Exam 3 (Ch. 10, 13, & 14) - Conner Flashcards
Who discovered the first anti-microbial drug, and what was it used for?
Paul Ehrlich and Sahachiro
-Salvarsan, an arsenic compound, was used as a chemical to inhibit Treponema pallidum
What is the Therapeutic Index?
compares the blood concentration at which a drug becomes toxic and the concentration at which the drug is effective
Lowest dose that is toxic to humans / Usual therapeutic dose of the drug
What is Selective Toxicity
The dosage that kills or inhibits a microbe while not damaging the host
Which is better: a HIGH or LOW Therapeutic Index?
HIGH - the higher the TI the safer it is because a patient would have to take a much higher dose of such a drug to reach the toxic threshold than the dose taken to elicit the therapeutic effect
SOLVE THE FOLLOWING TI QUESTION:
Which drug is better?
Drug A:
-Toxic at dose of 10 mg; therapeutic at 5 mg
Drug B:
-Toxic at dose of 100mg; therapeutic at 5 mg
DRUG B
Lowest dose that is toxic to humans / Usual therapeutic dose of the drug
Drug A: 10 toxic dose / 5 therapeutic dose
= TI of 2
Drug B: 100 toxic dose / 5 therapeutic dose
= TI of 20
Describe the discovery of Sulfa Drugs
In 1932 Germany, the red dye Prontosil was found to inhibit the growth of S. aureus in animals
However, this did not work on cultures
But, it was later determined that Sulfanilamide, a breakdown product, was the active form!
So, in 1935, Gehard Domagk gave the drug to his daughter who was gravely ill…and she survived!
What drug did Alexander Fleming discover when he closely examined a Staphylococcus culture contaminated with mold?
Penicillin!
Where was Sir Alexander Fleming entombed?
THIS IS A TRIVIA QUESTION ON THE SLIDES…SO POSSIBLE EXTRA CREDIT… MAYBE??
St. Paul’s Cathedral, London
Describe the discovery of Penicillin
In 1928, Alexander Fleming returned from a holiday to find mold growing on a Petri dish of Staphylococcus bacteria.
He noticed the mold seemed to be preventing the bacteria around it from growing - a zone of inhibition! He soon identified that the mold produced a self-defense chemical that could kill bacteria (Penicillium notatum).
He named the substance Penicillin
What anti-bacterial enzyme did Alexander Fleming discover in tears and saliva?
THIS IS A TRIVIA QUESTION ON THE SLIDES…SO POSSIBLE EXTRA CREDIT… MAYBE??
lysozyme
Why did Alexander Fleming decide to become a microbiologist?
THIS IS A TRIVIA QUESTION ON THE SLIDES…SO POSSIBLE EXTRA CREDIT… MAYBE??
So he could be in the St. Mary’s rifle club. There were no surgery spots available at St. Mary’s
What Bacterial Cell structures would you target for Antibacterial Drug development?
-Cell Wall (inhibition of cell wall synthesis and cell membrane function)
-Ribosomes (inhibition of translation)
-DNA (inhibition of transcription and replication)
-Metabolism (inhibition of metabolism
What are some Mechanisms of Action of Microbial Drugs?
DEFINITELY AN EXAM QUESTION!
-
Inhibition of pathogen’s ATTACHMENT or ENTRY into the host cell
-e.g., Arildone -
Inhibition of CELL WALL SYNTHESIS
-e.g., Penicillins -
Inhibition of DNA or RNA SYNTHESIS
-e.g., Quinolones -
Inhibition of GENERAL METABOLIC PATHWAY
-e.g., Dapsone -
Inhibition of PROTEIN SYNTHESIS
-e.g., Tetracyclines -
Disruption of CYTOPLASMIC MEMBRANE
-e.g., Polymyxins
Explain how Penicillin works as an antibacterial drug.
What is the active portion of a Penicillin molecule?
DEFINITELY AN EXAM QUESTION!
Penicillin is a Beta-Lactam Drug, meaning that it interferes with the FORMATION of the peptide side chains between adjacent strands of PEPTIDOGLYCAN by INHIBITING penicillin-binding proteins
Penicillin IRREVERSIBLELY binds to enzymes that crosslink NAM subunits.
