Chapter 20 & 19 Flashcards
Father of Chemotherapy
Paul Ehrlich
German, 1910
-drug treatment for syphillis
-Selective toxicity
Chemotherapy
Use of chemicals to treat a disease
selective toxicity
toxic to microbe, but not host cells
Domagk
1935 - Sulfa drugs -first major class of drugs with widespread clinical use
Antibiotics
antibacterial compounds produced naturally by a microorganism
father of penicillin
Flemming 1928
in Penicillium mold
father of streptomycin
Waksman - 1943
from soil bacteria Streptomyces griseus
Antimicrobial chemotherapy
use of drugs to destroy or inhibit the growth of microbes that are causing disease
Antimicrobic
a word that incorporates all types of antimicrobial drugs, regardless of origin
Synthetic
antimicrobial chemical produced in the lab (sulfa drug)
Semisynthetic
antibiotic that has been chemically altered
Types of antimicrobial drugs (4)
Antimicrobic
Antibiotic
Synthetic
Semisynthetic
Therapeutic Index (TI)
lowest dose toxic to patient divided by normal dose used for therapy
-OR toxic dose divided by therapeutic dose
Minimum Inhibitory Concentration (MIC)
lowest dose that prevents growth of the microbe (=normal dose used for therapy)
- TI= lowest dose toxic to patient divided by MIC
High TI
antimicrobics are usually less toxic to host.
- good ratio is 10:1
- usually because they are specific to non-host processes
Low TI
antimicrobics are potentially toxic to heat
Spectrum of Activity
Broad spectrum
Narrow spectrum
broad spectrum
affects a wide range of bacteria
- use if microbe is unknown and infection is serious
- usually have a low TI
Narrow spectrum
affects a limited range of bacteria
- used if bacteria pathogen has been identified
- Usually have a high TI
Half-life
time it takes for a drug to decrease in body by 50% = describes the rate of elimination.
- Determines the amount of drug given and how often
Tissue distribution
- Antibiotic characteristics determine which tissue can be entered and how drug id given
- Ex. to cross blood/brain barrier antibiotics are lipid soluble and smaller molecules
ex. Penicillin G given IV - not stable in low pH of stomach
Resistance to antimicrobials
Intrinsic (innate) resistance
acquired resistance
intrinsic (innate) resistance
natural resistance based on bacteria’s characteristics
ex. mycoplasma (no cell wall) is not affected by antibiotics specific to peptidoglycan
acquired resistance
resistance gained through mutation or genetic exchange
allergies
some antibiotics cause hypersensitivity in patient, resulting in immune responses or allergies
- most common - penicillin, cephalosporins, sulfas
Toxic effects
some antibiotics can cause damage to host often when used at high concentrations
-ex. streptomycin at high levels can damage kidneys
Antagonistic
two drugs make each other less effective.
- Ex. bacteriostatic drugs (prevent binary fission) interfere with Penicillin
Synergistic
drugs are more effective when taken together
ex. action of penicillin allows streptomycin to enter cell more easily
Additive
no drug interaction, drug combinations are neither antagonistic nor synergistic
Which microbes are easiest to treat using antimicrobial medication?
Prokaryote cells
because of selective toxicity, unique cellular targets different from host must be found
Targets of antimicrobial drugs
synthesis, structure, function of:
- cell wall
- cell membrane
- proteins
- nucleic acids
Cell Wall Synthesis
Target
- formation of cell wall is inhibited
- if cell wall is not intact, osmotic pressure will cause bacteria to lyse
- high TI b/c we do not have cell walls
Cell Membrane: function
target
- drugs bind to cell membrane and produce large holes
- causes “leaky” cells and cell death
- very low TI b/c we also have cell membranes
proteins: metabolic pathways
target
- some drugs target unique metabolic pathways
- high TI
proteins: synthesis/transcription
target
Transcription (DNA to mRNA) is prevented by inhibition of RNA polymerase
- low TI b/c our RNA polymerase is similar to microbes so it could affect us as well
Proteins: synthesis/translation
target
- protein synthesis is stopped by disrupting the ribosome
- drugs attach to bacteria 70S ribosomes
- Medium/high TI b/c ribosomes found in mitochondria are also 70S so they may be affected
Nucleic acids: DNA synthesis
target
- inhibition of bacterial enzymes needed for DNA synthesis (DNA polymerase, gyrase)
- low TI b/c our cells also have those cells to go through DNA synthesis
Antibacterial drug families
- Sulfonamides
- B-lactams
- Glycopeptides
- Aminoglycosides
- Tetracyclines
- Macrolides
- Rifamycins
- Quinolones
Sulfonamides
-Synthetic
Broad spectrum - both Gram - and +
Mode of Action for SULFONAMIDES
- competitive inhibitor in METABOLIC PATHWAY that synthesized folic acid
- human cells do not make folic acid
- Same pathway makes precursors to proteins and nucleic acids for bacteria
Toxicity of SULFONAMIDES
nearly harmless to humans
High TI
- Some allergic reactions
B- Lactams
- contain B-lactam ring
- antibiotics produced by fungi/molds
- many semi-synthetic versions (methicillin)
- used for first time in 1941, very important in WWII
Mode of action of B-LACTAMS
interferes with CELL WALL SYNTHESIS, causes bacteria cell to lyse
- inhibits enzymes that form peptide bridges between glycan chains
- only work on actively growing cells
Toxicity of B- LACTAMS
very little - high TI
- animal cells do not have cell walls or peptidoglycan
- sever allergies to penicillin possible
Current effectiveness of B-LACTAMS
- usually more effective against Gram+ bacteria
- difficult for B-lactams to penetrate Gram - outer membrane, but some can.
- Broad and narrow spectrum
- older and newer penicillins
Glycopeptides
- usually injected - is not absorbed well through intestines
- can be taken orally for intestinal pathogens
Mode of Action of GLYCOPEPTIDES
- inhibits CELL WALL SYNTHESIS by binging to peptidoglycan
Toxicity of GLYCOPEPTIDES
low toxicity, high TI
- serious side-effects can include nausea and hearing loss
Current effectiveness of GLYCOPEPTIDES
Narrow spectrum (Gram + only) - usually little resistance, although some seen with S.A and intestinal pahtogens
Aminoglycosides
- from filamentous soil bacteria Streptomyces griseus
mode of action of AMINOGLYCOSIDES
- inhibit TRANSLATION by attaching to 30S subunit of bacterial ribosomes, mRNA is misread and proteins are synthesized incorrectly
Toxicity of AMINOGLYCOSIDES
- severe = low TI
- used in low doses
- severs side-effects include kidney and inner ear damage
Current effectiveness of AMINOGLYCOSIDES
- broad spectrum
- many bacteria are resistant, so not used much
- often used with other antibiotics (PENICILLIN)
Tetracyclines
from streptomyces species and semi-synthetic
-drug of choice for un-diagnosed diseases
Mode of action of TETRACYCLINES
- inhibit TRANSLATION by attaching to 30S subunit of bacterial ribosomes, precents attachment of tRNA, protein synthesis completely blocked
Toxicity of TETRACYCLINES
- low = high TI, but not given to patients with liver and kidney damage or are pregnant
Current effectiveness of TETRACYCLINES
Very broad spectrum, resistance is common
Macrolides
-often used when patient is allergic to penicillin