University:
University of North Carolina at Chapel Hill
Course:
NURS 312 | Pharmacology
Academic year:

2020
Views:

152

Pages:

1
Author:

kundgetanufv

4.2 – “A N Nordic ordic Spring”: Fluor Fluoroquinolones oquinolones • Fluoroquinolones (Tiptoeing through the flowers). Mainly indicated in G- infections (red flowers). • Include ciprofloxacin, levofloxacin, moxifloxacin, delafloxacin. • Inhibit DNA topoisomerases, including DNA gyrase (unwinding braid). Inhibit normal transcription & replication, are therefore bactericidal. • Generally well absorbed when taken orally. Decreased by divalent & trivalent cations (trivalent medals). Should be administered a few hours before or after milk, antacids, and supplements. • Resistance can develop with mutations to the DNA gyrase, impaired influx, or increased efflux. • UTI & GI bug coverage o E.g. E. coli, proteus (red bladder cup) ▪ Uncomplicated UTIs usually treated with Bactrim or urinary agent like Fosfomycin or nitrofurantoin (in their own classes). o Fluoroquinolones are usually saved for complicated UTIs, e.g. h/o diabetes or urinary tract obstruction ▪ Levofloxacin & ciprofloxacin treat pseudomonas (e.g. nosocomial UTIs) (elevating and sipping from the glass) ▪ Levofloxacin & ciprofloxacin empiric treatment for pyelonephritis (polyurea) (milky kidney shaped flask) ▪ Treat acute prostatitis, and have good tissue permeation (kid pushing egg down man’s kilt) o Effective in treatment of G- gastroenteritis, including shigella, salmonella, E. coli, campylobacter (intestines on table with red flowers surrounding; salmon for salmonella; fish bone for G- osteomyelitis) ▪ Sickle cell patients specifically are high risk for osteomyelitis, especially from salmonella (Viking with a sickle) • G+ bugs o Bacillus anthracis → hemorrhagic & necrotizing PNA (bloody anthrax axe) o Levofloxacin & moxifloxacin are respiratory quinolones. Have improved activity against G+ particularly S. pneumoniae (rusty lung plate), H. influenzae. Used in treatment of both typical & atypical community acquired PNA (walking PNA) (snow-shoer), Legionella (legion of ships) • Adverse effects o Risk of prolonged QT interval (streamers) o N/V, diarrhea (guy looking nauseated at table) o Risk of tendon and cartilage damage, including tendon rupture in the elderly (old king gnawing on bones) & those on steroids (moon face). ▪ Damage to growing cartilage → arthropathy in fetal development and children under 10 yo (pregnant woman with tarantula sigil; kid gnawing on bones) ▪ Famous for Achilles tendonitis especially o Ciprofloxacin specifically can cause interstitial nephritis. o Fluoroquinolones have varying binding affinity for the CYP450 enzyme, with inhibitory effects. The order from most P450inhibitory to least, is enoxacin > ciprofloxacin > norfloxacin > ofloxacin, levofloxacin, trovafloxacin, gatifloxacin, moxifloxacin.