Anti-bacterial drugs Flashcards

1
Q

What is antibacterial chemotherapy?

A

Chemicals or substances produced by microorganisms to kill or prevent the growth of other microorganisms.

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2
Q

What does antibacterial chemotherapy target?

A

Targets bacteria that cause nonspecific infections in the body.
Many bacteria can cause the same symptoms.
Symptoms depend on the site, extent of infection and local reaction to infection.

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3
Q

How are bacteria categorised by Gram stain?

A

Gram positive bacteria is stained by Gram.
Gram negative bacteria do not take up the purple stain into their cytoplasm.
This is because they have an extra outer polysaccharide membrane that protects it against the dye, drugs and environmental effects.

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4
Q

What are forms of antibacterial drugs?

A

Bacteriostatic drugs stop the growth of bacteria.
Bactericidal drugs kills the bacteria, growth does not restart once the drug is removed.

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5
Q
A
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6
Q

What is the spectrum of antibacterial drugs?

A

Broad - affects many different types of bacteria
Narrow - affects a specific type of bacterium

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7
Q

What is selective toxicity?

A

Exploitable differences between the organism and the host cells.
Allows the drug is toxic to the target but not toxic to the human cells.

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8
Q

What is the difference in selective toxicity in chemotherapy?

A

Antibacterial chemotherapy can easily pick out drugs that harms bacteria but leaves the human alone, due to large differences between bacteria and human cells.
But in cancer chemotherapy, differences between cancer cells and human cells are small, so less selective toxicity, more side effects.

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9
Q

What are the differences betwen bacteria and mammalian cells?

A

Peptidoglycan cell wall.
Plasma membrane in prokaryoties has no sterols like eukaryotes.
DNA is packaged into a single, circular chromosome.
Protein synthesis end results are very different.
Energy metabolism - prokaryotes have no mitochondria.

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10
Q

What are the metabolic pathways?

A

Class I - utilise environmental energy sources to make precursor molecules - ATP.
Class II Use precursor molecules to build amino acids, hexosamines, nucleotides necessary for class III reactions to produce peptidoglycan, proteins, DNA and RNA.

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11
Q

How effective are class I pathways for chemotherapy?

A

Class I pathways are very similar to humans, so are not good targets for antibacterial chemotherapy.

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12
Q

How effective are class II pathways for chemotherapy?

A

Class II reactions are better targets than class I as some reactions are specific to bacteria.
Or class I may have identical pathways or reactions, but may have differential sensitivity to chemicals or drugs.

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13
Q

How effective are class III pathways for chemotherapy?

A

Class III are the best targets, as they are involved in production of cell wall, proteins, RNA, DNA required for bacteria to survive.
These are quite specific to bacteria.

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14
Q

What is the difference in folate metabolism between bacteria and humans?

A

Human cells cannot produce their own folate.
Need to take up folate from the environment, so have specific transport mechanisms that allow cells to take up and use preformed folate.
Bacteria don’t have transport mechanisms to take up folate, so produce their own folate.

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15
Q

What is the folate metabolism pathway for bacteria?

A

P-aminobenzoic acid (PABA) is converted to folate by dihydrofolate synthase.
Folate is converted to tetrahydrofolate by dihydrofolate reductase.
Tetrahydrofolate is essential for DNA replication.
Therefore folate is essential for cell proliferation.

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16
Q

What are sulphonamides?

A

Sulphonamides are analogues of PABA, essential for folate synthesis.
Compete with PABA to inhibit DNA synthesis
Bacteriostatic antibiotic

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17
Q

How are sulphonamides antagonised?

A

Can be antagonised by excess PABA due to it acting as a competitive inhibitor.
Procaine is a local anaesthetic that is a PABA ester.
So in abscess removal, sulphonamides cannot be used as the procaine antagonises the sulphonamide.

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18
Q

How can bacteria adapt to sulphonamides?

A

If bacterial cells cannot produce folate, they can take up purine and pyrimidine bases from the environment - pus - to bypass the need for folic acid.
Pus contains breakdown products of tissue, and contains purine and pyrmidine.

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19
Q

What is trimethoprim?

A

Trimethoprim interferes with folate utilisation in bacteria, but doesn’t affect the same pathway in humans due to differential sensitivity.
So trimethoprim is a very efficient bacteriostatic, with very few side effects on human DNA production.

20
Q

What is folate targeting in humans?

A

Targeting folate in humans would make it an anti-cancer or immunosuppressant drug because it is involved in DNA replication.
Methotrexate is a common immunosuppressant in humans, it does not affect bacteria.

21
Q

What is penicillin?

A

An antibiotic that interferes with the production of the peptidoglycan cell wall in bacteria.
Developments have taken it from a narrow spectrum, acid sensitive drug to a broad spectrum, less sensitive antibiotic.
Methycillin is resistant to the enzymes bacteria useds to breakdown penicillin - penicillinase.

22
Q

What antibiotics are used to prevent peptidoglycan synthesis?

A

Penicillins
Cephalosporins
Cycloserin
Vancomycin
Bacitracin
These are bactericidal as they cause the cell to die through interruption of the cell wall.

23
Q

What is resistance to penicillin?

A

Bacteria can produce B-lactamases enzymes which rapidly break down penicillin.
Staphylococci
Neisseria gonorrhoea
Hemophilus
B-lactamase inhibitors - clavulonic acid - are added to antibiotics to make sure bacteria cannot break down penicillin

24
Q

How else do bacteria have resistance to penicillin?

A

Gram negative bacteria can cause reduction of the membrane permeability of the antibiotic to the bacteria.
Methicillin resistant staphylococci (MRSA) can modify the penicillin binding sites.

