Fluoroquinalones, Other ABX

Question 1

Are fluoroquinalones bacteriostatic or icidal?

Answer 1

Bactericidal

Question 2

Are Fluoroquinalones concentration or time dependent?

Answer 2

Concentration dependent

Question 3

What is fluoroquinolone’s MOA?

Answer 3

They inhibit protein synthesis by binding to DNA gyrase, inhibiting the relaxation of the supercoiled DNA, promoting breaking of the DNA strands

Question 4

Which fluoroquinolones cover pseudomonas?

Answer 4

Cipro, high dose levo, norfloxacin, and ofloxacin

Question 5

What is fluoroquinolones’ relationship with atypicals?

Answer 5

They provide good atypical coverage, ex. Mycoplasma pneumonia
- provide good intracellular penetration to atypicals

Question 6

What are the general uses for fluoroquinolones?

Answer 6

CAP, nosocomial pneumonia, acute sinusitis, complicated and uncomplicated UTIs (except not gemifloxacin and moxifloxacin), prostatitis, some soft tissue infections and osteo, Crohn’s, campylobacter, legionella, brucella, salmonella, mycobacterium
- cipro, levo, and ofloxacin for eyes
- ofloxacin for ears

Question 7

Is cipro a good choice for strep pneumonia?

Answer 7

No, cipro is generally not great for gram +

Question 8

Where are cipro’s SE?

Answer 8

GI, QT prolong, tendon rupture, increased seizure frequ, renal dose required
- CYP1A2 inhibitor

Question 9

Which fluoroquinolone is good for MRSA

Answer 9

Only Delafloxacin

Question 10

Which fluoroquinolones are not good for peds?

Answer 10

Norfloxacin, ofloxacin, moxifloxacin, and levo

Question 11

Which fluoroquinolone does not require renal dosing?

Answer 11

Moxifloxacin

Question 12

What pregnancy and lactation category are fluoroquinolones?

Answer 12

Category C, L3

Question 13

General Fluoroquinolone SE

Answer 13

QT prolong (mostly with other meds or if you have prolongation syndrome
- seizure risk, mostly related to taking cipro with NSAID and used off label
- tendon rupture if organ transplant and taking steroids, and over 60y

Question 14

Which fluoroquinolone is good for CF?

Answer 14

Cipro

Question 15

What are the mechanisms of resistance to fluoroquinolones?

Answer 15

• change the structure of the DNA gyrase
• reduced abx uptake by the bacteria

Question 16

Which fluoroquinolone eye drop does not have a preservative?

Answer 16

Moxifloxacin

Question 17

Which otic solution is not sterile?

Answer 17

Cipro 0.2% and hydrocortisone suspension, don’t use if tympanic membrane is ruptured

Question 18

Which otic solution is appropriate for acute otitis media externa from pseudomonas?

Answer 18

Cipro

Question 19

Do bi and tri valent cations interact with fluoroquinolones?

Answer 19

Yes, Ca, Fe AL, and Mg interact with them, reducing the bioavailability of abx

Question 20

What drug class is Daptomycin?

Answer 20

Cyclic Lipopeptide, a concentration dependent bactericidal against Gram +

Question 21

What is Daptomycin mainly used for?

Answer 21

Gram + MRSA of skin/soft tissue infections
- also vanc sensitive enterococcus, s. Aureus endocarditis

Question 22

Can Daptomycin be used for CAP

Answer 22

No. Broken down by surfactant

Question 23

What are the SE of Daptomycin?

Answer 23

Increased CK and myopathy, caution with statins, fibrates, colchicine

Question 24

What is the MOA of Trimethoprim/Sulfamethoxazole (TMP/SMX [Bactrim])?

Answer 24

Inhibits folic acid synthesis causing cell div to stop or slow, can cause bone marrow suppression and anemias dt cross over to effects on human cells

Question 25

What is TMP/SMX prescribed for?

