Antimicrobials: Fluoroquinolones

Question 1

Fluoroquinolone drugs (3)

Answer 1

ciprofloxacin
levofloxacin
moxifloxacin

Question 2

MoA of fluoroquinolones

Answer 2

inhibits DNA gyros, thus inhibiting bacterial DNA synthesis which results in breakage of bacterial DNA

Question 3

fluoroquinolones as a group are active against

Answer 3

gram neg aerobes including psuedomonas

gram pos aerobes

Question 4

psuedomonas coverage in fluoroquinolones, in order of most effective to least

Answer 4

cipro > levo > moxi (no appreciable cvg)

Question 5

fluoroquinolone activity against gram positive aerobe: staph

Answer 5

good against MSSA

bad against MRSA

Question 6

fluoroquinolone against gram positive aerobe: strep

Answer 6

Moxi and Levo > Cipro

Question 7

Fluoroquinolone activity against gram negative anaerobes

Answer 7

some cvg from moxifloxacin, otherwise no.

Question 8

gram neg cvg: fluoroquinolones

Answer 8

cipro

Question 9

gram pos cvg: fluoroquinolones

Answer 9

moxi

Question 10

gram pos/neg cvg: fluoroquinolone

Answer 10

levo

Question 11

levofloxacin

Answer 11

most broad of the fluoroquinolones.

some pseudo
some strep
some staph

Question 12

fluoroquinolones: bone penetration

Answer 12

good, especially cipro/levo

Question 13

fluoroquinolones: respiratory

Answer 13

moxifloxacin is best, has great cvg against atypical pathogens of pneumonia

Question 14

which 2 fluoroquinolones are better for atypical pathogens of pneumonia

Answer 14

moxi

levo

Question 15

which fluoroquinolone for “below the waist”

bone, uti

Answer 15

cipro

Question 16

which fluoroquinolone for respiratory, head/neck?

Answer 16

moxi

Question 17

fluoroquinolones have activity against Staph and Strep but

Answer 17

they wouldn’t be your first line choices for these.

Question 18

bioavailability of PO levo

Answer 18

100%

Question 19

PO bioavailability of fluoroquinolones

Answer 19

excellent

Question 20

fluoroquinolones like cipro and levo are the only PO agents available to treat _____

Answer 20

psuedomonas

Question 21

we are starting to see resistance from S. pneumonia to

Answer 21

fluoroquinolones: levofloxacin.

Question 22

fluoroquinolones exhibit concentration dependent killing. What does this mean?

Answer 22

we need higher concs of the drug so we can dose less frequently

Question 23

fluoroquinolones adverse events: MSK

Answer 23

arthropathy with cartilage erosion, and potentially achilles tendon rupture.

Question 24

fluoroquinolones AEs: liver

Answer 24

transient increase in LFTs

potential hepatotoxicity

Question 25

fluoroquinolones AE: cardiac

Answer 25

QTc prolongation, risk for torsades.

Question 26

existing QTc prolongation in a patient who needs fluoroquinolones

Answer 26

be cautious, especially with moxifloxacin.

Question 27

distribution of fluoroquinolones

Answer 27

just about everywhere, especially levofloxacin.

Question 28

t 1/2 fluoroquinolones

Answer 28

variable: 3-20 hours.

Question 29

dosing of fluoroquinolones

Answer 29

1 - 3x day

Question 30

fluoroquinolones and renal impairment

Answer 30

dose adjust

Question 31

patient education for PO fluoroquinolones

Answer 31

avoid taking with dairy and antacids for a 2-4 hour window.

Question 32

fluoroquinolones monitoring

Answer 32

C&S CBC RFT

Question 33

fluoroquinolones pregnancy/lactation

Answer 33

contraindicated in pregnant women.

Question 34

fluoroquinolones: pediatric considerations

Answer 34

use with extreme caution because of growth issues.

Question 35

fluoroquinolones: geriatrics

Answer 35

watch for tendon rupture | watch for antacid use

Question 36

fluoroquinolones: critically ill

Answer 36

watch for QT prolongation with multiple concurrent drugs

Question 37

fluoroquinolones: renal impairment

Answer 37

dose adjustment needed for cipro, not moxi.

Question 38

fluoroquinolones: hepatic impairment

Answer 38

watch for QT prolongation in hepatic dysfunction