Lecture Notes: Fluoroquinolones
Overview
- Fluoroquinolones: Also known as quinolones, are antibiotics effective against both gram-negative and gram-positive bacteria.
Gram-Negative Bacteria Targeted
- Hemophilus influenzae: Causes epiglottitis and respiratory infections.
- Neisseria gonorrhea: Causes gonorrhea.
- Chlamydia
- E. coli
- Klebsiella pneumoniae
- Salmonella
- Pseudomonas aeraginosa
Gram-Positive Bacteria Targeted
- Streptococcus pneumoniae: Especially by newer quinolones.
- Enterococcus
- Staphylococcus aureus
Infections Treated
- Urinary tract infections
- Skin infections
- Respiratory infections
- Sexually transmitted infections
- Abdominal, joint, and bone infections
Administration
- Typically administered orally due to good absorption in the gut.
- Can also be given parenterally if needed.
Identification
- Look for the suffix "floxacin" in the generic name to identify a fluoroquinolone.
- Examples include:
- Ofloxacin, Norfloxacin, Ciprofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin, and Delafloxacin.
Mechanism of Action
- Fluoroquinolones have a bactericidal effect, killing bacteria.
- They inhibit bacterial DNA replication by targeting two enzymes:
- DNA Gyrase
- Topoisomerase IV
DNA Replication Disruption
- Gram-Negative: Targets DNA gyrase to disrupt supercoiling.
- Gram-Positive: Inhibits topoisomerase IV, preventing daughter DNA strand separation.
Nurse's Role
- Check for patient allergies before administration.
- Assess effectiveness of the medication.
- Monitor temperature, white blood cell count, and vital signs for symptoms of infection or septic shock.
Patient Education and Monitoring
- Fluid Intake: Prevent crystaluria, especially with ciprofloxacin. Ensure at least 2 liters of fluid daily.
- Long QT Interval: Monitor ECG for QT interval prolongation.
- Older Adults: Risk of tendon inflammation or rupture, especially with Achilles tendon.
- Cation Interactions: Avoid antacids, vitamins, and dairy products around administration times.
- Children and Pregnancy: Avoid use due to risk of bone and cartilage problems.
- C. diff Monitoring: Watch for symptoms of superinfection in the gut.
- Drug Interactions: Be cautious with caffeine, phenytoin, warfarin, theophylline, and amiodarone.
- Neuromuscular Exacerbation: Monitor patients with myasthenia gravis.
- Sun Sensitivity: Educate on skin protection from sunlight.
Note: Use the free quiz provided in the video description to test your knowledge on fluoroquinolones.