Fluoroquinolones Flashcards
(T/F) - Fluoroquinolones have a broad-spectrum activity against gram (-) and (+) organisms
FALSE - Gram (-), (+), and atypical organisms
(T/F) - Fluoroquinolones display an excellent oral F
TRUE
(T/F) - Fluoroquinolones have a high incidence of adverse effects
FALSE - low incidence
What is the MOA of fluoroquinolones?
Inhibits DNA gyrase (bacterial topoisomerase) leading to DNA strand breaks and rapid bactericidal activity
What are the mechanisms of resistance for fluoroquinolones?
- Mutation of target site (DNA gyrase)
- Decreased permeability of outer cell wall membrane of gram (-) bacteria
- Production of efflux proteins that actively trasnport fluoroquinolones out of bacteria
What are the drugs that fall under the fluoroquinolone class?
- Ciprofloxacin
- Moxifloxacin
- Levofloxacin
- Gemifloxacin
- Delafloxacin
Which fluoroquinolones are also known as respiratory quinolones?
- Gemifloxacin
- Moxifloxacin
- Levofloxacin
Ciprofloxacin has a good spectrum over which bacteria?
- Enteric GNRs
- Pseudomonas
- H. influenzae
Respiratory quinolones have a good spectrum over which bacteria?
- H. influenzae
- Enteric GNRs
- Pseudomonas
- S. pneumoniae
- Atypicals
Only one respiratory quinolone is active against pseudomonas, which one is it?
Levofloxacin
What adverse events could occur with fluoroquinolones?
- CNS
- CV
- Musculoskeletal
- Dermatologic
What type of CNS adverse events could occur?
- Dizziness
- Peripheral neuropathy
- Hallucinations
- Confusion
- Insomnia
What type of CV adverse events could occur?
QT prolongation
What type of musculoskeletal adverse events could occur?
- Arthralgias (uncommon)
- Achilles tendon rupture (black boxed warning)
Who is more likely to gain Achilles tendon rupture as an adverse event w/ fluoroquinolones?
- Elderly
- Renal dysfunction pts
- Pts on corticosteroids
What type of dermatologic adverse event could occur?
Photosensitivity
What is a contraindication of flouroquinolones?
Pregnant and children
What is the dose of ciprofloxacin in pseudomonas?
- 400 mg IV q 8 h
OR - 750 mg PO q 12 h
What is the dose of levofloxacin in pseudomonas?
- 750 mg PO or IV q 24 h
What is the percentage of bioavailability with fluoroquinolones?
80-100%
(T/F) - ALL fluoroquinolones dose given PO are the same dose as IV
FALSE - all except ciprofloxacin (po = 1.25 x IV)
(T/F) - ALL fluoroquinolones chelate cations which decrease the oral F of fluoroquinolones
TRUE
Which cations chelate with fluoroquinolones?
- Mg
- Ca
- Fe
- Milk
- MVIs
- antacids
What should be done if a patient is taking cations and flouroquinolones?
Separate by at least 2 hrs
Fluoroquinolones are problematic with what else?
Tube feeds
How are fluoroquinolones cleared?
Renally
Which fluoroquinolone is not renally cleared?
Moxifloxacin
Moxifloxacin is not best to be used in which indication?
UTIs
The FDA has stated to use fluoroquinolones if risks outweigh benefits for which indications?
- Sinusitis
- Bronchitis
- Uncomplicated UTIs
Delafloxacin can be administered how?
- IV
- PO
Delafloxacin has a good spectrum in which bacteria?
- Gram (+) including MRSA
- Gram (-) including pseudomonas
What is delafloxacin FDA approved of?
Skin/soft tissue infections
Should delafloxacin be used whenever for any infections?
No, it shouldn’t be used unnecessarily to avoid development of resistance
What is the usual dose of delafloxacin given PO?
450 mg PO q 12 h
What is the usual dose of delafloxacin given IV?
300 mg IV q 12 h
