T3-Fluoroquinolones

Question 1

What is the MOA of fluoroquinolone?

Answer 1

Block the enzymes of bacterial cells (mess up the bacteria’s DNA). Those enzymes are needed for DNA replication and cell division

Note: Humans have these enzymes, but they are a little different; our DNA/enzymes are not affected by the antibiotic

Question 2

What are the two enzymes that are affected by fluoroquinolone?

Answer 2

DNA gyrase

Topoisomerase IV

Question 3

What are the major fluoroquinolone?

Answer 3

Ciprofloxacin
Levofloxacin
Moxifloxacin

Question 4

What are the four common uses for fluoroquinolone?

Answer 4

Travelers Diarrhea
UTIs (complicated: fever, chills)
Respiratory infections
Anthrax (give cipro, even for a child)

Question 5

What is travelers diarrhea and what fluoroquinolone do we give for it?

Answer 5

When you forget not to drink the water in foreign places; give ciprofloxacin

Question 6

What kind of UTIs are fluoroquinolone given for? What drug specifically?

Answer 6

Complicated UTIs (fever, chills, etc)
Give cipro!

Question 7

What respiratory infections would we give a fluoroquinolone for? What specific fluoroquinolone would we give?

Answer 7

Pneumonias and bacterial sinusitises; give Levofloxacin or moxifloxacin can treat pneumonias and bacterial sinusitises

Question 8

What are the COMMON adverse effects with fluoroquinolones?

Answer 8

GI upset
Photosensitivity
Altered mental status (older adults)

Question 9

COMMON adverse effects: Do all antibiotics cause GI upset?

Answer 9

Yes

Question 10

COMMON adverse effects: Photosensitivity- what happens if there is a reaction to sunlight?

Answer 10

STOP DRUG and CALL DOC

Question 11

COMMON adverse effects: Altered mental status-explain what happens?

Answer 11

This is in older adults and it isn’t super common but is significant enough to be in COMMON adverse effects. The altered mental status can involve CONFUSION and HALLUCINATIONS

Question 12

What are the RARE adverse effects of fluoroquinolone?

Answer 12

QT prolongation
Seizures
Peripheral neuropathy
Superinfection
Tendon rupture

Question 13

RARE adverse effects: Why can fluoroquinolone cause seizures?

Answer 13

The drug decreases the seizure threshold

Question 14

RARE adverse effects: What happens with peripheral neuropathy? Should we call the doc?

Answer 14

Tingling, numbness-this is A BIG DEAL. CALL THE DOC!!!

Question 15

RARE adverse effects: What kind of superinfection may be caused?

Answer 15

C. diff!

*Clidamycin and 3rd generation cephalosporins can also cause C. diff!!!

Question 16

RARE adverse effects: What tendon is usually affected? Can all tendons be affected? Who are most at risk? Who should avoid and why?

Answer 16

• Achilles
• Yes
• Most at risk: >60 year old, people taking corticosteroids, people with an organ transplant (prob bc they are taking steroids too)
• Preg. women and children (bc they are still forming their tendons and joints)

Question 17

Fluoroquinolones have a RARE adverse effect of tendon rupture, especially in children since they are still forming their tendons and joints. What are the exceptions for giving a fluoroquinolone for children and which one specifically?

Answer 17

Exceptions: If child has a COMPLICATED UTI or if the child has anthrax (the benefits outweigh the risk–the risk of this is 1 in 10,000 people)
Give CIPRO!

Question 18

What are the food/drug interactions that occur with fluoroquinolone?

Answer 18

Don't take with:
Ca2+ (milk or milk products, supplements)
Fe3+ (iron) (supplements)
Mg+2 (laxatives)
Al+3 (antacids)
Zn+2

Question 19

If a patient must take one of those cationic compounds, when should they take it in relation to the fluoroquinolone?

Answer 19

Cationic compounds 6 hours before the Fluor. OR 2 hours after they take their Fluor.

It is best to take the Fluor. first, then 2 hours later take the cationic compound!

Question 20

What is the client education regarding fluoroquinolone?

Answer 20

1. Avoid direct sunlight
2. Report unexplained joint pain
3. Avoid dairy products, antacids
4. Complete the whole course
5. Call the doc. if you don’t get better!

Question 21

What should we teach about avoiding direct sunlight?

Answer 21

Avoid direct sunlight, cover up, wear sunscreen!

If you have a reaction, CALL THE DOC

Question 22

What should we teach our client if the report unexplained joint pain and they are waiting to be seen by the doc (i.e their appt. is in 3 days)?

Answer 22

DON’T GO RUNNING, the unexplained joint pain may be due to the tendon being close to rupturing!

Question 23

We should teach our patients to avoid dairy products and antacids for the time being. But if they must take them, they should space them out. What is the best option?

Answer 23

Take the fluoroquinolone first!! Then wait 2 hours before taking the supplement! (taking them together or not spacing them out enough will cause NEITHER drug to be absorbed!)

Question 24

T/F. The patient needs to complete the entire course of the antibiotic–even if they start feeling better.

Answer 24

TRUE

Question 25

When do you STOP the drug and call the doc with fluoroquinolones? (4)

Answer 25

• Reaction to sunlight
• Unexplained joint pain
• Numbness/tingling in periphery
• If you aren’t feeling better after being on the antibiotic for a few days!