Active Portion = BETA-LACTAM RING!
DISRUPTION OF BACTERIAL CELL WALL
What are drugs that affect the cell wall, and how?
-
Beta-Lactam Drugs
-INTERFERE with the FORMATION of the PEPTIDE SIDE CHAINS between adjacent strands of PEPTIDOGLYCAN by INHIBITING penicillin-binding proteins…so prevents cross-linking! -
Vancomycin
-BINDS to the AMINO ACID SIDE CHAIN of NAM molecules, INTERFERING with PEPTIDOGLYCAN SYNTHESIS (remember the inter bridge on that you had to draw before?) -
Bacitracin
-INTERFERES with the transport of PEPTIDOGLYCAN PRECURSORS across the cytoplasmic membrane
DISRUPTION OF BACTERIAL CELL WALL
In broad terms, how exactly do drugs that affect the cell wall inhibit growth?
For bacteria to enlarge and divide, a cell synthesizes more peptidoglycan by adding new NAG and NAM subunits to existing NAG – NAM chains, the new NAM subunits then must be bonded to other new nearby NAM subunits.
This is being inhibited when drugs (like Beta-Lactams) prevent the cross-linking between the NAM subunits!
DISRUPTION OF BACTERIAL CELL WALL
In what way do Vancomycin-resistant bacteria form their resistance to the drug?
modifies the cross-bridge of the altered D-alanine adding a lactic acid side chain.
DISRUPTION OF BACTERIAL CELL WALL
After a bacterial cell is treated with a Beta-Lactam drug, what physical changes occur?
The cell loses its membrane integrity, inflating as it is unable to withstand changes in osmotic pressure
DISRUPTION OF PROTEIN SYNTHESIS
What are some of the types of antibiotics that affect ribosomes, and what do they do?
-
Aminoglycosides
-BLOCK the initiation of translation and causes the MISREADING of mRNA -
Tetracyclines
-BLOCK the attachment of tRNA to the ribosome -
Chloramphenicol
-PREVENTS peptide bonds from being formed -
Lincosamides
-PREVENT the continuation of protein synthesis
DISRUPTION OF PROTEIN SYNTHESIS
List 3 ways antibiotics target translation
MUST KNOW 3 FOR THE EXAM!
- Aminoglycosides, like Streptomycin, cause a CHANGE IN THE SHAPE of the 30S subunit, causing the mRNA to be misread - leading to incorrect amino acids being added
- Tetracycline and some Aminoglycosides BLOCK the DOCKING SITE of tRNA, inhibiting translation
- Oxazolidinone PREVENTS the 50S subunit from BINDING to the mRNA
DISRUPTION OF BACTERIAL NUCLEIC ACID SYNTHESIS
How does Sulfonamide inhibit nucleic acid synthesis?
The structure of Sulfonamide is similar to PABA, except that the side chain differs.
- Normally, PABA sits in the active site of an enzyme to allow for the synthesis of FOLIC ACID…this across other steps forms the nucleic acids necessary for DNA and RNA
- Sulfonamide is able to bind into the active site of this enzyme instead due to its similar structure, inhibiting the formation of FOLIC ACID SYNTHESIS…stopping the ability for the necessary nucleic acids to be created for DNA and RNA
What considerations must be made when prescribing an antibiotic?
- Spectrum of Action (broad or narrow?)
- Effectiveness (how well does an antibiotic have on a specific bacteria?)
What is the difference between broad- and narrow-spectrum antibiotics? When would you use each?
Broad-spectrum = antibiotics that target many types of bacteria (gram + and -)
-used when a bacterial infection is suspected, but the group of bacteria is unknown
Narrow-spectrum = antibiotics that target only a few types of bacteria
- used when the causative organism of specific infection is known
What are the advantages/disadvantages of broad- and narrow-spectrum antibiotics?
BROAD:
(+) very powerful and flexible drugs
(+) can used to treat bacterial infections when the infecting bacterium has not yet been identified or remains unknown
(-) attacks normal bacterial flora of the host
(-) is a leading cause of more drug-resistant bacteria
NARROW:
(+) prevent the treatment from causing widespread collateral damage to the body’s good bacteria
(+) less likely to encourage superinfection or produce “superbugs”
(-) identity of the bacterium needs to be known in advance
(-) choosing the wrong drug can result in the patient’s condition worsening when multiple bacteria are in question
Are broad-spectrum antibiotics always better?
