fluoroquinolones

Question 1

MOA fluoroquinolones

Answer 1

inhibit DNA synthesis by inhibiting bacterial topoisomerase

Question 2

fluoroquinolones target this in G- bacteria

Answer 2

DNA gyrase

Question 3

fluoroquinolones target this in G+ bacteria

Answer 3

topoisomerase 4

Question 4

concentration or time dependent?

Answer 4

concentration

Question 5

bactericidal or bacteriostatic?

Answer 5

bactericidal

Question 6

3 mechanisms of resistance

Answer 6

decreased binding affinity
expression of active efflux pump
altered cell wall permeability

Question 7

has poor affinity against G+ aerobes

Answer 7

ciprofloxacin

Question 8

have enhanced activity against G+ aerobes

Answer 8

levofloxacin, moxifloxacin

Question 9

list of G+ aerobes that fluoroquinolones have activity against

Answer 9

MSSA

PRSP

Question 10

fluoroquinolones have limited activity against these G+…

Answer 10

viridians

enterococcus

Question 11

fluoroquinolones that have excellent activity against enterobacteriaceae

Answer 11

ciprofloxacin, levofloxacin

Question 12

which fluoroquinolone has best activity against P. aeruginosa?

Answer 12

ciprofloxacin

Question 13

which fluoroquinolones have no activity against P. aeruginosa?

Answer 13

moxifloxacin, gemifloxacin

Question 14

has some activity against anaerobes…

Answer 14

moxifloxacin

Question 15

given for prophylaxis with those at risk for (and has good activity against) anthrax infection

Answer 15

ciprofloxacin

Question 16

have activity against mycobacterium tuberculosis

Answer 16

levofloxacin and moxifloxacin

Question 17

PAE for G+ bacteria

Answer 17

2h

Question 18

PAE for G- bacteria

Answer 18

2-4h

Question 19

IV or PO?

Answer 19

PO (has good bioavailability)

Question 20

which fluoroquinolone achieves good penetration in the CNS?

Answer 20

moxifloxacin

Question 21

dosage adjustment with renal insufficiency?

Answer 21

yes

Question 22

fluoroquinolone that undergo hepatic metabolism and elimination

Answer 22

moxifloxacin

Question 23

use of fluoroquinolones for UTIs…

Answer 23

most fluoroquinolones accumulate in the urine for elimination, making them useful in treating UTIs
levofloxacin, ciprofloxacin…not gemifloxacin or moxifloxacin

Question 24

removed during hemodialysis?

Answer 24

none

Question 25

fluoroquinolones used in community acquired pneumonia

Answer 25

levofloxacin, moxifloxacin, gemifloxacin

Question 26

used in bacterial exacerbations in CF due to P. aeruginosa infections

Answer 26

ciprofloxacin

Question 27

used for acute chronic bronchitis and sinusitis

Answer 27

all fluoroquinolones

Question 28

anti pseudomonal fluoroquinolones used for nosocomial pneumonia

Answer 28

ciprofloxacin, levofloxacin

Question 29

used in bone/osteomyelitis infections

Answer 29

ciprofloxacin, levofloxacin, moxifloxacin

Question 30

used in intraabdominal infections (anaerobic bacterial)

Answer 30

ciprofloxacin, levofloxacin, moxifloxacin with metronidazole

Question 31

important adverse effects with fluoroquinolones: cardiac

Answer 31

can cause slight prolongation of QT interval, potentially leading to torsades contraindicated in hypokalemic patients or those with an already prolonged QT interval

Question 32

important adverse effects with fluoroquinolones: bone

Answer 32

can cause articular damage and joint swelling in children

Question 33

important adverse effects with fluoroquinolones: tendons

Answer 33

patient should avoid exercise if tendon pain develops while on therapy

Question 34

important drug interactions with fluoroquinolones

Answer 34

divalent/trivalent cations: will chelate any orally administered fluoroquinolone warfarin: fluoroquinolones enhances effect cyclosporine: metabolism may be inhibited with fluoroquinolones = potential toxicity

Question 35

fluoroquinolone action in the urine

Answer 35

achieve a high concentration in the urine (except for gemifloxacin and moxifloxacin), making them useful in treating UTIs

Question 36

removed during hemodialysis?

Answer 36

none