Antibiotics I Flashcards

1
Q

Why do organisms make antibiotics?

A

Bacteria grow in competition with other organisms. In order to effectively compete, they produce things that will inhibit the growth of other organisms. Among these
are antibiotics. We’ve taken advantage of these naturally produced compounds, and learned to purify, amplify, or even modify them to increase their bioavailability by increasing their solubility.

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2
Q

What are the major classes of antibiotics?

A

Penicillin and other beta-lactam antibiotics, Streptomycin and Aminoglycosides, Tetracyclines.

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3
Q

What did Flemming discover?

A

Fleming realized that the fungi were secreting some substance that inhibited the growth of bacteria. Seemed to work well against bacteria that were gram positives but not gram negative bacteria, aside from neisseria. Neisseria cause ghonneria, an STD. Penicillin is a primary treatment for ghonneria.Also found out about lysozyme.

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4
Q

What’s an important thing to take into account when making antibiotics?

A

When making a new antibiotic, one thing you have to take into account is specificity. Is it going to be selective for the target organisms or is it going to harm the host given that we often share the same or similar
metabolic pathways. In order to choose a potential antibiotic target, ideally you want to find a unique structural feature of bacteria or fungi, that differentiate them from our cells. If thats not available then the
other way is to look at binding affinities. We’ve seen the latter with some sulfanilamides and some other drugs that actually do target enzymes found in both prokaryotes and eukaryotes, but they have a sufficiently
different binding affinity so that the therapeutic index is fairly high. Its often difficult to find distinct structural features when dealing with fungi, so this strategy is often used.

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5
Q

What distinguishes an antibiotic from other antibacterial agents?

A

Antibiotics are produced by other living organisms. Other general antibacterial agents, such as sulfanilamides, are synthetically
produced. Sulfanilamides are derived from the red dye prontosil, never found naturally in other living organisms. Antibiotics are primarily made by the bacteria genus streptomyeces.

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6
Q

How is a gram stain done?

A

Gram stain: Done by adding two different stains. The idea is that the first stain added is retained in the bacteria (blue or purple color), however it can be removed with a subsequent wash with an
alcohol solution in some bacteria, whereas other bacteria with the stain will retain it even after the wash. The ones that retain the stain are called gram positive, the ones that are cleared
with the wash are gram negative. This separates almost all bacteria into two basic groups. The ones that have the stain washed out can then be stained with a red stain so that you can
quantify them. These differences in staining have to do with the cell wall structure of the bacteria.

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7
Q

Why was Flemming not able to put penicillin to full use?

A

Although Fleming discovered penicillin, he wasnt able to figure out how to get large quantities of it, so he gave up. Later, florey and chain discovered how to grow and purify enough of it to make it useful in WW2. Before they could make it in such large quantities, the alternative was to collect urine from individuals treated with penicillin and purify it from that to reuse it.

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8
Q

How was the MOA of penicillin discovered?

A

Penicillin was found to be causing lysis of the bacteria. The researchers looked at 3 different parameters: the viable count, going down with the addition of penicillin. Then decreased turbidity (even though the
line is shown to be going up, it actually represents a decrease in the turbidity of the bacterial culture. When you grown bacteria in solution the growth media becomes more and more turbid as the bacteria grow more
and more and you can use a spectrophotometer to quantify this by looking at the increased absorbance of light. The key discovery was that when they centrifuged the culture grown in the presence of penicillin, they
found that normally you could isolate bacterial DNA from the pellet, which makes sense, but when they did the same thing after treatment with penicillin, there was decreased DNA found in the pellet and increased
DNA found in the supernatant. This hints that the DNA is being released as a result of cell lyses.

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9
Q

What’s isotonic mean?

A

Isotonic: ions are in equal concentrations inside and outside the
cells. This means that the flow of water is not going to go to one side or the other, so no potential for lysis.

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10
Q

What does hypotonic mean?

A

Hypotonic: less dissolved solutles on the outside, so water will flow into
the cell and the cell will burst. Hypertonic is the opposite and youll
get cell shrinkage.

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11
Q

What hinted towards penicillin disrupting the formation of the cell wall? (Specific media setup)

A

If you grow the cells in isotonic media, you still see changes in morphology.
This was the first clue. The cell wall controls the morphology, so this hinted
that penicillin was affecting the cell wall structure. Unlike mammalian cells, bacterial cells can normally survive a hypontonic solution without rupture, however when treated with penicillin, the bacterial cells were observed to undergo lysis when in a hypotonic solution.

