quinolones Flashcards
name 5
- ofloxacin
- levofloxacin
- ciprofloxacin
- moxifloxacin
- deflafloxacin
can you use in MRSA Infections
no as many staphylococci are resistant to quinolones
you see that a pt who takes meloxicam is prescribed levofloxacin for a UTI. is there an interaction or is this safe
NSAIDs increase the risk of seizures when given with quinolones. caution. severe interaction
interaction between NSAIDs and quinolones (systemic or inhalation)
increased risk of seizures in pt with or without a history of convulsions!
important safety advice re quinolones and convulsions
quinolones may induce convulsions in pt with or without a history of convulsions
taking NSAIDs at the same time may also induce them
quinolones safety advice re tendon damage
- 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
quinolones are associated with a risk of tendon damage. this risk is increased by the concomitant use of ….
CCs
MHRA Advice re quinolones and increased risk of aortic aneurysm and dissection
- 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
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
aortic aneurysm or dissection
MHRA advice - rare reports of disabling and potentially long lasting or irreversible SE
- 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
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
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
MHRA advice - small risk of heart valve regurgitation
- 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
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
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
MHRA advice - suicidal thoughts and behaviour
- 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
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.
risk of psychiatric disorders
refer to GP
stop and seek immediate medical advice if suicidal thoughts or behaviour
