Quinolones

Question 1

What are the quinolone drugs?

Answer 1

Ciprofloxacin, Levofloxacin, Moxifloxicin

Question 2

What is the MOA of the quinolones?

Answer 2

Inhibit DNA gyrase, inhibit topoisomerase IV. Quinolones trap or stabilize the enzyme-DNR complexes after strand breakage and before resealing DNA

Question 3

What gram positive organisms are quinolones effective against?

Answer 3

• In-vitro activity against S. aureus
• S. pneumonia: Levo/Moxi
• Enterococus: poor, may be effective for UTI

Question 4

What gram negative organisms are quinolones effective against?

Answer 4

• Enteric GNR’s: E. coli, Klebsiella, Proteus
• H. influenza
• P. aeruginose: Cipro/Levo

Question 5

True/False: Quinolones are not effective against atypical bacteria

Answer 5

False. quinolones are effective against atypical bacteria

Question 6

True/False: Quinolones are effective against mycobacterium bacteria

Answer 6

True

Question 7

Which quinolone is effective against anaerobes?

Answer 7

Moxifloaxin

Question 8

What UTI disorders are quinolones used for? Except which drug?

Answer 8

• Cystitis
• Pyelonephritis
• Prostatitis
NOT Moxifloaxin

Question 9

What GI/Abdominal Infections are quinolones used for?

Answer 9

• Traveler’s diarrhea

* Intra-abdominal infection: moxifloxacin alone, Cipro or Levo + Metronidazole

Question 10

What respiratory infections are quinolones used for?

Answer 10

• CAP: moxi/levo (activity against S. pneumoniae)
• HAP: cipro/levo (activity against P. aeruginosa); high dose
• Cystic fibrosis

Question 11

What bone and joint infections are quinolones used for?

Answer 11

• Osteomyelitis

* Prosthetic joint infection: retained joint: quinolone + rifampin

Question 12

True/false: quinolones are used to treat osteomyelitis?

Answer 12

True

Question 13

True/false: quinolones are used as an adjunct to treat MDR in pulmonary TB?

Answer 13

true

Question 14

What are the SE of quinolones?

Answer 14

o GI: usually mild; higher association with C. difficile than other agents
o Central nervous system: HA, dizziness, confusion
o Tendinitis, tendon rupture (rare)
• Risk increased in older patients, pts on steroids
o QT prolongation
• Moxifloxacin > cipro or levo
• Risk increased in patients:
o Receiving Class III or Class IA antiarrhythmics or other agents that prolong QT (erythromycin, haloperidol)
o With hypokalemia, hypomagnesemia, bradycardia

Question 15

What is the MOA of Metronidazole?

Answer 15

o Interacts with DNA to cause a loss of helical DNA structure and strand breakage resulting in inhibition of protein synthesis

Question 16

What organisms does metronidazole cover?

Answer 16

o	Anaerobes
•	B. fragilis
•	Clostridium including difficile
•	Note a good choice for Actinomyces
o	Trichomonas

Question 17

What are the clinical uses of metronidazole?

Answer 17

o C. difficile diarrhea
o Intra-abdominal infections in combination with other agents
o Surgical prophylaxis in colon surgery (with other agents)
o Trichomoniasis

Question 18

What are the SE of metronidazole?

Answer 18

o Metallic taste
o GI disturbances
o Peripheral neuropathy (long term use or high doses)
o Disulfiram reaction with alcohol