Quinolones Flashcards
MOA of quinolones
- Avoid if MRSA
- Inhibits nucleic acid tf DNA synthesis (bactericidal)
- Broad spec
What is the indication of quinolones?
RTI
UTI
- MHRA: new restrictions, long term, irreversible side effects. Do not prescribe for non-severe or self limiting infections (uncomplicated lower UTI)
Give examples of quinolones
- Ciprofloxacin (BD)
- Levoflocaxin
- Moxiflocacin (most QT prolongation + life threatening hepatotoxicity)
What are the side effects of quinolones?
Tendon damage
- Caution: 60+, RI, organ transplants, Myasthenia gravis
- Counsel: STOP + seek medical attention if joint/tendon pain + swelling, muscle pain
- Avoid corticosteroids: causes muscle wasting + myopathy s/e
Peripheral neuropathy (pins + needles)
Aortic aneurysm
- MHRA: seek medical attention sudden severe abdominal, chest or back pain
Lower seizure threshold/induce convulsions
QT prolongation
- CI (moxifloxacin): hypokalaemia or concomitant drugs
Heart valve regurgitation
- MHRA: report dyspnoea, oedema, palpitation
Suicidal thoughts + behaviours
Hypersensitivity
Arthropathy (not in children)
Pregnancy + quinolones
Avoid
What are the counselling points of quinolones?
Reduced absorption
- Label: do not take indigestion remedies or medicines containing iron or zinc 2 hours before or after taking this medicine
- Label (cipro): do not take milk, indigestion remedies or medicines containing iron or zinc 2 hours before or after taking this medicine
Avoid sunlight during treatment + 48H after stopping
- Label (ofloxacin): protect your skin from sunlight - even on bright but cloudy day. Do not use sunbeds
Driving
What are the interactions of quinolones?
Cipro is an enzyme inhibitor
Cipro + theophylline/NSAIDs → INC seizures
Warfarin → bleed
Drugs that prolong QT interval → ventricular arrhythmias
Drugs that cause hypokaelaemia → INC risk of torsade de pointes
