hey everyone it's the Earth registered nurse rn.com and in this video I'm going to be covering fluoroquinolones so let's get started fluoroquinolones also known as quinolones for short are a group of antibiotics that are really good at targeting gram negative and gram-positive bacteria so some of the gram-negative bacteria can Target includes hemophilus influenzae which is a cause of epiglottitis in young children and other respiratory infections it can also Target nyseria gonorrhea which causes gonorrhea chlamydia E coli klebsiella pneumoniae salmonella and pseudomonas araginosa the gram-positive bacteria that this group targets includes streptococcus pneumoniae especially the newer quinolones and this includes the ones that have the little pink star beside of them which we're going to go over here in a moment and enterococcus and staphylococcus aureus now because quinolones can treat a wide variety of bacteria they're really good at treating cases of urinary tract in infections skin infections respiratory infections sexually transmitted infections and then infections that affect the abdomen joint and Bones now let's talk about how quinolones are administered and how you can identify if your patients taking a quinolone so typically these medications are given orally because they're absorbed very well in the gut but we can also give them parentally if we need to so for identification purposes whenever you're looking at your patient's medication list they tell you they're on an antibiotic this is the name how can you tell that this is a fluoroquinolone well remember the word floxacin and that is what you're going to find in that generic name of this group of antibiotics so we're talking about fluoroquinolone which begins with FL and we're talking about remember floxacin and notice FL is in all of those so if you can remember floxacin you're dealing with fluoroquinolones try to make that connection in your mind and you'll just never forget it so some of these medications include o floxacin norfloxacin ciprofloxacin Gemma walks Us in levofloxacin and this was my favorite one to say it's moxifloxacin and delafloxacin and then here as I pointed out earlier these ones with the pink little stars these are the newer ones in this group so now let's talk about how this group of antibiotics Works to treat bacterial infections so with fluoroquinolones what they do is they have a bacterial subtle effect on the bacteria meaning that they actually kill these bacteria instead of having a bacteriostatic effect like some of the other antibiotics we've talked about in this series where they inhibit its growth or reproduction instead these just kill them dead they're they're not going to fool around so how they do this is that they inhibit the bacteria's DNA replication process and bacteria knows in order for it to continue surviving in its environment it has to make copies of itself so how it does this is it makes copies of its DNA and remember DNA is like the instruction manual for a living organism it tell that organism how to function how to reproduce and survive so it has to make copies of this and there's many enzymes that play a role in this replication process and fluoroquinolones Target two particular enzymes that I want you to remember one enzyme is called DNA gyrase and then the other type is topoisomerase IV so to help us understand how quit alone's work let's first simplify the process of how this bacteria undergoes DNA replication hence makes copies of itself and then talk about how fluoroquinolones come along and disrupt some of this process and in the end kills our bacteria so here whenever we have double strand DNA it looks similar to this we have one strand here and then we have another strand here it's like wrapped around itself well in order to replicate hence make copies of itself those strands have to separate so we can get some copies made so in order to do this an enzyme comes in called helicase and separates these strands so you have one hanging out here and one hanging out there then what comes behind that is another enzyme called DNA polymerase it comes in and makes copies so it slides up and down this Strand and makes a beautiful copy here and then makes another beautiful copy here now as this was happening this other part of the Strand that wasn't separated has started to in a sense get tightly wound around itself we call this it's become super coiled now we need to alleviate this super coiledness of this strand because we need these parts to fold over so we can continue with this replication process so an enzyme is going to come in called DNA gyrase and it's going to help alleviate this tightness this super coil that's happened so how it does is it's going to like slice and reconnect parts of it it loosens it up so once we have the role of DNA gyrase complete these newly copied daughter DNA strands are going to fold over now as they fold over we have the beautiful copies but there's a problem they're still connected and they need to separate so they can go on do their own thing and make more bacteria so we need them to separate in order to separate the enzyme topoisomerase 4 is going to come in and it separates it so when we throw on a fluoro quinolone it can disrupt this process and how it does this it really depends on if we're dealing with a gram-negative bacteria or a gram-posa bacteria so if we're dealing with gram-negative it mainly goes after the DNA gyrase enzyme so it's going to disrupt how this strand is able to not be super coiled so if we can prevent this process of