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12
Q

What does penicillin do to nongrowing bacteria? What does this show?

A

Non-growing bacteria were not significantly affected by penicillin. So this was an indication that unlike the action of lysozyme, which basically breaks down a pre-existing cell wall, what it looks like is happening is that the formation of the cell wall is being inhibited. This was supported by finding that further examination of the supernatant, you could detect some precursors of cell wall syntheiss.

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13
Q

What’s different about sulfanilamides and penicillin?

A

Sulfanilamides are bacteriostatic: they stop bacteria from growing after a certain lag point. Penicillin is bacteriocidal in that you get a decrease in the number of viable bacteria after adding the agent. So penicillin actually kills the bacteria, so even in someone who is immunocomprimised, penicillin will still work effectively because you dont need the immune system to clear out the bacteria. Gram positve bacteria have a very extensive peptidyl-glycan structured cell wall outside of the plasma membrane. They additionally have teichoic acid which is not made by gram negative bacteria. Gram negative bacteria have a more complex structure of cell wall. They have a plasma membrane, then a peptidyl glycan layer that is significantly thinner than what you see in gram positives. The thickness of the peptidyl-glycan layer explains the staining difference between the bacteria in that the thicker one more effectively traps the dye in the cells and gives gram positives their positive appearance. Additionally, gram negatives have an outer layer of polysaccharides which is essentially an additional membrane. Gram negatives also have bacterial pores that are formed by porins which are important for regulated entry of molecules in gram negative bacteria, including penicillin. Standard penicillin cannot penetrate gram negative bacteria. because it cant fit through the porins.

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14
Q

What part of the cell wall is the target for penicillin?

A

Peptidyl-glycan layer is the target for

penicillin.

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15
Q

If Neisseria is gram negative, how is penicillin able to affect it?

A

Neisseria have a different type of porin present, which penicillin is able to penetrate, which explains why penicillin can be used to treat infections of neisseria (ghonneria).

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16
Q

What allows penicillin to affect gram positive but not gram negative bacteria?

A

The process of cell wall formation is similar in gram negative and gram positive cells, so it was clear that the
selectivity of penicillin form gram positive cells was not due to some inherritant differnce in the cell wall formation,
but rather the selective pores in gram negative. Both have alternating subunits of N-acetylglucosamine and N-acetylmuranic
acid. A series of side chains are formed that are built by non-ribosomal amino acid attachment (carried out by transpeptidases instead).

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17
Q

What step in cell wall formation is affected by penicillin? Specifically what type of proteins are targeted?

A

Transpeptidases were first identified as penicillin-binding proteins. It appears that the last
cross-linking step described to the right is the key step that is interfered with by penicillin
and leads to a weakened cell wall, which leaves the bacteria being susceptible to lysis. If the
bacteria are not actively
growing then this wont
really affect them.

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18
Q

What’s special about the amino acid attachments in bacterial cell walls?

A

The addition of D-alanines distinguishes the amino acid attachments from typical ribosomal attachments because
ribosomal synthesis only incorporates L isomers of amino acids. There are branches of 5 L-glycines that are added
to the L-lycines which cross-link the side chains. The cross-linking involves a removal of D-alanine.

19
Q

Go into great detail of penicillins MOA

A

Penicillin: mimic peptide that the transpeptidase thinks that it is the amino acid that it needs to cross-link. Penicillin
then binds the active site of the transpeptidase covalentyl and inhibits it. A key feature
of these drugs is the presence of a beta lactam ring. This is a suicide substrate: something gets incorporated into a growing
polymer (in some cases penicillin is actually added onto the growing peptide) that cannot cross-link to the next amino acid.
Its specifically the D-alalyl D-alanine transition state intermediate that is believed to be mimiced by penecillin.

20
Q

What does penicillin resemble?

A

Resembles the D-alanyl-D- alanine transition state

21
Q

Common side effects of penicillin

A
  • Most common is drug allergy. If you have developed drug allergies to other drugs, its more likely you will develop an allergy to penicillin as well.
  • Candida superinfections. Candida are part of the normal body flora, and are
    normally inhibited by bacteria present in the normal flora. But if you treat
    them with penicillin, then you can wipe out the gram positives in your body,
    giving candida the chance to grow. Candida is a fungi.
    -Pseudomembranous colitis- clostridium difficile. Seen in infants. The bacteria form a membrane-like structure that can block passage of waste through the colon. There is however, a type of penicillin that can be used to treat this.
22
Q

What’s a form of resistance to beta lactamases?