Answer 25

Drug of choice for PJP/PCP* Only drug for ventilator associated Stenotrophomonas maltophilia* -otitis media, UTIs, travelers diarrhea, shigella, cholera, prostatitis, nocardiosis - Gram +: CA S. Aureus (MRSA), S. Epidermidis, S. Pneumoniae, S. pyogenes, s. Viridans - Gram -: H. Influenzae, enterobacteriaceae, salmonella, shigella - poor strep coverage

Question 26

What are the TMP/SMX SE?

Answer 26

-increased bili/kernicterus (avoid in last trimester and breastfeeding) - sulfa allergy (SJS) - Major inhibitor of CYP2C9 (will increase effects of warfarin) - renal dosing - avoid in G6PD - crystalluria - hyperkalemia (dt K sparing) - bone marrow suppression (TMP=Treats Marrow Poorly)

Question 27

What type of drug is Dapsone?

Answer 27

Bacteriostatic, Sulfone, similar in action to sulfonamides

Question 28

What is Dapsone used for?

Answer 28

Leprosy and alternative for PJP

Question 29

What are the SE for Dapsone?

Answer 29

Anemia and increased bili if G6PD, N/V, HAs, neuropathy

Question 30

What is the MOA of Nitrofurantoin (Macrobid, macrodantin)

Answer 30

Bactericidal, interferes will cell wall synthesis

Question 31

What is nitrofurantoin (macrobid) prescribed for?

Answer 31

Gram + and gram - UTIs

Question 32

What are the SE of nitrofurantoin (macrobid?)

Answer 32

Hemolytic anemia with G6PD(don’t give near term), caution with folate def, pulm tox with prolonged use, CNS effects, brownish urine, peripheral neuropathy, false + urine glucose, avoid with renal impairment since it needs to make to the urine for UTI treatment

Question 33

Fluuroquinalones are the ________ line treatment for chlamydia and epididymitis, the ______ line therapy for traveler’s diarrhea, and no longer recommended for __________.

Answer 33

First line treatment for chlamydia and epididymitis Second line therapy for diarrhea No longer rec for gonorrthea

Question 34

Which drug is a first line treatment for typhoid fever?

Answer 34

Cipro

Question 35

Linezoilid is what type of abx?

Answer 35

Oxazolidinones

Question 36

What is Linezolid used for?

Answer 36

Most effective against Gram +: -also includes gram - and anaeorbic - main ones are group A and B strep, S. Pneumoniae, E. Faecalis, E. Faecium, S. Aureus (both MSSA and MRSA), S. Epidermis is, C. Perfringens, Peptostreptococcus, Corynebacterium jeikeium, L. Monocytogenes, Enterococcus including VRE

Question 37

What are the contraindications and SE for Linezolid?

Answer 37

Contra: concomitant use with MAOI, SSRIs, tricyclics, QT prolonging meds - an cause serotonin syndrome, myelosupression, lactic acidosis, neuropathy, with long term use

Question 38

What is Linezolid typically used for?

Answer 38

Group A and B strep, , esp MRSA pneumonia as alternative to vanc, Vanc resistant Enterococcus faecium (VRE)

Question 39

Sulfonamides, TMP-SMZ, trimethoprim, nitrofurantoin, and fosfomycin can be used for what?

Answer 39

UTIs specifically cystitis -TMP-SMZ can also be used for community acquired MRSA

Question 40

Sulfanimides should be used cautiously in pts with which deficiency?

Answer 40

G6PD def and folate def Use cautiously w renal impairment Can also cause kernicterus, crystalluria unless urine alkaline and not enough water, TEN/SJS, hepatitis, photosens, increased K-, neuropathy, CNS changes, aseptic meningitis, increased QT -Preg D

Question 41

Trimethoprim should be used cautiously in pts with which deficiency?

Answer 41

Folate, renal impairment, pregnancy category C, although TMP-SMZ is Category D