it helping the super coiled part of the DNA strand we're going to prevent it from being able to go further in this replication process hence killing our bacteria now if we're dealing with a gram-positive Act area and mainly wants to inhibit this topoisomerase IV so it's going to prevent these daughter DNA strands from separating from itself they can't separate we can't get DNA replication hence we get dead bacteria now let's talk about the nurse's role for administering quinolones so before you administer you want to just confirm your patient is not allergic to this medication and then during Administration you want to make sure that this medication is being effective is it actually treating your patient and are they getting better for instance how are their temperatures are they hypo or hyperthermic that's not good how's their white blood cell count is it normal or is it really elevated remember a normal white blood cell count is anywhere between five to ten thousand also how do they look how's their Vital Signs is their blood pressure really low are they hypotensive are they tachycardic are they having mental status changes breathing problems all this could indicate that your patient may be experiencing septic shock talk so you want to monitor for those things now in addition to that you want to make sure you also know things to educate your patient about and things you need to watch out for in your patient whenever they're taking these medications so to help us remember those main Concepts we're going to remember the mnemonic floxacens F is for fluid intake to prevent Crystal urea and this can especially happen with ciprofloxacin so you want to educate the patient to take this with at least eight ounces of water and to drink fluids throughout the day because we want to prevent crystals from developing within the urinary system because with Crystal urea this can happen whenever the urine becomes too alkaline and if we get the development of crystals it can cause a blockage in the kidneys and it could lead to renal failure so as the nurse you want to make sure you're monitoring your patient's hydration status so if it's not contraindicated they need at least two liters of fluid per day and you want to be monitoring that urinary output now as a side note whenever you're studying the other antibiotics this is also a teaching point with the sulfonamides as well the crystal urea L is for Long QT interval so quinolones can prolong the QT interval and whenever this happens it can lead to a lethal Rhythm called torsoids to plant and there's an increased risk of the patient getting a prolonged QT interval if they're taking aquinolone along with another medication that prolongs the QT interval like an antiarhythmic like amioderm so as a nurse you want to be looking at that ECG measuring that QT interval making sure it falls within normal limits O is for older adults 60 or older because they are at risk for tendon inflammation and rupture especially with the Achilles tendon being involved so you want to educate the patient to immediately report any pain swelling or like this snap feeling or immobility that they may be experiencing around a tendon now this is particularly important if your patient is taking corticosteroids or they have a history of diabetes or renal issues because there is a more increased chance of this happening in that older adult and then X is for don't administer with medications that contain cations like calcium zinc iron magnesium and aluminum now these are Big ingredients in antacids and vitamins and you also don't want to give this with dairy products like milk cheese or yogurt because all of these can actually decrease the absorption of oral quinolones so as a nurse you want to remember to administer oral quinolones two hours before or after meals and administer oral quinolone six hours after administering antacids or vitamins containing the ingredients I just went over or two hours before an antacid by doing this this will help decrease the risk of altering the absorption of that quinolone a is to avoid quinolones in children and during pregnancy it's been found that quinolones can cause bone and cartilage problems in children and then C is for C diff this is actually a super infection that occurs in the gut that can happen from taking quinolones so you want to educate your patient and monitor your patient for any type of fever watery diarrhea or abdominal pain and if they do have this you want to report it to the physician who will order a culture of the stool to send it off to make sure the patient hasn't developed C diff and then there's eye for interactions you want to be familiar with the medications that could interfere with quinolone so the big ones are like caffeine phenytonin Warfarin Theophylline and amioderone then we have in for neuromuscular exacerbation so you really want to monitor patients who have myasthenia gravis because quinolones can actually make the condition worse so you'd want to be monitoring for muscle weakness and then lastly is s for sun sensitivity so quinolones can make this skin more susceptible to Burns and blistering from the sunlight's Rays so you want to educate the patient that this can happen while they're taking the medication and for several days afterward so they want to take measures to protect their skin whenever they're Outdoors so they don't get these adverse effects okay so that wraps up this video over quinolones and don't forget to access the free quiz in the YouTube description that will test your knowledge on this material