A

A form a resistance to beta lactamases is to give penicillin along side cavulanic acid which inhibits beta lactamase because its a false substrate. Cavulanic acid is a higher affinity substrate than the penicillin. Bacteria have developed clavulanic resistant beta lactamases.

23
Q

What’s a problem with giving penicillin too much?

A

Particular problem with most drug resistance to penicillin is the ability of bacteria to produce
enzymes called beta lactamase which cleaves th beta lactam ring at the carbon-nitrogen
linkage. When this happens the penicillin cannot take on the correct conformation
to mimic the substrate of peptidyl transferase. Typically the genes for the enzyme are encoded
on a plasmid that can be passed from one bacteria to another through conjugation or abcterial
rupture and uptake of scattered genes. To overcome this, a second class of penicillin compounds
was developed called cephalosporins. They are more resistant to the actions of beta lactamases.

24
Q

How can drug resistance be measured?

A

Grow bacteria on a plate. Use little filter papers with the antibiotic on them and measure diameter of growth inhibition zones.

25
Q

Give some examples of beta lactamase resistant drugs

A

Monoabctam drugs eliminate the A ring but keep the beta lactam ring,
making them resistant to beta lactamases. Highest resistance
comes from carbapenem drugs. Given enough time, bacteria
are expected to develop mutant beta lactamases that can cleave even
the highest beta lactamase resistant drugs.

26
Q

What’s procaine benzylpenicillin?

A

Procaine Benzylpenicillin: Made up of two drugs that are covalently linked. Procain is a local
anesthetic. Injected into deep wound infections. Ester linkage
between them gets hydrolyzed which releases the procain and is able to have
its affect of reducing pain while the penicillin can attack the
gram positive bacteria that are contributing to the infection.

27
Q

What are some penicillin derivatives?

A

Penicillin Derivatives

  • Benzylpenicillin (Penicillin G)
  • Methoxypenicillin (Penicillin V) (Orally administered)
  • Procaine Benzylpenicillin
28
Q

Are beta lactams competitive inhibitors?

A

Beta lactams: penicillins and cephalosprin. Compete with the natural substrates (amino peptidases) for transpeptidases. They bind covalently, so they are not competitive inhibitors. These are
irreversible inhibitors which explains how they fit into the suicide substrate complex. Any time you have a compound that fits into the category of suicide substrates then that indicates
that it is binding irreversibly to either an enzyme or a growing chain of polymer, and therefor prevents any further action of that system. Were it not for drug resistance, these would be
very ideal antibiotics. Becuase of resistance, there have been at least 4 generations of cephalosprins that have been derived synthetically from the basic penicillin nucleus.

29
Q

Where does the first step of cell wall synthesis take place?

A

First step in the formation of the cell wall takes place in the cytoplasm of the bacteria. this is the addition of UDP onto N-acetylmuramic acid. This is an input of energy which is needed to incorperate the
structure into the cell wall via the linkage with it to an amino acid chain (5 aas) which is par of the building of the cell wall. Peptidases that
penicillin binds
to are within the
periplasmic space.

30
Q

Penicillin and cephalosporin spectrum of action

A

4th gen has a structure with a zwitterion. Charged molecules
with usually one positive and one negative charge, so the charges balance
out and they are overall neutral. These compounds tend to penetrate
the gram negative cell wall structure more readily than other types of
compounds.

31
Q

E. Coli

A

Many E. coli strains are inhabitants of the gut and provide many metabolic benefits as well as compete with other flora that might otherwise take over. There are however, strains called enteropathogenic E. coli
which are able to leave the gut and enter the surrounding tissue and casue severe enteritis, vomitting, and diahrrea. These can be life threatoning if no support is given or the patient is very old or young. So cephalosporins
were made to treat this.

32
Q

What do flipases do?

A

flipase moves the cell wall units to the periplasmic facing

side of the plasma membrane.

