Fluoroquinolones

Question 1

What are 4 advantages to fluorinated quinolones?

Answer 1

1) broad spectrum of activity
2) excellent oral availability
3) tissue penetration
4) long half lives

Question 2

What is the MOA for fluoroquinoloines?

Answer 2

inhibit bacterial topoisomerase II (DNA gyrase) and V – blocks DNA replication

Question 3

___________ is the target for gram - bacteria while __________ is the target for gram +

Answer 3

topo II (gram-)
topo V (gram+)

Question 4

What are 4 MORs of fluoro?

Answer 4

1) altered target sites
2) expression of active efflux
3) altered cell wall permeability
4) cross resistance

Question 5

What is the older FQ?

Answer 5

ciprofloxacin

Question 6

What are the 2 newer ones?

Answer 6

levofloxacin

moxifloxacin

Question 7

What benefit do the new FQs have over the old ones?

Answer 7

expanded gram + coverage

cipro only for gram -

Question 8

What gram+ can newer FQs cover?

Answer 8

strep pneumo

Question 9

What is the ONE FQ that does not cover pseudomonas?

Answer 9

moxi

cipro and levo have comparable coverage there

Question 10

name the 4 atypical bacteria covered by FQs

Answer 10

1) legionella pneumophila (DOC)
2) chlamydophila
3) mycoplasma
4) ureaplasma

Question 11

FQs are __________ dependent killing

Answer 11

conc

Question 12

True or false: FQs have good bioavailbility after oral admin

Answer 12

TRUE

Question 13

Where are the primary sites of distribution?

Answer 13

lung, bone

urinary tract and prostate: cipro/levo

CSF: moxi

Question 14

How are FQs eliminated?

Answer 14

renally (cipro and levo)

hepatically (moxi)

Question 15

What are FQs most commonly used for?

Answer 15

respiratory tract infections

Question 16

What FQ cannot cover CA pneumo and why?

Answer 16

cipro (poor gram+ coverage)

but it CAN cover HA pneumo because that is pseudomonal

Question 17

What do you use for HA pneumo?

Answer 17

cipro and levo

Question 18

What drug do you use for exacerbations in cystic fibrosis?

Answer 18

cipro

Question 19

What 2 FQs do you use for UTIs?

Answer 19

cipro and levo

Question 20

Name 6 adverse effects of FQs

Answer 20

1) GI (nausea, vomiting)
2) CNS (headache)
3) hepatotoxicity
4) phototoxicity
5) cardiac (prolonged QT)
6) tendonitis

Question 21

Can you give FQs to kids? or pregnant women?

Answer 21

No (articular cartilage damage)

Question 22

What is a huge drug interaction shared by all PO FQs?

Answer 22

divalent and trivalent cations (impair absorption of orally administered FQs –> can lead to clinical failure)

(also all FQs interact with warfarin)

Question 23

What does cipro interact with specifically

Answer 23

theophylline and cyclosporine

Question 24

What is the gram NEG FQ?

Answer 24

cipro

Question 25

Which FQ best serves pseudomonas?

Answer 25

cipro

Question 26

What is the only FQ to serve anaerobes?

Answer 26

moxi

Question 27

What is the only FQ that cannot serve UTIs?

Answer 27

moxi

Question 28

What is metronidazole very useful against?

Answer 28

anaerobes

Question 29

What is the MOA of metronidazole?

Answer 29

inhibits DNA synthesis (prodrug activated in body via ferredoxins)

Question 30

What are 2 MORs for metronidazole?

Answer 30

1) altered growth requirements
2) altered ferredoxin levels

altogether uncommon resistance

Question 31

What are the 2 main anaerobes treated with metronidazole?

Answer 31

bacterides

clostridium

Question 32

True or false: metronidazole penetrates the CSF

Answer 32

true (PO and IV)

Question 33

How is metronidazole eliminated?

Answer 33

liver and HD

Question 34

What are 3 main uses for metronidazole?

Answer 34

1) anaerobic infections (intraab, pelvic, diabetic foot, decubitus ulcer, brain abscesses)
2) pseudomembraous colitis (C. diff)
3) trichomonas

Question 35

What is the DOC for c. diff?

Answer 35

metronidazole

Question 36

What are 3 adverse effects of metronidazole?

Answer 36

GI: stomatitis, metallic taste
CNS: peripheral neuropathy