Ciprofloxacin

The exam rarely asks what cipro is — it tests safe administration and discharge teaching. Expect a “which patient statement indicates understanding?” item where the keyed answer separates the dose from dairy, antacids, and calcium/iron/zinc supplements by 2 hours before or 6 hours after, plus a select-all on serious effects: tendon pain that mandates holding the drug and reporting it (highest risk in patients over 60, on corticosteroids, or post-organ-transplant), QT prolongation, and a lowered seizure threshold. When ciprofloxacin appears alongside warfarin, the priority answer is monitor INR for bleeding — cipro inhibits CYP1A2 (and, more weakly, CYP3A4), potentiating warfarin’s effect.

Classic traps: students pick “take with food to reduce GI upset,” forgetting plain food is fine but divalent/trivalent cations are not. The timing-separation logic mirrors levothyroxine — and the core mechanism overlaps, since both are chelated by calcium and iron. Also watch theophylline toxicity (seizures, arrhythmias); tizanidine is outright contraindicated with cipro. Memory hook: “cipro snaps tendons and chelates cations” — both get held or separated.