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MNI (immuno pharm) > L31- Nucleic Acid Synthesis Inhibitors > Flashcards

L31- Nucleic Acid Synthesis Inhibitors Flashcards

1
Q

list the nucleic acid synthesis inhibitors

A
  • fluoroquinolones
  • sulfonamides
  • trimethoprims
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2
Q

list the fluoroquinolones (by generation)

A

2nd: Ciprofloxacin
3rd: Levoflozacin
4th: Gemifloxacin, Moxifloxacin

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3
Q

Fluoroquinolones:

  • (narrow/broad) spectrum
  • bacterio-(static/cidal)
  • earlier generations effective against (3) bacteria
  • later generations are more effective against (4) in addition to (3)
A

1- broad
2- bacteriocidal

3- Gram- bacteria
4- Gram+ bacteria (and anaerobes); even broader spectrum

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4
Q

Fluoroquinolone MOA:

  • (1) entry
  • binds to (2) to interfere with (3)
A

1- porins
2- topoisomerase II (DNA gyrase) and IV
3- bacterial DNA replication

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5
Q

Fluoroquinolones:

  • (1) mechanism of resistance
  • effects (2) generation most
  • (presence/absence) of cross-resistance
A

1- chromosomal mutations:

  • encoding subunits of topo. II/IV
  • regulation of efflux pumps

2- 2nd (Ciprofloxacin)

3- present

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6
Q

2nd generation Fluoroquinolones:

  • (1) agents
  • effective against (2) bacteria, especially when paired with (3)
  • drug of choice for (4)
  • treats (5) in CF patients
  • for (6) prophylaxis
A

1- Ciprofloxacin
2- Gram- mostly, some Gram+ / atypicals
3- β-lactams (allows entry into bacteria)

4- Traveler’s diarrhea
5- P. aerugosa
6- meningitis

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7
Q

3rd generation Fluoroquinolones:

  • (1) agents
  • effective against (2) bacteria, especially (3)
  • (4) is the main clinical use
  • (5) are the other uses
A

1- levofloxacin
2- Gram- (improved), expanded Gram+/atypical activity
3- S. pneumoniae

4- CA-pneumonia
5- prostatitis, STD (not syphilis), skin infections, sinusitis, bronchitis, Tb

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8
Q

4th generation Fluoroquinolones:

  • (1) agents
  • effective against (2) bacteria
  • (3) is the main clinical use
A

1- gemifloxacin, moxifloxacin
2- Gram- + even more expanded Gram+ / anaerobic activity
3- CA-pneumonia

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9
Q

discuss the criteria or guidelines for use of Respiratory Fluoroquinolones (indicate agents)

A

Levofloxacin (3rd), Gemifloxacin (4th), Moxifloxacin (4th)- for most common causes of pneumonia in the following situations:

  • 1st line agents have failed
  • other co-morbidities
  • in-patient Tx
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10
Q

Fluoroquinolone Pharmacokinetics:

  • (1) route of administration- (2) may disrupt absorption (similar to what other antibiotic)
  • (3) discuss distribution
  • dosage may be adjusted in (4) Pts
A

1- oral, good F
2- divalent cations (Ca, Fe, Zn)- like with tetracyclines
3- all tissues including bones- like tetracyclines
4- renal dysfunction (not moxifloxacin)

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11
Q

______ is the black box warning for Fluoroquinolones

A

CT issues (tendon ruptures, Achilles mostly) —> avoid in:

  • Pregnancy, Lactation
  • Children <18y/o (unless benefits outweigh risks)
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12
Q

Fluoroquinolone AEs:

  • (1) are minor and common
  • (2) are more serious
  • (3) may occur post-therapy
A

1- GI distress, rash, photosensitivity + CNS (?)

2- peripheral neuropathy; QT prolongation (except Cipro)

3- Superinfection: C. diff, C. albicans, Strep. spp.

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13
Q

list the Sulfonamides

A
  • sulfamethoxazole
  • sulfadiazine
  • sulfisoxazole
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14
Q

Sulfonamides:
-(1) structure which is used to inhibit (2) process in bacteria, affecting (3) enzyme

-effective against (4) bacteria

A

1- PABA (p-aminobenzoic acid) analog
2- folic acid synthesis
3- competitive inhibition of Dihydropteroate synthase (PABA –> DHF)

4- Gram+, Gram- bacteria

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15
Q

describe the mechanisms of resistance for Sulfonamides

A

Plasmids or Mutations:

  • altered dihydropteroate synthase
  • enhanced PABA production
  • dec permeability
  • dec intracellular drug accumulation
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16
Q

discuss the common clinical uses for Sulfonamides

A

In combination due to high resistance:

  • Topical agent for ocular or burn infections
  • Oral agent for simple UTIs (+ trimethoprim)
17
Q

Sulfonamide AEs:

  • (1) minor and common AEs
  • (2) is the major concern, explain mechanism
  • (3) and (4) reactions are also concerns before prescribing
A

1- GI distress, fever, rash, photosensitivity
2- Crystalluria — nephrotoxicity via accumulation in renal failure Pts

3- hypersensitivity (allergy)
4- G6PD def. Pts => hemolysis

18
Q

Sulfonaminde contraindications

A
  • <2mo old (neonates) –> may cause Kernicterus

- many drug interactions —> displaces drugs from albumin binding

19
Q

Trimethoprim:

  • (1) structure allows it to be an inhibitor of (2) enzyme to inhibit (3) synthesis)
  • bacterio-(static/cidal) activity, effective against (5) bacteria
A

1- folic acid analog
2- dihydrofolate reductase (DHF –> THF)
3- purine, pyrimidine, amino acid synthesis

4- bacteriostatic
5- Gram+/- bacteria

20
Q

describe the distribution, elimination of Trimethoprims and how it related to the clinical uses for Trimethoprim

A
  • 80-90% excreted via kidney
  • high concentrations reach prostatic and vaginal fluid

Uses:

  • UTIs
  • bacterial prostatitis
  • bacterial vaginitis
21
Q

Trimethoprim AEs:

  • (1) are the common AEs
  • (2) is the main contraindication
A

1- rash, pruritus

2- pregnancy –> antifolate effects

22
Q

Cotrimoxazole = (1):

  • bacterio-(static/cidal)
  • (3) basic MOA
A

1- trimethoprim + sulfamethoxazole
2- bacteriocidal
3- inhibits sequential steps of THF synthesis and then nucleic acid synthesis

23
Q

Cotrimoxazole:

  • drug of choice for (1)
  • commonly used in (2) Pts for (3) infections
  • (4) are other common infections
A

(trimethoprim + sulfamethoxazole)
1- uncomplicated UTIs

2- immuno-compromised / opportunistic infections:

  • PCP (drug of choice)
  • Nocardiosis (drug of choice)
  • Toxoplasmosis (alternative)

3- URI, ear / sinus infections

24
Q

Cotrimoxazole Pharmaokinetics:

  • (1) route of administration
  • (2) discuss distribution
A

1- oral (sometimes IV)

2- well distributed, including CSF

25
Q

Cotrimoxazole AEs:

  • (1) are common
  • (2) is the major concern
  • (3) inc risk of AEs (what Pts)
  • (4) contraindications
A

1- dermatological or GI issues
2- hemolytic anemia (especially G6PD)
3- AIDS
4- pregnancy / 1st trimester due to folate analog

MNI (immuno pharm) (15 decks)

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