Quinolones and fluoroquinolones are a group of synthetic antibacterial agents that are mainly effective against gram-negative organisms. Nalidixic acid was the first member introduced in 1964 for urinary and gastrointestinal infections. Synthetic fluorinated analogs of nalidixic acid called fluoroquinolones were developed in the 1980s and have an extended spectrum and systemic effects. Fluoroquinolones are bactericidal and act by interfering with bacterial DNA replication through inhibition of DNA gyrase and topoisomerase enzymes. While effective, quinolones have limitations including low potency, resistance development, and side effects such as gastrointestinal issues.
synthetic antimicrobials having a quinolone structure that are active primarily against gram-negative bacteria, though newer fluorinated compounds also inhibit gram-positive ones.
synthetic antimicrobials having a quinolone structure that are active primarily against gram-negative bacteria, though newer fluorinated compounds also inhibit gram-positive ones.
Pharmacology of cephalosporins, monobactums and carbapenums including their mechanism of action, indications, adverse effects.
The various generations of cephalosporins and their spectrum of action
Sulphonamides Pharmacology For Pharmacy studentsMalay Pandya
This is the PowerPoint presentation of the Antimicrobial drug - SULPHOANMIDE.
Sulphonamide is the first antimicrobial agent
It Can be employed for suppressive therapy of chronic urinary tract infection, streptococcal pharyngitis and gum infection.
Combined with trimethoprim (cotrimoxazole) sulfamethoxazole is used for many bacterial infections.
This will be useful to all Pharmacy Student ...
macrolide antibiotics with detailed description of classification and individual drug with mechanism of action, pharmacokinetics, adverse effect, uses for undergraduates and post graduates
the presentation is all about the antibacterial agent focusing on quinoloes and fluroquinolones. helping the viewer to understand
quinoloes basic pharmacology
Pharmacology of cephalosporins, monobactums and carbapenums including their mechanism of action, indications, adverse effects.
The various generations of cephalosporins and their spectrum of action
Sulphonamides Pharmacology For Pharmacy studentsMalay Pandya
This is the PowerPoint presentation of the Antimicrobial drug - SULPHOANMIDE.
Sulphonamide is the first antimicrobial agent
It Can be employed for suppressive therapy of chronic urinary tract infection, streptococcal pharyngitis and gum infection.
Combined with trimethoprim (cotrimoxazole) sulfamethoxazole is used for many bacterial infections.
This will be useful to all Pharmacy Student ...
macrolide antibiotics with detailed description of classification and individual drug with mechanism of action, pharmacokinetics, adverse effect, uses for undergraduates and post graduates
the presentation is all about the antibacterial agent focusing on quinoloes and fluroquinolones. helping the viewer to understand
quinoloes basic pharmacology
Quinolones are synthetic antimicrobials having a quinolone
structure.
Active against gram-ve bacteria, newer fluorinated compounds also inhibit gram +ve bacteria.
First member was nalidixic acid introduced in 1960’s
Their usefulness is limited to urinary and GI tract infections because of
Low potency
Modest blood and tissue levels
Limited spectrum
High frequency of bacterial resistance
In gram negative bacteria –
Inhibition of DNA gyrase enzyme (Inhibit negative super coiling)
In gram positive bacteria –
Inhibition of Topoisomerase IV – Inhibition of nicking and separation of daughter DNA strands after DNA replication
The malformed DNA is digested by Exoneucleases
complete information of tuberculosis including OLD RNTCP and new RNTCP with the novel drug that is marketed; classification of tuberculosis (MDR XDR TDR). special population and tuberculosis treatment clinical presentation and diagnosis
Quinolones are synthetic, bactericidal antibacterial agents with broad-spectrum activity. They inhibit the enzyme topoisomerase II, a DNA gyrase that is necessary for the replication of the microorganism.
Pharmacology of quinolone, mechanism of action of quinolone, pharmacokinetics of quinolone, adverse effects of quinolone, uses of quinolone, contra indications of quinolone.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. QUINOLONES AND FLOUROQUINOLONES
• Introduction
• A group of synthetic antibacterial agents mainly effective
against gram negative organisms
• Nalidixic acid first member introduced in 1964 for urinary and
GIT infections
• Synthetic fluorinated analogs of nalidixic acid: are
fluoroquinolones (FQs) with extended spectrum and systemic
effects in 1980s.
