fluoroquinolones Flashcards Preview

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Flashcards in fluoroquinolones Deck (29):
1

Ciprofloxacin (CIPRO)

oral, IV, ophthalmic

2

Levofloxacin (LEVAQUIN)

oral, IV, ophthalmic

3

Moxifloxacin (AVELOX)

oral, IV

4

Early fluoroquinolones are largely ?? in spectrum, while subsequent generations widen to include more ??

G-
G+s, anaerobes, and some atypicals such as Mycobacterium

5

MOA: FQs target ??

two DNA synthesis enzymes: DNA gyrase and DNA topoisomerase IV
-fix supercoiling that results from the unwinding of helical strands necessary for replication (so this is inhibited in bacteria)

6

FQs selective for bacteria??

Eukaryotes lack DNA gyrase, but do possess a topoisomerase II that is vaguely similar to bacterial topoisomerase IV (only affected by extremely high FQ concentrations)

7

?? appears to be the more important target in G-s

while in G+s ?? is more important.

Fluoroquinolones accumulate rapidly inside bacteria via ??

DNA gyrase

topoisomerase IV

porins

8

incorporation of ?? improves lipid solubility and bacterial accumulation, and also increases affinity for the DNA enzymes

fluorine atoms

9

FQ absorption: good or bad???

good to excellent
inhibited by polyvalent cations typical of antacid and supplement formulations, including *calcium, magnesium, aluminum, iron and zinc*

10

Fluoroquinolones distribute widely and penetrate many tissues and fluids. They exceed serum concentration in ??. Penetration to ?? is lower but still effective.
not regularly used for ?? in part because ??.

macrophages, neutrophils, kidney, urine, prostate, lung, stool, and bile

bone and prostatic fluid

CNS infections, CSF accumulation is unreliable

11

FQ half-life ??
how cleared??

which one depends on hepatic metabolism, so use with caution in hepatic failure??

3-10 hrs.
cleared by renal mechanisms (dosage adjustment in renal impairment)

Moxifloxacin

12

FQ uses: GU tract infections

-UTIs and bacterial prostatitis; *E. coli is the most common pathogen in both*
-Chlamydial trachomatis and chancroid resulting from Haemophilus ducreyi.
NOT used:
-Treponema pallidum however is unaffected
-N. gonorrhoeae is v. commonly resistant (use ceftriaxone)

13

FQ uses: diarrhea caused by

Salmonella typhi, Shigella species, and E. coli.

14

respiratory FQs??
effective against pneumonia-causing pathogens including ??

levofloxacin, moxifloxacin, and gemifloxacin
G+: S. pneumo, S. aureus
atypicals: Mycoplasma pneumoniae and Legionella pneumophila
(prominent but not necessarily first-line role in tx CAP in adults, less in HCAP, and in kiddos)

15

Oral ?? is also used for Pseudomonas aeruginosa in cystic fibrosis and, despite growing resistance

ciprofloxacin

*FQs are the only abx class with oral formulations that are reliably active against Pseudomonas*

16

Among FQs ?? is the best choice for anaerobic infection.

moxifloxacin

In a trial of patients with complicated intra-abdominal infections, moxifloxacin outcomes were comparable to piperacillin-tazobactam or amoxicillin-clavulanate

17

FQs also used in ??

bone, joint and soft tissue infections, including chronic osteomyelitis and diabetic foot infections.

18

FQs can be used in atypical scenarios, including ??

multidrug treatment of TB and Mycobacterium avium in AIDS patients.
-infections caused by Francisella tularensis and Anthraces bacillus

19

Resistance to FQs: quick and widespread
most rapidly developing resistance results from ??

plasmid factors:
-Quinolone resistance (Qnr) proteins that protect bacterial DNA gyrase
-production of an aminoglycoside acetyltransferase that can also modify ciprofloxacin, yielding cross-resistance
-efflux pumps

20

Resistance to FQs can also occur via ??

chromosomal point mutations in the quinolone binding site.

21

Cross-resistance to FQs and other agents is common: For example ??

Enterobacter spp and Kleb are often resistant to both FQs and beta-lactams

22

FQs used to tx MRSA??

NO!
resistance in MRSA is widespread, and even in isolates that are initially FQ-sensitive, resistance is very likely to emerge during the course of tx
FQ resistance is also a concern in Pseudomonas?

23

SEs that caused FQ withdrawal

highest offender??

QT prolongation, hypoglycemia, immune hemolytic anemia, hepatotoxicity, and phototoxicity

moxifloxacin

24

most common FQ SE

GI disturbance, upwards of 20% of patients experiencing N/V/D
usually mild, one of the most common causes of C. diff colitis (selection for v. toxic strain)

25

about 10% of patients receiving FQs experience ??

CNS disturbances: ha, dizzy (hallucinations, delirium, seizures- rare)

epileptogenic: displacement of GABA from its receptors, can be exacerbated by theophylline and NSAIDs

26

FQs: 2 boxed warnings!!

-Achilles tendon rupture, especially in the elderly, in patients receiving corticosteroids, and those with organ transplants (can be used in kids, but typ. avoided)
-NM blocking and exacerbation of myasthenia gravis

27

FQs: safe for pregnancy??

No, pregnancy category C: associated with etabolic acidosis and hemolytic anemia in pregnancy

28

Up to about 2% of pts taking FQs experience ??

rash or sensitivity reactions.

-FQs also assoc. w. with peripheral neuropathy

29

take care when combining FQs with other drugs that cause Q-T prolongation including ??

?? can exacerbate the seizure-inducing potential of FQs

SSRIs, tricyclic antidepressants (TCAs), antipsychotics and diuretics


NSAIDs and theophylline