quinolones

Question 1

name 5

Answer 1

• ofloxacin
• levofloxacin
• ciprofloxacin
• moxifloxacin
• deflafloxacin

Question 2

can you use in MRSA Infections

Answer 2

no as many staphylococci are resistant to quinolones

Question 3

you see that a pt who takes meloxicam is prescribed levofloxacin for a UTI. is there an interaction or is this safe

Answer 3

NSAIDs increase the risk of seizures when given with quinolones. caution. severe interaction

Question 4

interaction between NSAIDs and quinolones (systemic or inhalation)

Answer 4

increased risk of seizures in pt with or without a history of convulsions!

Question 5

important safety advice re quinolones and convulsions

Answer 5

quinolones may induce convulsions in pt with or without a history of convulsions
taking NSAIDs at the same time may also induce them

Question 6

quinolones safety advice re tendon damage

Answer 6

• tendon damage, including rupture, has been reported rarely in pt
• can occur within 48h of starting treatment
• some cases several months after stopping
• contraindicated in pt with Hx tendon disorders related to quinolone use
• pt >60 are more prone to tendon damage
• risk of tendon damage increased by concomitant use of CCs
• if tendinitis suspected, discontinue

Question 7

quinolones are associated with a risk of tendon damage. this risk is increased by the concomitant use of ….

Answer 7

CCs

Question 8

quinolones have been associated with tendon damage. what age of pt are more prone to this

Answer 8

• pt >60 are more prone to tendon damage

Question 9

MHRA Advice re quinolones and increased risk of aortic aneurysm and dissection

Answer 9

• benefit-risk assessment and consider other options before using fluoroquinolone in pt at risk of aortic aneurysm and dissection
• factors that increase its risk include FHx, pre-existing, and other Rf e.g. known atherosclerosis, hypertension, giant cell arteritis etc
• seek immediate medical attention if sudden onset severe abdominal, chest, or back pain

Question 10

a patient comes into the pharmacy complaining of abdominal and back pain that is very painful and has come on quite suddenly. you have a look at their pmr and see they were recently prescribed ofloxacin. what could this be

Answer 10

aortic aneurysm or dissection

Question 11

MHRA advice - rare reports of disabling and potentially long lasting or irreversible SE

Answer 11

• concerning the MSK and NS
• stop treatment at first signs of serious adverse reaction e.g. tendinitis, tendon rupture, muscle pain, muscle weakness, joint pain, joint swelling, peripheral neuropathy and CNS effects and contact GP immediately.
• avoid use with CCs
• prescribe with caution in over 60s and in pt with RI or solid organ transplants as they are at higher risk of tendon injury

Question 12

state 3 types of pt who are at higher risk of tendon damage, therefore prescribe quinolones with caution

Answer 12

over 60s
RI
solid organ transplants

Question 13

a patient comes in wanting to buy some ibuprofen to help with his pain. upon questioning he reveals that his elbow is painful and swollen. you look at his PMR and see he was recently prescribed an abx which you suspect has caused this. what is it and what do you do

Answer 13

tendon damage caused by quinolone abx (ofloxacin, moxifloxacin, levofloxacin etc)
stop taking and see GP urgently
don’t sell NSAIDs because increased risk of seizures when taken with quinolones

Question 14

MHRA advice - small risk of heart valve regurgitation

Answer 14

• consider other options first in pt at risk
• only use in serious, life threatening infections after careful benefit-risk assessment
• only use after careful benefit ro risk assessment and consideration of other options in pt with the following RF: congenital or pre existing heart valve disease, connective tissue disorders, other RF predisposing to heart valve regurgitation e.g. hypertension, RA, infective endocarditis
• seek immediate medical attention if rapid onset of SOB (esp when lying flat in bed), swollen ankles, feet, abdomen or new onset heart palpitations

Question 15

a patient comes in and tells you their ankles have been very swollen. they also have SOB when lying flat in bed and have noticed some palpitations. you look at their record and see they take blood pressure pills and was recently prescribed an abx. what is it and why did this happen

Answer 15

a quinolone - small risk of heart valve regurgitation. having hypertension is a risk factor that predisposes to heart valve regurgitation. advice to seek immediate medical attention

Question 16

MHRA advice - suicidal thoughts and behaviour

Answer 16

• psychiatric SE, including depression and psychosis
• can occur even after first dose
• rare cases: thoughts or attempts of suicide
• can worsen existing psychiatric symptoms
• stop immediately if such SE, including new or worsening depression or psychosis, occur
• be alert to any changes in mood or behaviour even after treatment has stopped for some time

Question 17

a patient comes in to the pharmacy and says she would like to purchase St Johns wart as she has heard about it. you ask her about her symptoms and she says that recently she has been feeling depressed. she cannot think of any triggers. you look at her PMR and see she was recently prescribed ofloxacin.

Answer 17

risk of psychiatric disorders
refer to GP
stop and seek immediate medical advice if suicidal thoughts or behaviour

Question 18

contraindications of quinolones

Answer 18

history of tendon disorders related to quinolone use

Question 19

do quinolones affect the QT interval

Answer 19

yes they can prolong it

Question 20

cautions

Answer 20

• can prolong QT interval
• conditions that predispose to seizures
• diabetes - may affect BG
• avoid excessive sunlight and UV radiation during treatment and for 48 hours after stopping treatment
• G6PD deficiency - very likely to cause haemolysis
• Hx epilepsy
• MG (exacerbation risk)
• psychiatric disorders

Question 21

food interactions with ciprofloxacin

Answer 21

avoid concurrent administration of dairy products and mineral-fortified drinks with oral ciprofloxacin due to reduced exposure

Question 22

cautionary label

Answer 22

do not take milk (for ciproflox), indigestion remedies, or meds containing iron or zinc 2h before or after

Question 23

advice on taking oral antacids with ciprofloxacin

Answer 23

they decrease absorption of oral ciproflox so take 2 hours before or 4 hours after antacids

Question 24

advice on taking calcium with ciprofloxacin

Answer 24

they decrease absorption or oral ciproflox so separate administration by 2 hours

Question 25

can a pt who takes duloxetine be given ciproflox

Answer 25

avoid as ciproflox is predicted to increase exposure to duloxetine

Question 26

iron and ciproflox

Answer 26

oral iron decreases exposure to oral ciproflox
separate admin by 2 hours

Question 27

tendon pain and swelling with fluoroquinolone often begins in the…
if this happens, …..

Answer 27

ankle or calf
rest the painful area until you can see your doctor

Question 28

which group of pt have higher risk of SE and therefore should be used with caution

Answer 28

over 60
kidney damage
organ transplant

Question 29

ofloxacin label

Answer 29

• protect skin from sunlight
• space doses evenly
• no indigestion remedies, zinc, iron, 2 hr before or after

Question 30

oral antacids decrease absorption of oral ofloxacin. separate by

Answer 30

2h before
4 hours after antacids

Question 31

MOA and bacteristatic or bactericidal

Answer 31

bactericidal
inhibit bacterial DNA replication by binding to and forming complexes with two bacterial enzymes

Question 32

nephrotoxic or hepatotoxic?

Answer 32

hepatotoxic

Question 33

summarise the interactions they have

Answer 33

NSAIDs - increased risk seizures
Coumarins - increase INR, bleeding increased
Antacids - decrease absorption of the abx. take abx 2h before or 4h before
Iron and zinc - decrease absorption of abx, take it 2h before or after