25
Q

What is polymixin B?

A

Increases the permeability of the cytoplasmic membrane.
Effective against gram- bacteria.
Side effects - kidney damage, vertigo, muscle weakness, apnoea.

26
Q

What is gramicidin?

A

Increases the permeability of the cytoplasmic membrane.
Effective against gram+ bacteria.
But causes severe haemolytic reactions so only used topically.

27
Q

What is protein synthesis in bacteria?

A

mRNA brings code of polypeptide to ribosome.
tRNA brings the amino acid to attach onto the chain.
Once tRNA is inserted into the ribosome, it is elongated.
The previous mRNA chain is released from the A site of ribosome, and the tRNA moves from the P site to the A site to repeat the process.

28
Q

What antibiotics can be used to inhibit protein synthesis?

A

Tetracyclins
Streptomycin
Chloranphenicol
Puromycin
Erythromycin

29
Q

How do tetracyclins inhibit protein synthesis?

A

Compete with tRNA for the A site of the ribosome.
This interrupts the bulding of the polypeptide chain, so bacteria produces fragments of proteins and dies.
There is selective uptake of tetracyclin by bacteria, wherease eukaroytic cells keep tetracyclin out of the cell.

30
Q

What are the features of tetracyclin?

A

Broad spectrum.
Absorption from the GIT.
Side effects - hepatoxicity.
Dental hypoplasia and bone deformities in foetus or young children.
Renal damage for those pre-disposed to renal damage.

31
Q

How does streptomycin inhibit protein synthesis?

A

Interferes with the reading of the triplet code, so the bacteria produces jumbled polypeptides, long chains that are not functional.
This inhibits proper protein synthesis, so is bactericidal.
It is an aminoglycaside.

32
Q

What are the features of streptomycin?

A

Broad spectrum - affects gram- bacteria, streptococcus, listeria, pseudomonas, aeruginosa, sepsis.
Not absorbed from the GIT - administered intramuscular or intravenous route.
Aminoglycasidases can affect hearing by the organ of Corti, which can cause deafness in patients.

33
Q

What is resitance to aminoglycosides?

A

Produce inactivating enzymes.
Reduction of membrane permeability.
But can cause autotoxicity.

34
Q

What is inhibition of transpeptidation?

A

Protein synthesis can be inhibited by inhibiting transpeptidation - inhibiting the elongation of the chain.
This leads to premature termination of polypeptide chain.
Bactericidal.
Puromycin and Chloranphenicol

35
Q

How does erythromycin inhibit protein synthesis?

A

Inhibits translocation of the chain from the A site to the P site of the ribosome, this causes early termination of the polypeptide chain.

36
Q

What is erythromycin?

A

Erythromycin has similar efficacy and spectrum to penicillin, so can be given to patients with penicillin sensitivity.
But resistance can occur, causing cholestatic jaundice and hypersensitivity.

37
Q

What is Clindamycin?

A

Clindamycin is a drug that inhibits protein synthesis in most bacteria, except for clostridium bacterium.
Clostridium lives in the lower intestinal tract, but an intact bacterial flora constrains this bacteria through its microbiome.
Clindamycin sterilises the bacterial flora, so clostridium has room and nutrients to grow, causing rapid proliferation and pseudomembranous colitis (C.Diff), which causes death.

38
Q

What antibiotics can inhibit nucleic acid synthesis?

A

Inhibit DNA and RNA polymerase
e.g. Rifampicin, for TB.
Inhibit DNA gyrase.
e.g. Quinolones, for Gram- infections.
Altering base pairing properties of template.
e.g. Proflavin, a local antiseptic.

39
Q

What is the selective advantage of drug resistance?

A

Bacteria that are resistant to certain antibiotic will survive where other bacteria die.
This leads to propagation of that bacteria in the population.
Methicillin kills methicillin-sensitive bacteria, which gives an advantage to MRSA, as it can spread easier in hospital.

40
Q

How are bacteria resitant to antibiotics?

A

Antibiotic resistant genes in plasma can code for antibiotic degrading enzymes - B-lactasome.
Efflux pumps which pump the antibiotic out of the bacterial cell so it can’t have an effect
Or alters binding site of antibiotic so bacteria is resistant to antibiotic.

41
Q

How is resistance to antibiotics spread?

A

Resistant bacteria share resistant genes by conjugation - share the plasmid.
If a resitant bacteria dies, the plasmid can be taken up by live bacteria through transformation.
Viruses can traffic resistant genes to other bacteria by transduction.

42
Q

What are the mechanisms of drug resistance?

A

Altered drug targets or metabolic pathways, affects acyclovir, rifampicin.
Decreased access/increased export, affects chloroquine.
Drug inactivation, affects penicillin, aminoglycosides.

43
Q

How can antibiotic resistance be avoided?

A

Prudent antibiotic use - only use when needed.
Targeted antibiotic use.
Optimal dosages and regimens - to achieve the bactericidal effect, prevent bacterial colonies from growing once antibiotics are finished.
Preventing infections through vaccines and hygiene.

44
Q

How are antibiotics selected?

A

Choose the site of antibiotic based on:
The site of infection.
Considering other drugs that could interact with it.
Pregnancy.
The immune system.
Previous use of antibiotics - possibility of resistance.
Side effects - age, renal and hepatic function.
Hypersensitivity reactions.

45
Q

What is the use of drug combinations?

A

Use drugs in combination to achieve a total kill.
Be careful how combine, as some have additive or synergistic effects to bacteria or side effects.
Synergistic - penicillin and aminoglycoside.
Antibiotics can antagonise each other - penicillin and tetracyclin
Increased risk of side effects.