Quinolones:

Fluoroquinolones
 Quinolones: Fluoroquinolones
 Potent bactericidal  Prototype:
broad-spectrum Ciprofloxacin
 Excellent oral (Cipro)
absorption  Levofloxacin
 Black-box warning:  Gemifloxin
 ______________  Moxifloxacin
 Norfloxacin
 Ofloxacin
 Mechanism of Action

 Bactericidal as a  Urinary tract

result of inhibition infections:
of the enzyme cystitis
necessary for DNA [females]
replication  Respiratory,
 Broad-spectrum skin, , STDs, GI,
 Extensive G – bone, joint, skin
coverage and soft tissue
 Select G + infections
bacteria
 DOC: Anthrax
[inhalation]
ADVERSE EFFECT
ACHILLES TENDON RUPTURE
TENDONITIS: BLACK BOX
Superinfection [bacterial
overgrowth]: fever, perianal
itching, lethargy, yeast
overgrowth, black furry tongue,
pseudomembraneous colitis
Cardiac: Prolonged QT
Peripheral neuropathy: PO &
Injection
Photosensitivity: SUNBURN on
exposure to direct/indirect
sunlight, sunlamps
Instruct to observe for pain,
swelling, redness at Achilles site
& notify provider
d/c cipro
Instruct the client to observe for
clinical manifestations of
yeast infection (cottage
cheese/curd-like lesions on the
mouth & genital area); notify the
provider
Drysrhythmias in clients on
antidysrhythmics 1a & III drugs:
disopyramide & amiodarone
Discontinue if pain, burning,
tingling, numbness/and or
weakness
Instruct to avoid sun exposure
Wear protective clothing &
sunscreen at all times
 INTERACTIONS
 Antacids, AL, Ca, Mg, Zn, Fe salts,
sucralfate, milk/dairy products:
decrease absorption
 NSG: Administer 1 hour before or after
cipro
 Theophylline: increases levels of cipro
 NSG: Monitor plasma levels & adjust
 Warfarin levels; INCREASE
 NSG: MONITOR PT/INR & adjust
 Tube feedings, probenecid,
nitrofurantoin
Ciprofloxacin (Cipro)

 Prototype for group

 Route: PO, IV, opthalmic & otic
 Preferred drug for preventing
anthrax in those with inhalation of
anthrax spores
 Poor choice for Staph infections due
to high rate of resistance
 Can kill atypical organisms:
chlamydia, mycoplasma,
mycobacterium
Ciprofloxacin (Cipro)

 Two approved pediatric uses

1. Treatment of complicated urinary
tract and kidney infections due to
E. coli
2. Post exposure tx of inhalation
anthrax
Only systemic fluoroquinolone
approved for pediatric use.
Nursing
 Monitor lab studies
 Send c/s prior to starting AB if
ordered
 Careful assessment of CNS for
preexisting conditions: stroke, or
seizures
 Assess for neuropathies
 Assess for liver injuries:
Hepatic/liver panel
 Infuse over 60-90 minutes
Nursing
 Administer with full glass of water [8 0z]
 Ensure maintenance of urine output of at least
1200 to 1500 mL/day
 Discontinue other IV infusions or use
another IV site when administering IV
ciprofloxacin.
 Instruct not to overuse or abuse AB
 Perform handwashing; hand sanitizer
 Stress to avoid sun tanning, tanning beds; use
sunglasses and sunscreen
 Instruct regarding drug interactions
Nursing

 Avoid calcium, magnesium, zinc and

copper
 Alkaline foods and fluids (dairy
products, peanuts, NaHCO3: higher
incidence of cyrstalluria
 Forcing fluids and increasing intake
of fluids and foods high in ascorbic
acid: prevent crystalluria
 Instruct pt to restrict coffee intake