Lecture 18 - Antimicrobial Medications Flashcards
what is an antimicrobial?
a drug that inhibits growth of or kills microbes
what are specific types of drugs within antimicrobials?
antibacterial, antifungal, antiprotozoal, anthelmintic
what is an antiviral?
A drug that interferes with viral replication (viruses)
what is an antibiotic?
a drug that is naturally made by certain microbes against competing microbes, ex: penicillin made by Penicillium mold
who discovered penicillin made by Penicillium mold?
Alexander Fleming in 1928
nowadays, the term “antibiotics” also includes what two things?
semisynthetic (eg. amoxicillin) and synthetic (eg. ciprofloxacin) drugs.
are the terms antimicrobials and antibiotics used interchangeably?
yes, they are just drugs that are affected by microbes
what are antimicrobials toxicity levels?
selective toxicity to microbes
what are the two antimicrobial actions and what do they mean? (-cidal and -static)
Kill: -cidal (eg. bactericidal)
Inhibit growth: -static (eg. bacteriostatic)
what are the two spectrums of activity in antimicrobials?
-Broad spectrum: effective against MORE than 1 group. Example: Gram-positive and negative bacteria.
-Narrow spectrum: effective against ONLY 1 group. Example: Only Gram-positive or negative.
isoniazid’s only effect mycobacteria (made of waxy mycolic acid). what type of spectrum is this?
narrow spectrum
tetracyclines effect Gram-positive, negative, chlamydias, and rickettsias. what type of spectrum is this?
broad spectrum
what are the routes of administration of antimicrobials?
IV, IM, oral, or topical
antimicrobials are distributed in what way?
they can get into tissues. so tissue distribution, metabolism,, and excretion of the drug.
do most drug combinations interact?
no
when drug combinations do interact, what are the two effects?
-Synergistic: the drugs work better together. Example: sulfa drugs + trimethoprim.
-Antagonistic: the drugs DO NOT work together. Example: tetracycline + penicillin.
do Chlamydias/Rickettsias have cell walls? what are they?
no, they do not have cell walls. they are obligate intracellular parasites
can there be adverse effects of antimicrobials? what are they?
Yes:
-Allergies, especially penicillins and sulfas
-Toxic side effects: in rare cases, chloramphenicol attacks bone marrow cells causing anemia.
-Suppresses normal microbiota
can bacteria be resistant to antimicrobials?
yes
what are two types of resistance to antimicrobials and what do they mean?
-Innate: the target isn’t present
-Acquired: resistant due to antibiotic-resistance genes
what are last-resort drugs?
last resort, saved, antimicrobials are only used if nothing else works. examples:
-vancomycin for resistant Gram-positives.
-carbapenem for resistant Gram-negatives.
you test a patient’s infection against 10 antibiotics at standard doses and find that three will work for that infection. what is the most important consideration to further narrow down the antibiotic list for your particular patient?
1. whether the drug is -cidal or -static?
2. whether the drug is oral or injected?
3. whether the patient is allergic to the drug?
4. whether the drug is narrow or broad spectrum?
- whether the patient is allergic to the drug?
how many targets do antibacterial drugs have?
5
what are the 5 targets of antibacterial drugs?
- Cell wall (peptidoglycan) synthesis.
- Cell membrane integrity.
- Protein synthesis.
- Metabolic pathways (folate biosynthesis).
- Nucleic acid synthesis.
how do antibacterial drugs target the cell wall?
by inhibiting peptidoglycan synthesis, causing cell lysis
what are the 3 categories that stop PG synthesis?
- B-lactam drugs (B-lactam rings)
- Glycopeptide drugs
- Bacitracin
what do all three classes that stop PG synthesis do?
they all inhibit cross-linking. they all block PG synthesis and they lyse the cell
what do B-lactam drugs consist of?
-Penicillin and derivatives
-Cephalosporins (5 generations)
-Others, ex. carbapenems
what do glycopeptide drugs consist of / what is an example of glycopeptide drugs?
Vancomycin, which is a last resort drug
what is bacitracin in?
in triple antibiotic ointment (neosporin), G+
what is the spectrum of antibiotics targeting cell wall synthesis?
the spectrum varies from narrow to broad
is targetting cell wall synthesis cidal or static?
Bactericidal since it kills cells by lysis
what is selective toxicity?
when the antibiotics kill the pathogenic cells, but not the host cells
what are two resistances of the target cell wall (PG) synthesis?
- B-lactamases
- Alternate target - mecA gene (in MRSA - methicillin-resistant S. aerues).
B-lactase makes these enzymes that kill the B-lactam antibiotics, which is resistance. List the 3 B-lactamase enzymes and what they are resistant to.
- Penicillinase: kills penicillin.
- Extended-spectrum B-lactamases (ESBL): kill penicillin AND cephalosporins.
- Carbapenemases: kills penicillin, cephalosporins, AND carbapenems.
a. NDM-1 (New-Delhi metallo-B-lactamase).
b. KPC (Klebsiella pneumoniae carbapenemase).
what is the mecA gene in MRSA?
When methicillin kills the cells by targeting an enzyme used to build PG crosslinks.
MRSA encodes for an alternate enzyme MecA that is resistant to the action of methicillin.
what are topicals used in cell wall (PG) synthesis target?
-Used in a concentrated area - does not diffuse away.
-Contains 3 antibiotics - at least 1 will be effective.
Not usually resistant
Antibiotics also target Plasma Membrane (cell membrane) Integrity. What does is cause?
It interferes with the plasma membrane - which causes cell leakage and death
when antibiotic drugs target the cell membrane integrity, does it cause cidal or static?
Bacteriocidal
what is the spectrum for plasma membrane integrity?
Narrow spectrum
is the plasma membrane integrity target selectively toxic?
no - the selective toxicity is not too good
what are examples of drugs that target plasma membrane integrity?
-Polymyxin B (triple antibiotic ointment): Gram-negative; topic only (this is the 2nd antibiotic in Neosporin).
-Daptomycin: Gram-positive; specifically binds to bacterial lipids