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Pharm Exam 4 > Quinolones and UT Antiseptics > Flashcards

Quinolones and UT Antiseptics Flashcards

1
Q

T or F: Fluoroquinolones are a natural product.

A

False: they are totally synthetic

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2
Q

What spectrum are Fluoroquinolones?

A

Broad spectrum

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3
Q

Fluoroquinolone’s are structurally related to which drug?

A

Nalidixic acid

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4
Q

What are Quinolones used for?

A

Used to treat UTI’s Gram (-)

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5
Q

Which quinolone has the widest clinical application?

A

Ciprofloxacin

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6
Q

What is the 1st gen Quinolone?

A

Nalidixic acid

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7
Q

What are the 2nd gen Quinolones?

A
  1. Ciprofloxacin
  2. Noxacin
  3. Lomefloxacin
  4. Norfloxacin
  5. Ofloxacin
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8
Q

What are the 3rd gen Quinolones?

A
  1. Gatifloxacin
  2. Levofloxacin
  3. Sparfloxacin
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9
Q

What are the 4th gen Quinolones?

A
  1. Moxifloxacin

2. Trovafloxacin

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10
Q

How is Ciprofloxacin administered?

A

PO/IV

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11
Q

How is Enoxacin administered?

A

PO

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12
Q

How is Lomefloxacin administered?

A

PO

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13
Q

How is Ofloxacin administered?

A

PO/IV

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14
Q

How is Norfloxacin administered?

A

PO

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15
Q

How is Gatifloxacin administered?

A

PO/IV

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16
Q

How is Levofloxacin administered?

A

PO/IV

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17
Q

How is Sparfloxacin administered?

A

PO

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18
Q

How is Moxifloxacin administered?

A

PO

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19
Q

How is Trovaloxacin administered?

A

PO/IV

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20
Q

What is the MOA of the quinolones?

A

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

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21
Q

How do the quinolones enter the bacterial cell?

A

by diffusion via porins

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22
Q

What does DNA gyrase do?

A

topoisomerase ii

necessary for proper coiling of DNA

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23
Q

What does topoisomerase IV do?

A

affects replicating cells

24
Q

Are quinolones CIDAL or STATIC?

A

CIDAL

25
Q

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

A

False: Quinolones do NOT treat syphilis

26
Q

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

A

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
27
Q

What is the 4th generation Quinolones used to treat?

A

effective against anaerobes and gram (+)

28
Q

Most of the Quinolones are administered how?

A

orally but some are IV

29
Q

What type of medication can interfere with the Quinolone absorption?

A

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

30
Q

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

A

Ofloxacin

31
Q

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

A

True

Fluoroquinolone’s are useful in treating intracellular bugs

32
Q

How are the Fluoroquinolones excreted?

A

Kidney some are also hepatic

33
Q

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

A

False; they are NOT safe to use in renal damage

34
Q

What are some adverse rxns to the quinolones?

A
  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)
35
Q

What are some contraindications for the Quinolones?

A

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

36
Q

What are some drug interactions with Quinolones?

A 
Theophylline,    
warfarin,    
caffeine, 
cyclosporine,    
Cimetidine inh Fluoroquinolone elimination

Moxifloxacins prolong QT interval – Contraindicated in patients with Dysrhythmias!!!

37
Q

What are some therapeutic uses for the Quinolones?

A
  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
38
Q

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

A

E. coli

39
Q

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

A

Staphylococcus saprophyticus

40
Q

What are some other causes of uncomplicated cystitis & pyelonephritis?

A

Klebsiella pneumoniae

Proteus mirabilis

41
Q

What is the MOA of Methenamine?

A

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

42
Q

What is Methenamine used for?

A

Used for chronic suppressive therapy of cystitis, not upper UTI

43
Q

Which bug is “resistant” to Methenamine? And how?

A

Proteus is resistant as it makes urine basic

44
Q

What are the contraindications for Methenamine?

A

hepatic insufficiency:

  • Liver converts ammonium into urea
  • ammonia toxicity in CNS
45
Q

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

A

Nope.

46
Q

What is Nitrofurantoin used for?

A

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

47
Q

What is Nitrofurantoin, CIDAL or STATIC ?

A

static

48
Q

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

A

False: Nitrofurantoin is less commonly used due to its toxicity

49
Q

What kind of spectrum is Nitrofurantoin ?

A

Narrow

50
Q

How is Nitrofurantoin absorbed?

A

Orally

51
Q

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

A

Nitrofurantoin

52
Q

What are some adverse effects of Nitrofurantoin?

A 
GI disturbance – take with food/milk
Acute pneumonitis – interstitial pulmonary fibrosis- very bad!!
Hemolytic anemia
Agranulocytosis
Hepatotoxic,  pancreatitis
53
Q

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

A

TMP/SMX (Bactrim) – 1 po BID x3d

Fluoroquinolone po x 3d

54
Q

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

A

doxycycline, azithromycin

55
Q

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

A

eradicate infection, then Bactrim 1 po qd long term

Pharm Exam 4 (10 decks)

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