INFECTIONS - TETRACYCLINES + QUINOLONES

Question 1

MOA of tetracyclines?

Answer 1

prevents protein syntheiss by binding to 30S subunit of ribosomes.

Question 2

Are tetracyclines bacterostatic or bactericidal?

Answer 2

Bacteriostatic

Question 3

What spectrum is tetracyclines?

Answer 3

Broad

Question 4

What are 4 uses of tetracyclines?

Answer 4

Chlamydia, malaria prophylaxis, Resp tract Infection

Acne, Rosacea

Question 5

List 7 tetracyclines?

Answer 5

Demeclocyline

Doxycline

Lymecycline

Minocycline

Oxytetracycline

Tetracycline

Tigecycline

Question 6

What is the 2 indications of doxycycline?

Answer 6

Malaria prophylaxis

Chlamydia

Question 7

Why is minocycline rarely used?

Answer 7

Due to broader spectrum - more harsh SEs

Question 8

What is common dose of doxycycline?

Answer 8

200mg OD

Question 9

What are 5 SEs of tetracyclines?

Answer 9

Benign Intracranial hypertension

Tooth discolouration

Dental hypoplasia

hepatotoxic

photosensitivity

Question 10

What to do if patient has headache and is on tetracycline?

Answer 10

Stop med

report to doctor

Question 11

What is a contraindication of using tetracyclines?

Answer 11

Can’t be used in children under 12 years

Question 12

Which tetracycline is contraindicated in children under 8?

Answer 12

Lymecycline

causes teeth staining + dental hypoplasia

Question 13

Which tetracycline is caution in children between 8-11 + can be only used for severe acute infections?

Answer 13

Doxycycline

Question 14

Which tetracycline can ONLY be used in life-threatening infections (rocky mountain spotted fever) in under 8 years old?

Answer 14

Doxycycline

Question 15

Can tetracyclines be used in pregnancy?

Answer 15

NO avoid

Question 16

Can tetracyclines be used in renal impairment?

Answer 16

Avoid usually

Question 17

What tetracycline has high risk of irreversible pigmentation/ LE syndrome?

Answer 17

Minocycline

Question 18

What are the 2 tetracyclines which can be used in renal impairment (exemptions)?

Answer 18

Doxycycline

Minocycline

Question 19

Can tetracyclines be used in hepatic impairment?

Answer 19

Avoid

Question 20

What 6 drug classes interact with tetracyclines to increase hepatotoxicity?

Answer 20

Antibiotics (co-amoxiclav, flucloxacillin, isoniazid)

anti epileptics ( carbamazepine, valproate)

Fluconazole, itraconazole

Methotrexate

Statins

Sulfasalazine

Question 21

What 2 counselling points to let patients who are taking tetracyclines know?

Answer 21

Avoid sunlight or sun lamps - photosensitivity

Avoid antacids, iron or zinc- - leave 2 hr gap

Question 22

What 3 things should be avoided or given in 2 hr gap in patients taking tetracyclines?

Answer 22

Antacids , iron, zinc

Question 23

How long to leave gap when taking antacids, iron or zinc when taking tetracyclines?

Answer 23

2 hr gap

Question 24

What 3 tetracyclines to avoid drinking milk + to take on empty stomach due to reduced absorption? (DOT)

Answer 24

Demeclocycline

Oxytetracycline

Tetracycline

Question 25

Which 3 tetracyclines can you have with milk (DLM)?

Answer 25

Doxycycline Lymecycline Minocycline

Question 26

What 3 tetracyclines are used for oesophagitis (ulcers, dysphagia)? (DMT)

Answer 26

Doxycycline Minocycline Tetracycline

Question 27

What is label for tetracycline regarding milk?

Answer 27

Do not take milk, indigestion remedies, meds containing iron or zinc 2 hours before or after you take this medicine.

Question 28

What advice to give patient taking tetracycline for oesophagitis?

Answer 28

Swallow whole with plenty of fluid sitting or standing.

Question 29

MOA of quinolones?

Answer 29

Inhibits nucleic acid + DNA synthesis Bactericidal

Question 30

What condition to AVOID giving quinolones?

Answer 30

MRSA

Question 31

Spectrum of quinolones?

Answer 31

Broad

Question 32

What are 2 uses of quinolones?

Answer 32

RTI UTI

Question 33

What is MHRA warning about quinolones and side effects?

Answer 33

Long term irreversible SEs DO NOT prescribe for non severe infections (not for normal UTIs)

Question 34

What are 4 drugs in quinolone class?

Answer 34

Ciprofloxacin Levofloxacin Moxifloxacin Ofloxacin

Question 35

How often to take ciprifloxacin?

Answer 35

BD

Question 36

What quinolone drug is the most dangerous - increased QT prolongation + life-threatening hepatotoxicity?

Answer 36

Moxifloxacin

Question 37

What are 5 main SEs of quinolones?

Answer 37

Psychiatric disorders Arthropathy (in children), aortic aneurysm, antacids reduce absoprtion Tendon damage CNS disorders Heart valve regurgitations, hypersensitivity (QT prolongation too) Seizures

Question 38

What abx lowers seizure threshold?

Answer 38

Quinolones

Question 39

Can quinolones be used in pregnancy?

Answer 39

No - causes joint issues in animal studies

Question 40

Interaction between quinolones + antacids?

Answer 40

Antacids reduce quinolone absorption. Give Abx 2 hrs before antacid OR take Abx 4 hours after antacid

Question 41

What is a risk factor for quinolones since they cause QT prolongation?

Answer 41

Patients with hypokalaemia

Question 42

What is an MHRA warning regarding heart valve regurgitation when using systemic or inhaled fluoroquinolone + how to counsel patients?

Answer 42

Valve doesn't close properly - blood leaks out. Counsel patient on symptoms like oedema, palpitations, dyspnoea.

Question 43

Who is arthropathy common in?

Answer 43

children/ teenagers

Question 44

What is arthropathy?

Answer 44

Joint disease

Question 45

What are the 5 MHRA warnings for quinolones?

Answer 45

Suicidal tendencies QT prolongation + heart valve regurgitation Life long threatening SEs Aortic aneurysm Tendon damage + Seizures

Question 46

What 3 patient counselling points to tell patients taking quinolones?

Answer 46

1.Avoid sunlight 2.Reduced absorption - no indigestion meds + no dairy products, iron or zinc 2 hrs before or after taking med. 3. Driving - may impair *(Give MHRA advice sheet too)

Question 47

dairy + quinolones?

Answer 47

reduces absorption

Question 48

What does UV radiation do to patients on quinolones

Answer 48

mild rash

Question 49

Is ciprofloxacin an enzyme inducer or inhibitor?

Answer 49

Inhibitor

Question 50

What 2 drugs/classes interact with ciprofloxacin to increase seizure risk?

Answer 50

NSAIDs Theophylline

Question 51

What anticoagulant increases bleeding when used with quinolones?

Answer 51

Warfarin

Question 52

What 10 drugs can increase QT prolongation when given with quinolones?

Answer 52

Antispychotic drugs, Anti-arrhythmic drugs - amiodarone, sotalol Macrolides Abx Lithium SSRIs Clomipramine Domperidone lithium methadone 5HT1 antagonists - triptans

Question 53

What condition does hypokalaemia increase risk of?

Answer 53

Torsade de pointes

Question 54

What 4 drugs/classes can increase risk of hypokalaemia + QT prolongation?

Answer 54

B2 agonists Corticosteroids Loop + thiazide diuretics Theophylline

Question 55

What tetracylcine does not need to be taken with plenty of fluid while sitting or standing ?

Answer 55

demeocycline