• FQs are BACTERICIDAL, act by interfering with DNA
replication. Since then many synthesized with useful spectrum.
8/24/2021 DR WAF JUNE 2021 2
3. Nalidixic acid
• The first quinolone, nalidixic acid, was isolated as a by-product
of the synthesis of chloroquine
• Less potent ,limited spectrum Active against gram negative
bacteria – E.coli, Proteus, Klebsiella, Enterobacter, Shigella
• Inhibits bacterial DNA gyrase, Bactericidal Resistance develops
rapidly
• Pharmacokinetics: Absorbed orally Metabolized in liver, highly
protein bound, excreted in urine, half life – 8 hrs.
• Concentration in urine is lethal to common urinary pathogens
(20 – 50 times that in plasma) Quinolones
8/24/2021 DR WAF JUNE 2021 3
4. • Nalidixic acid Adverse effects :
• GI upset, rashes Neurological toxicity (in children) – headache,
vertigo, drowsiness, visual disturbances, seizures
• Hemolysis in G6PD deficiency
• Indication:
• Urinary antiseptic
• Diarrhoea caused by E.coli, Proteus, Shigella, Salmonella
Ampicillin resistant Shigella enteritis (cont..,) Quinolones
8/24/2021 DR WAF JUNE 2021 4
5. QUINOLONES.
• 2 Quinolones are synthetic antimicrobials having a quinolone
structure. • Active against gram-ve bacteria, newer fluorinated
compounds also inhibit gram +ve bacteria.
• • First member was nalidixic acid introduced in 1960’s
• • Their usefulness is limited to urinary and GI tract infections
because of
• Low potency
• Modest blood and tissue levels
• Limited spectrum
• High frequency of bacterial resistance
8/24/2021 DR WAF JUNE 2021 5
7. MODE OF ACTION.
In gram negative bacteria – Inhibition of DNA gyrase enzyme
(Inhibit negative super coiling)
In gram positive bacteria – •Inhibition of Topoisomerase IV –
Inhibition of nicking and separation of daughter DNA strands after
DNA replication
•The malformed DNA is digested by Exoneucleases Mechanism
of Action
8/24/2021 DR WAF JUNE 2021 7
9. Mechanism of action.
• DNA- Enzyme- . The gyrase is composed of two A subunits
and two B subunits.
• The A subunits can cut one of double strands of the DNA
• .This is an ATP- dependent reaction. The energy is provided by
B units.
• . FQs are inhibitor of A subunits.
• Therefore, the action of gyrase is inhibited and DNA replication
or transcription is blocked as result of the death of bacteria.
8/24/2021 DR WAF JUNE 2021 9
11. Mechanism of Resistance to Quinolones
& FQ.
• Due to
• 1. a) One or more point mutations in the quinolone binding
region of the target enzyme
b) A change in the permeability of the organism
2. DNA gyrase is the primary target in E coli, with single-step
mutants exhibiting amino acid substitution in the A subunit of
gyrase
3.Topoisomerase Ⅳ is a secondary target in E coli that is
altered in mutants expressing higher levels of resistance.
8/24/2021 DR WAF JUNE 2021 11
12. 4.In staphylococci and streptococci, the situation is reversed,
topoisomerase Ⅳ is the primary target, and gyrase is the
secondary target.
5.Resistance to one fluoroquinolone, particularly if of high level,
generally confers cross-resistance to all other members of this
class.
8/24/2021 DR WAF JUNE 2021 12
13. General features of FQs
• Rapidly bactericidal & high potency
• Long post antibiotic effect on pseudomonas &
enterobacteriaceae
Attain high levels in body fluids & tissues
• Diarrhea and antibiotic-associated colitis unusual
• Low frequency of mutational resistance
Active against many β-lactam & aminoglycoside resistant
bacteria
Less active at acidic pH
8/24/2021 DR WAF JUNE 2021 13
14. Classification of FQs First generation.
1. Introduced in 1980 with one fluoro substitution Norfloxacin
Ciprofloxacin Ofloxacin (only as ophthalmic in the United
States) Pefloxacin
2. Second-generation: In 1990s with additional fluoro & other
substitution extending antimicrobial spectrum to gram positive
bacteria ,anaerobes and longer half life.