No - they can attack the body’s normal bacterial flora and have been shown to lead to more drug-resistant bacteria
REVIEW QUESTION
What chemical structure is responsible for the DISRUPTION of CELL WALL SYNTHESIS in many antibiotics?
Beta-Lactam Rings
List some of the Routes of Administration for antibiotics
-Topical
-Oral
-Intramuscular (IM)
-Intravenous (IV)
Describe the relative concentration of an antibiotic in the blood for the following methods:
- Oral
- Intramuscular (IM)
- Intravenous (IV)
- Oral: lower concentration, decreases over time
- Intramuscular: higher concentration at first, but greatly decreases shortly after
- Intravenous: HIGH concentration, remains constant and continuous until the IV is removed
What are some notable side effects that need to be considered when prescribing antibiotics?
- Toxicity
- Special Cases:
-Tetracycline + Calcium can lead to stained teeth and a malformed skill in an infant
-Pregnancy and breast-feeding - Allergies
- Disruption of Normal Microbiota
-overgrowth of yeast can lead to thrush
-C. diff leads to inflamation in inner lining of large intestine
Essentially, antibiotic resistance is __________
NATURAL SELECTION!
-sensitive organisms are killed or inhibited by an antimicrobial drug
-resistant survivors can multiply without competition
More than 50 million unnecessary antibiotic prescriptions are written each year for patients outside of hospitals.
Why is this?
Many people go to the doctor wanting “something” to feel better, like a pill.
There are no laws on how a doctor can prescribe an antibiotic. However, for a viral infection, an antibiotic does nothing to the patient, its simply some “placebo”
If you were a bacterial cell, what tools would you use to protect yourself from antibiotics?
-Formation of endospores
-Pass resistance from one bacterial strain to another
-Changing the binding site of the antibiotics
-Alter ribosomes into a different shape
List the various Mechanisms of Antibiotic Resistance
BE ABLE TO THINK ABOUT WHAT MECHANISM OF RESISTANCE YOU WOULD USE IN THE PRESENCE OF AN ANTIBIOTIC…WILL BE AN ESSAY QUESTION!
- Production of an enzyme that INACTIVATES the drug (e.g., Beta-Lactamase)
- Altered porins (chromosomal mutation, prevent entry into cell)
- Altered target molecule (chromosomal, drug cannot bind target)
- Changing metabolic activity, which produces MORE of an enzyme or NOT using a pathway
- Efflux Pumps (ejects drug out of cell, R plasmids)
- Biofilms - slower MR and diffusion of the drug
How does Beta-Lactamase inactivate Penicillin?
(these used to be called “Pencillinases”)
BE ABLE TO THINK ABOUT WHAT MECHANISM OF RESISTANCE YOU WOULD USE IN THE PRESENCE OF AN ANTIBIOTIC…WILL BE AN ESSAY QUESTION!
This enzyme, secreted from the bacterial cell, CLEAVES and HYDROLYZES the cyclic amide bond in the beta-lactam ring of penicillin, rendering it INACTIVE
T/F: Mutations can alter the shape of a receptor that transports the drug so that it CANNOT enter the cell
BE ABLE TO THINK ABOUT WHAT MECHANISM OF RESISTANCE YOU WOULD USE IN THE PRESENCE OF AN ANTIBIOTIC…WILL BE AN ESSAY QUESTION!
TRUE
Explain how a bacterial cell may use an alternative metabolic pathway as a mechanism of resistance.
BE ABLE TO THINK ABOUT WHAT MECHANISM OF RESISTANCE YOU WOULD USE IN THE PRESENCE OF AN ANTIBIOTIC…WILL BE AN ESSAY QUESTION!
