Quinolones and UT Antiseptics

Question 1

T or F: Fluoroquinolones are a natural product.

Answer 1

False: they are totally synthetic

Question 2

What spectrum are Fluoroquinolones?

Answer 2

Broad spectrum

Question 3

Fluoroquinolone’s are structurally related to which drug?

Answer 3

Nalidixic acid

Question 4

What are Quinolones used for?

Answer 4

Used to treat UTI’s Gram (-)

Question 5

Which quinolone has the widest clinical application?

Answer 5

Ciprofloxacin

Question 6

What is the 1st gen Quinolone?

Answer 6

Nalidixic acid

Question 7

What are the 2nd gen Quinolones?

Answer 7

1. Ciprofloxacin
2. Noxacin
3. Lomefloxacin
4. Norfloxacin
5. Ofloxacin

Question 8

What are the 3rd gen Quinolones?

Answer 8

1. Gatifloxacin
2. Levofloxacin
3. Sparfloxacin

Question 9

What are the 4th gen Quinolones?

Answer 9

1. Moxifloxacin

2. Trovafloxacin

Question 10

How is Ciprofloxacin administered?

Answer 10

PO/IV

Question 11

How is Enoxacin administered?

Answer 11

PO

Question 12

How is Lomefloxacin administered?

Answer 12

PO

Question 13

How is Ofloxacin administered?

Answer 13

PO/IV

Question 14

How is Norfloxacin administered?

Answer 14

PO

Question 15

How is Gatifloxacin administered?

Answer 15

PO/IV

Question 16

How is Levofloxacin administered?

Answer 16

PO/IV

Question 17

How is Sparfloxacin administered?

Answer 17

PO

Question 18

How is Moxifloxacin administered?

Answer 18

PO

Question 19

How is Trovaloxacin administered?

Answer 19

PO/IV

Question 20

What is the MOA of the quinolones?

Answer 20

Inhibit bacterial DNA replication by interfering with the action of DNA gyrase

Question 21

How do the quinolones enter the bacterial cell?

Answer 21

by diffusion via porins

Question 22

What does DNA gyrase do?

Answer 22

topoisomerase ii

necessary for proper coiling of DNA

Question 23

What does topoisomerase IV do?

Answer 23

affects replicating cells

Question 24

Are quinolones CIDAL or STATIC?

Answer 24

CIDAL

Question 25

T or F: Quinolones can be used an an alternate to syphillis.

Answer 25

False: Quinolones do NOT treat syphilis

Question 26

1-3rd generation Quinolones are used to treat what kind of spectrum?

Answer 26

Broad spectrum AEROBIC 1. Bacillus anthraces 2. Enterobacteria 3. Pseudomonas 4. Haemophilus influenza 5. Moraxella catarrhalis 6. Legionella 7. Chlamydia 8. Mycobacteria, except M. avium-intracellulare complex 9. Neisseria gonorrhea

Question 27

What is the 4th generation Quinolones used to treat?

Answer 27

effective against anaerobes and gram (+)

Question 28

Most of the Quinolones are administered how?

Answer 28

orally but some are IV

Question 29

What type of medication can interfere with the Quinolone absorption?

Answer 29

Sucralfate, antacids (Ca, Al, Mg) Fe, Zn

Question 30

All of the Fluoroquinolones do NOT penetrate into the CSF, except for which one?

Answer 30

Ofloxacin

Question 31

T or F: Fluoroquinolones are widely distributed in body tissues such as bone, urine, kidney, prostate, lung, PMNs and even macrophages.

Answer 31

True | Fluoroquinolone's are useful in treating intracellular bugs

Question 32

How are the Fluoroquinolones excreted?

Answer 32

Kidney some are also hepatic

Question 33

T or F: Quinolones are safe to use with renal damage.

Answer 33

False; they are NOT safe to use in renal damage

Question 34

What are some adverse rxns to the quinolones?

Answer 34

1. GI: Diarrhea, nausea 2. Phototoxicity, rash 3. CNS: Headache, dizziness, light-headedness 4. Achilles tendon rupture (especially elderly or on steroids) 5. Kidney: Crystalluria with alkaline urine (rare)

Question 35

What are some contraindications for the Quinolones?

Answer 35

CONTRAINDICATION PREGNANCY, LACTATION, < 18 y/o Concern for articular cartilage erosion???

Question 36

What are some drug interactions with Quinolones?

Answer 36

``` Theophylline, warfarin, caffeine, cyclosporine, Cimetidine inh Fluoroquinolone elimination ``` Moxifloxacins prolong QT interval – Contraindicated in patients with Dysrhythmias!!!

Question 37

What are some therapeutic uses for the Quinolones?

Answer 37

1. UTI & prostatitis 2. Respiratory Tract Infections 3. STDs – Gonorrhea NOT syphilis 4. GI infections – traveler’s diarrhea 5. Bone, joint, & soft tissue infections 6. Multi-drug resistant Tb & atypical Mycobacterial infections

Question 38

What are the most common causes of uncomplicated cystitis and pyelonephritis?

Answer 38

E. coli

Question 39

What are the second most common causes of uncomplicated cystitis and pyelonephritis?

Answer 39

Staphylococcus saprophyticus

Question 40

What are some other causes of uncomplicated cystitis & pyelonephritis?

Answer 40

Klebsiella pneumoniae | Proteus mirabilis

Question 41

What is the MOA of Methenamine?

Answer 41

In acid environment, Methenamine breaks down into formaldehyde and ammonium, which kills bugs

Question 42

What is Methenamine used for?

Answer 42

Used for chronic suppressive therapy of cystitis, not upper UTI

Question 43

Which bug is "resistant" to Methenamine? And how?

Answer 43

Proteus is resistant as it makes urine basic

Question 44

What are the contraindications for Methenamine?

Answer 44

hepatic insufficiency: - Liver converts ammonium into urea - ammonia toxicity in CNS

Question 45

Is it a smart choice to have a pt on a Sulfonamide and Methenamine simultaneously?

Answer 45

Nope.

Question 46

What is Nitrofurantoin used for?

Answer 46

UTIs for: E. coli Some gram (+) cocci

Question 47

What is Nitrofurantoin, CIDAL or STATIC ?

Answer 47

static

Question 48

T or F: Nitrofurantoin is used widely because it is known to have less toxic effects.

Answer 48

False: Nitrofurantoin is less commonly used due to its toxicity

Question 49

What kind of spectrum is Nitrofurantoin ?

Answer 49

Narrow

Question 50

How is Nitrofurantoin absorbed?

Answer 50

Orally

Question 51

A pt is complaining of brown urine, which agent is the likely cause?

Answer 51

Nitrofurantoin

Question 52

What are some adverse effects of Nitrofurantoin?

Answer 52

``` GI disturbance – take with food/milk Acute pneumonitis – interstitial pulmonary fibrosis- very bad!! Hemolytic anemia Agranulocytosis Hepatotoxic, pancreatitis ```

Question 53

What is the recommended treatment for those with an acute uncomplicated UTI?

Answer 53

TMP/SMX (Bactrim) – 1 po BID x3d | Fluoroquinolone po x 3d

Question 54

What is the treatment for a patient with a UTI with an STD risk?

Answer 54

doxycycline, azithromycin

Question 55

What is the treatment for a patient with a recurrent UTI?

Answer 55

eradicate infection, then Bactrim 1 po qd long term