3.Levofloxacin, Moxifloxacin, Gemifloxacin, Prulifloxacin,
Lomefloxacin, Sparfloxacin, Finafloxacin .
8/24/2021 DR WAF JUNE 2021 14
16. Pharmacokinetics of FQs:
• Prototype : Ciprofloxacin • Oral given, well absorbed, be impaired
by divalent cations, including those in antacid
• Distributed widely in body fluids and tissues but CSF & aqueous
levels are low
• Urinary & billiary concentrations are 10-50 fold higher than plasma
• Less active in acidic pH
• Pass placenta reach to the fetus,
• Biotransformation of the drugs in the liver
• Most eliminated by renal, either tubular secretion or glomerular
filtration.
8/24/2021 DR WAF JUNE 2021 16
17. Therapeutic applications of FQs.
• Fluoroquinolones are extensively used treating general
infection.
• a. Urinary tract infections, even when caused by multidrug-
resistant bacteria: cystitis, prostatitis,pyelonephritis.
• b. Intestinal and biliary tract infections
• c. skin and Soft tissue infections, infected skin ulcers and
burns.
• d. Bone, joint and intra-abdominal infections
• e. Respiratory tract infections: empyema, pneumonia, lung
abcess.
8/24/2021 DR WAF JUNE 2021 17
18. Uses
• Bacterial Meningitis
• Enteric fever, caused by Salmonelle spp
• Bacterial Diarrhoeal diseases caused by campylobacter, shigella
• Gonorrhea and chancroid
• Conjuctivitis
• Tuberculosis
8/24/2021 DR WAF JUNE 2021 18
19. CIPROFLOXACIN
• prototype): Highly effective against pseudomonas •
• Drug of choice for prophylaxis & treatment of Anthrax & prophylaxis
of meningococcal meningitis.
• Typhoid
• UTIs • Bacterial gastroenteritis • Osteomyelitis & joint infections •
Gonorrhea & chanchroid • Septicemia due to gram negative
organisms •
• Respiratory infections especially due to Mycoplasma, H. influenza,
Legionella • Prophylaxis of infections in neutropenic & cancer
patients •
• Topical use: conjunctivitis Unique features of different FQs.
8/24/2021 DR WAF JUNE 2021 19
20. NORFLOXACIN
• Minimum oral bioavailability •
• Minimum Inhibitory concentration for gram negative bacteria is
8-10 times higher than that of ciprofloxacin.
• Attains lower concentration in tissues
Less potent than ciprofloxacin
Primarily used in urinary & genital tract infections
For bacterial diarrheas it is good as anaerobic flora of the gut not
affected. Unique features of different FQs.
8/24/2021 DR WAF JUNE 2021 20
21. Unique features of different FQs
PEFLOXACIN:
• Methyl derivative of Norfloxacin
Completely absorbed, exhibits cumulation on repeated absorbtion
• More lipid soluble, CSF concentration are higher than other FQs •
Highly metabolized in liver to active metabolite
• Dose needs to be reduced in liver disease but not in renal
insufficiency
• Preferred for meningeal infections
• 200,400mg tablet available & injection 400mg/5ml to be used diluted
in glucose solution but not in saline as it precipitates in presence of
Chloride ions.
8/24/2021 DR WAF JUNE 2021 21
22. Unique features of different FQs
OFLOXACIN:
• Lipid soluble oral bioavailability is high
• Food does not interfere its absorption
Oral tablet (200 & 400mg) & i.v.(200mg)
Largely excreted unchanged by kidney ,so dose need reduced in
renal failure
Effective for gonococcal infection, including disseminated disease.
• Occasionally used for treatment of tuberculosis and atypical
mycobacterial infections
• Suitable for eradication of meningococcal infections from carriers.