Some drugs BLOCK the usual metabolic pathway
So, organisms can CIRCUMVENT this by using an ALTERNATIVE, UNBLOCKED, pathway that produces the REQUIRED PRODUCT
This can also be done by producing MORE of an enzyme
Explain what the activation of “drug pumps” does as a mechanism of resistance
BE ABLE TO THINK ABOUT WHAT MECHANISM OF RESISTANCE YOU WOULD USE IN THE PRESENCE OF AN ANTIBIOTIC…WILL BE AN ESSAY QUESTION!
specialized membrane proteins are ACTIVATED and CONTINUALLY PUMP the drug OUT of the cell
Efflux pumps are particularly interesting as a mechanism of resistance but also concerning.
How so?
Some eject MANY DIFFERENT ANTIBIOTICS as well as DISINFECTANTS and ANTISEPTICS
-E. coli has over 35 genes that code for efflux pumps
-Pseudomonas contains 4 families of a 3-protein efflux system
Vertical Evolution is a mechanism for Acquiring Antibiotic Resistance.
Explain this
- A spontaneous mutation occurs in the genome of a bacterial cell (sometimes beneficial or not)
- This cell rapidly divides, and eventually there is a large population of bacteria that contain this mutation within their genomes
Horizontal Evolution is a mechanism for Acquiring Antibiotic Resistance.
Explain this
- A bacterial cell containing an R plasmid attaches to another cell with its F pilus
- The F pilus transfers the plasmid, resulting in these new cells to contain it and become resistant
How is antibiotic resistance transferred from one cell to another? Within a human? Within a community?
- One cell to another? -> horizontal evolution
- Within a human? -> improper use of antibiotics that allows for resistant bacteria to proliferate as part of natural selection
- Within a community? -> spread of germs from surfaces, directly (e.g., coughing), and indirectly (e.g., unclean hands); via animals who retain resistant bacteria that remain in their meat…when not handled/cooked properly it can spread to humans; contamination of water or fertilizer on crops, which make their way into food eaten by humans
How are multi-drug resistant strains created?
By accumulation, on-resistance (R) plasmids or transposons, genes, with each coding for resistance to a specific agent, and/or by the action of multidrug efflux pumps
Is antibiotic resistance inevitable?
Sadly, yes - it is a naturally occurring process.
Resistance can be VERY QUICK! (e.g., took only 3 years for resistance to penicillin)
What are ways to PREVENT the development of resistance?
- Maintain a HIGH enough concentration of the drug for sufficient time in a patient (DON’T STOP ANTIBIOTIC TREATMENT WHEN PRESCRIBED!)
- Drug cocktails - different targets or synergism (or both!)
- DON’T USE ANTIBIOTICS FOR NON-BACTERIAL INFECTIONS!
- Limit the use of certain antibiotics to “save” them for MRD strains
*MRD = multi-resistant drug
So…are we losing the race?
…Yes
-As microorganisms gain resistance to the current anti-microbial drugs, new ones need to be found
What are Virulence Factors?
molecular determinants of VIRULENCE
pathogen components that are NON-ESSENTIAL to in vitro growth in rich media, BUT cause INCREASED virulence during INFECTION OF A HOST
*Virulence Factors are the KEY target of anti-virulence drugs
Are virulence factors “evolution-proof?”
It depends on whether the virulence factors provide an ADVANTAGE to bacteria
i.e., the balance between COST of producing VF and the advantage to the bacterium
What are some examples of “targeting virulence factors?”
- Bicyclic 2-pyridones = inhibits pilus formation in E. coli; prevents interaction of chaperone-pilus complex
- Virstatin = inhibits the expression of cholera toxin and the toxin co-regulated pilus in V. cholerae
- 2-imino-5-arylidene thiazolidinedione = inhibits porins in a wide range of Gram- pathogens
- Urtoxazumab = antitoxin antibody that acts as an inhibitor of Shiga toxin function in enterohaemorrhagic E. coli (still in clinical trials)
READING RESPONSE
What is a zoonotic disease?
disease that is transferred from an animal host to a human
READING RESPONSE
How did human evolution impact viral disease spread?
By settling down and no longer being hunter-gathers, humans were in closer contact with each other.
This along with the domestication of animals served as a breeding ground for bacteria to thrive and infect - it essentially lead to zoonosis and the prevalence of diseases like measles
READING RESPONSE
What two diseases is the Measles virus related to?
Most closely related to 1) Rinderpest virus of cattle and (2) Distemper virus of canine