33
Q

Vancomycin usage

A

Glycopeptide antibiotic. Produced by fermentation of Amycolatopsis orientalis. Used primarily against gram positive organisms, however it
has poor oral bioavailability so it needs to be given through IV
admin. Exception to this is when an infant has pseudomembranous colitis
which involve the bacteria forming a biofilm via their pili. The organism
is a clostridium dificile, an anaerobic gram positive rod. Since when given orally it stays in the GI tract for longer
than normal which is desireable in the case of pseudomembranous colitis.

34
Q

Vancomycin MOA

A

acts as a mimic of the substrate for the
enzyme that cleaves the terminal alanine.
Produced by growing a lot of the bacteria.
This bacteria has branching that occurs between
the filamentous colonies it forms. It can be
considered multicellular. You dont see a really
high amount of signaling between the cells
though. Binds to D-allyl D-alanine and has
two roles. One that invovles inhibiting the
cross-linking function in that it stops the cleavage
of the terminal alanine from the peptide. It also has been shown
to inhibit the polymerization between the N-acetylglucosamine
and N-acetylmuranic acid. So it hits both steps.

35
Q

What’s required for lipids to be incorporated into the cell wall?

A
In order for cycle to 
continue, lipid has to
get back out to the
outer layer of the
plasma membrane. 
This requires a 
dephosphoylation to
occur. There are a 
number of linkages
that have phosphates on
them, so one of them 
needs to be removed, 
giving a monophosphate
before it can relink to the
cell wall material. 
Vasotracin is an
antibiotic that inhibits this, 
its one of the most
overused antibiotics and is not very bioavailable
and is given as an ointment for wound infections.
36
Q

Blood brain barrier

A

Blood brain barrier: A construction of the circulatory system as it enters the CNS. The endothelial cells, that throughout the rest of the body normally have gaps in between them that can allow many drugs and
other substances can pass to and from the tissues and into the circulation, these gaps are missing in CNS blood vessels. Therefor, anything that gets from the blood into the CNS, has to be able to cross a couple
of lipid bilayers (both sides of the endothelial cells) in order to get out into the CNS tissues. So either you have to have a drug that is highly lipophylic to cross the barrier, or is recognized by some sort
of transporter. In the case of the third generation, the drug is being recognized by a transporter and transported across.

37
Q

What is cycloserine

A

Addition of D-allyl D-alanine amino acids is inhibited by cycloserine. It is a structuralanalog of D-allyl D-alanine and is
useful in treating some types of resistant gram positive bacteria such as stapholococcus.

38
Q

What does vancomycin NOT work against?

A
Doesnt work against
gram negatives
because it cant get
passed the cell wall. 
Side effect: thrombophlebitis:
formation of blood clots usually in
the legs. These will sometimes
break loose and make their way abck to the heart to block
the coronary arteries leading to a heart attack.
39
Q

Is vancomycin chemically synthesized in a lab?

A

basically just want to grow the abcteria and
purify the antibiotic instead of
synthesisizing chemically. Its secreated.

40
Q

Vancomycin side effects

A
Another side effect: red-neck
syndrom which is a red rash
on the enck that can 
spread to the upper
chest and face. Its an allergic
type reaction.
41
Q

What was vasotracins role in the development of MRSA

A

Vasotracin had a role in the develop of MRSA: methacyline resistant staphylococcus areus. This has been the biggest problem in terms of wound infections. Very hard to treat simply because
antibiotics were overused and developed the resistant strains.

42
Q

Polymyxin B

A

Source: Bacillus polymyxa

Mech: Basically its a detergent. It doesnt affect cell wall synthesis.
Its a cationic detergent (surfactant) that disrupts the structure of both inner and
outer bacterial membranes. It has some degree of specificity
for the bacterial membranes. Bacteriocidal for gram
negative bacteria, used solely for these because it cannot effectively
penetrate the gram positive cell walls. Since it has detergent activity,
it also affects our cells. Its not given systemically, otherwise neuronal
damage can occur: acute renaltubulosis. Normally given as a topical
antibiotic, which is not toxic if its given to the surface of a small wound.
If you have a major wound, you shouldnt use it because it can possibly
get into the blood flow. Use with caution.

43
Q

What’s a benefit of using two different types of antibiotics?

A

You can use two different antibiotics that target the same biological process/ pathway, by giving them simultaneously, you can often get by by giving a lower dosage of each. This has the potential
of reducing side effects.

44
Q

How is polymyxin B2 synthesized?

A

Bacteria grown and antibiotic is isolated from the growth media and
purified.