• Highly effective in: leprosy, Chlamydial urethritis or cervicitis ,
atypical (Mycoplasma) pneumonia & Chronic bronchitis (cont..,)
8/24/2021 DR WAF JUNE 2021 22
23. SPARFLOXACIN.
• Excreted by both renal & hepatic Long half life
• Increased action against gram positive bacteria, Streptococcus,
Staphylococcus, Enterococcus,Anaerobes & mycobacteria
• NOT effective against Peudomonas
• Indication: upper and lower respiratory tract infections. Highly
effective in Tuberculosis, , Macobacterium Avium Complex,
Leprosy
• Adverse effects: Phototoxic QT prolongation (cont..,)
8/24/2021 DR WAF JUNE 2021 23
24. MOXIFLOXACIN
• Hepatic metabolism & biliary excretion Tablet & intravenous
(400 mg) Indications: MDR tuberculosis, Bronchitis, pneumonia,
otitis media, Urinary concentrations are low not suitable for UTI
• Contraindications : Primarily metabolised in liver, not used in
liver disease Patients with Seizures & Patients receiving
proarrythmic drugs as it prolong Q-T interval.
8/24/2021 DR WAF JUNE 2021 24
25. LEVOFLOXACIN:
• L-isomer of ofloxacin
• Maximum oral bioavailablity, given orally or i.v.
• Excreted unchanged by kidney Indications :
• Upper and lower respiratory tract infections. Community
acquired pneumonia :
• (Respiratory FQ) MDR TB, nosocomial infections Eye drops for
bacterial conjunctivitis & corneal ulcer. (cont..,)
8/24/2021 DR WAF JUNE 2021 25
26. LOMEFLOXACIN
• Similar to Ciprofloxacin ,more active against Gram negative
bacilli & chlamydia Longer plasma half life ,once daily
administration 400 mg tablet available & Topical eye drops
available (0.3%) Side effect:
• Photo toxicity & Q-T prolongation Withdrawn in USA & other
countries, available in India (cont..,)
8/24/2021 DR WAF JUNE 2021 26
28. WITHDRAWN FROM THE MARKET
• Due to adverse effects like
• Gatifloxacin: QT prolongation & dysglycemia (increase or
decrease blood sugar level: risky in diabetics) withdrawn from
market.
• Temafloxacin: immune hemolytic anemia
• Grepafloxacin: cardiotoxicity: QT prolongation
• Clinafloxacin : phototoxicity
8/24/2021 DR WAF JUNE 2021 28
29. SIDE EFFECTS.
• The most common effects are
• a) nausea, vomiting, and diarrhea.
• b) Headache, dizziness, insomnia, skin rash, occasionally.
• c). Photosensitivity occurs with lomefloxacin and pefloxacin.
• d). FQs may damage growing cartilage and cause an arthropathy.
• They are not used in patients under 18years of age.
• The arthropathy is reversible.
• e) FDA has issued warning regarding peripheral neuropathy
• f) Ciprofloxacin prophylaxis use in anthrax patients associated with
damage to muscle ligament.
8/24/2021 DR WAF JUNE 2021 29
30. Drug interactions
• Complexation with metallic ions (Fe, Al, Mg, Ca & Zn) - Common to
all fluoroquinolones. - Chelation complexes provides the basis for
their incompatibilities with antacids, hematinics, and mineral
supplements containing divalent or trivalent metals
• CYP1A2 inhibition: increase the levels of theophylline, warfarin &
caffeine; especially by ciprofloxacin & pefloxacin ( Lomefloxacin,
Levofloxacin & Sparfloxacin have no effect )
• NSAIDS: increase CNS toxicity of FQs; seizures may occur
• FQs which prolong QTs interval should be used with caution those
receiving class 1A, class III antiarrhythmic; erythromycin, TCAs etc.
8/24/2021 DR WAF JUNE 2021 30
31. Contraindications & precautions
• Patients with seizures
• Pregnancy & lactation
• Children below 18 years
• Drugs prolonging QT interval are contraindicated in patients of
cardiac arrhythmia & in hypokalemia
• Hepatic & renal failure
8/24/2021 DR WAF JUNE 2021 31
