin vs levofloxacin?

Answer 7

Cipro: 70%
Levo: 99%

Question 8

How does ciprofloxacin get eliminated?

Answer 8

40-50% excreted unchanged in urine; remainder in feces

Question 9

How does levofloxacin get eliminated?

Answer 9

87% unchanged in urine; remained eliminated by tubular secretion

Question 10

What are the black box warnings for fluoroquinolone?

Answer 10

1. Tendonitis & tendon rupture
2. Exacerbation of muscle weakness; avoid in patients with myasthenia graves

Question 11

Fluoroquinoles should be dosed for:

Answer 11

Impaired renal function: CrCl <50mL/min

Question 12

Can Ciprofloxacin be given safely & confidently to pregnant mothers?

Answer 12

No. There is conflicting evidence & the FDA recommends alternative medications unless the organism is solely susceptible to Cipro (inhalation anthrax)

Question 13

Ciprofloxacin is used as first-line treatment for:

Answer 13

typhoid fever

Question 14

What are the primary indications for levofloxacin?

Answer 14

Bronchitis
Community acquired pneumonia
pyelonephritis/
uncomplicated UTI’s
Sinusitis

Question 15

What are the primary indications for Ciprofloxacin?

Answer 15

-Bacterial diarrhea
-Inhalation anthrax
-Severe or complicated UTI’s
-Meningococcal carriers
-Intra-abdominal infections

Question 16

Both Ciprofloxacin & Levofloxacin require special dosing in these types of patients. State the lab value as well.

Answer 16

Renal impairment
Creatinine clearance of <50mL/min

Question 17

Levofloxacin should not be given concurrently with these drugs. State why:

Answer 17

NSAIDS
Dairy
Antacids

Question 18

Ciprofloxacin should not be given concurrently with these drugs/foods:

Answer 18

Caffeine
Dairy
Phenytoin
Probenecid
Theophylline
Antacids

Question 19

What effect does the fluorine molecule have on fluoroquinolone activity?

Answer 19

Provides increased potency against gram-negative organisms and broadens the spectrum to include gram-positive organisms as well.

Question 20

How is resistance mediated against fluoroquinolones?

Answer 20

By mutations in the quinolone-binding region of the target enzyme or by a change in the permeability of the organism

Question 21

Fluoroquinolones have notable activity against which types of organism?

Answer 21

gram-negative bacteria

Question 22

What is the age recommendations for fluoroquinolones?

Answer 22

not recommended for children younger than 18 years

Question 23

What are three possible adverse effects of fluoroquinolones?

Answer 23

1. C. Diff
2. hypersensitivity reactions
3. Phototoxicity

Question 24

Generally speaking, Fluoroquinolones are first-line therapy in the treatment of?

Answer 24

Traveler’s diarrhea and severe diarrhea not associated with antibiotic therapy

Question 25

Fluoroquinolones undergo metabolism by which enzymes?

Answer 25

CYP3A4

Question 26

Fluoroquinolones can increase risk of toxicity of these two drugs which are metabolized by the sam enzymes:

Answer 26

Theophylline and Warfarin

Question 27

What is the MOA?

Answer 27

Prevent transcription of supercoiled DNA by inhibiting DNA Gyrase

Question 28

Fluoro’s can cause these adverse effects:

Answer 28

Tendon rupture
Prolonged QTC
Increased risk of aortic dissection
Phototoxicity; STJ