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Ama - Infections (Medications) > Quinolones > Flashcards

Quinolones Flashcards

1
Q

MoA

A

Inhibits DNA synthesis
Broad spectrum (active against gram+ and gram-)
Bactericidal

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2
Q

Indications

A

LRTIs
UTIs
AVOID in MRSA infections (innate resistance)

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3
Q

Examples

A

Ciprofloxacin
Ofloxacin
Levofloxacin
Moxifloxacin
Delafloxacin

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4
Q

Ciprofloxacin

A

Gram + and -
PARTICULARLY against gram - (salmonella, shigella, campylobacteria, Neisseria, pseudomonas)
Moderate activity against gram +
Active against chlamydia and some mycobacteria

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5
Q

Ciprofloxacin - indications

A

RTIs (not pneumococcal pneumonia)
Infections of GI systems (including typhoid)
Bone + joint infections
Gonorrhoea
Septicaemia

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6
Q

Ofloxacin

A

UTI
LRTI
Gonorrhoea
Non-gonococcal urethritis and cervicitis

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7
Q

Levofloxacin

A

Gram + and -
Greater activity against Pneumococci than ciprofloxacin.

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8
Q

Moxifloxacin

A

Gram + and -
Greater activity against gram +, including Pneumococci than ciprofloxacin
QT prolongation
Life threatening hepatotoxicity

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9
Q

Delafloxacin

A

Gram + (including MRSA) and -
Acute bacterial skin and skin structure infections (ABSSSI) when standard treatments are inappropriate

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10
Q

Side effects - severe

A

Seizures
Tendon damage
QT prolongation
Arthropathy

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11
Q

Side effects - common

A

GI disturbances
Headache
Dizziness

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12
Q

QT prolongation

A

Ventricular arrhythmias
ESPECIALLY moxifloxacin (C/I in risk factors for QT prolongation)

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13
Q

Risk factors for QT prolongation

A

Electrolyte disturbances
Acute MI
HF with reduced LVEF
Bradycardia
Congenital long QT syndrome
Concomitant QT prolongation drugs
Symptomatic arrhythmias

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14
Q

Arthropathy

A

Avoid in pregnancy, children + adolescents

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15
Q

DISCONTINUE if…

A

Psychiatric, neurological and hypersensitivity reactions occur

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16
Q

Interactions - QT prolongation

A

SSRI
Quinine
Amiodarone
Macrolide
Antipsychotics

17
Q

Increased risk of seizures

A

Ciprofloxacin + theophylline
Pk and Pd interaction
Ciprofloxacin is an enzyme inhibitor - causes theophylline toxicity
Theophilline SE = convulsions

18
Q

NSAIDs

A

Induces convulsions

19
Q

Counselling

A

Driving - can impair performance of skilled tasks; increased effect when taken with alcohol
Antacid and zinc/iron - 2 hours before or after taking
Milk - avoid milk with ciprofloxacin and norfloxacin
Protect skin from sunlight + avoid sunbeds

20
Q

MHRA warnings

A
  • Induces convulsions
  • Tendon damage
  • Small increased risk of aortic aneurysm and dissection
  • Restrictions + precautions for use due to reports of disabling, potentially long-lasting and irreversible side effects
  • Suicidal thoughts and behaviours
21
Q
A
21
Q

Induces convulsions

A

With or without a history of convulsions
Increased risk when taken with NSAIDs

22
Q

Tendon damage

A

Occurs within 48 hours of starting up to months after stopping.
Stop if tenditis is suspected
- C/I in patietns with a history of tendon disorders related to quinolone use.
- Patients over 60 (more prone)
- Risk of tendon damage increased with corticosteroid use

23
Q

Aneurysm

A

Small increased risk of aortic aneurysm + dissection
Factors that increase risk:
- FH of aneurysm disease
- Pre existing aortic aneurysm/aortic dissection
- Other risk factors predisposing to aortic aneurysm (e.g. hypertension + atherosclerosis)

24
Q

Restrictions + precautions for use

A

Restrictions and precautions for use due to reports of disabling, potentially long-lasting and irreversible side effects.
Counsel patients to report:
- Tenditis
- Tendon rupture
- Muscle weakenss
- Joint pain
- Swelling
- Peripheral neuropathy
- CNS side effects

25
Q

Small risk of heart valve regurgitation

A

Consider other therapeutic options first in those with:
- Congenital or pre-existing heart valve disease
- Connective tissue disorders
- Other risk factors predisposing to heart valve regurgitations (e.g. hypertension, RA, infective endocarditis)

26
Q

Suicidal thoughts and behaviours

A

Can occur after the first dose
Seek advice if this occurs

Ama - Infections (Medications) (14 decks)

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