Sulfonamides Flashcards by Iseoluwa Ojo

SULFONAMIDES

The stain sulfonamide is a generic name for derivatives of _________________ (____________).

para aminobenzene sulfonamide

sulfanilamide

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para aminobenzene sulfonamide (sulfanilamide) was the 1st effective chemotherapeutic agent to be employd systemically for the prevention and cure of bacterial infections in man.

T/F

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SULFONAMIDES
para aminobenzene sulfonamide (sulfanilamide) were the main stay of antibacterial chemotherapy before the __________ become genrally available.

penicillin

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SULFONAMIDES

Most of them are relatively (soluble or insoluble ?) in H2O but their sodium salts are readily (soluble or insoluble?) .

Insoluble

Soluble

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SULFONAMIDES

Conc of sulfonamides in body fluids are determined by ________ rather than by _______.

chemical techinicals

bioassay

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SULFONAMIDES

The minimal structural prerequisites for antibacterial action are in __________________.

The ______________ is not essential as such, but the important feature is that the _________________ is ________________.

sulfanilamide itself

SO2 NH2 gaps

sulfur is directly linked to the benzene ring

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SULFONAMIDES

The para-__________ is essential.

NH2gp (N4)

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SULFONAMIDES

_______ of the para –_____ abolishes in-vitro activity; but _______ may occur in vivo with a resulting _________

Acylation

NH2

deacylation

return of potency.

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SULFONAMIDES

EFFECTS ON MICROBIAL AGENTS
Effective against gram ____________________ microorganisms, they are generally Bacterio________ .

both gram – positive & gram negative

static

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SULFONAMIDES

MECHANISM OF ACTION
Sulfonamides are __________ and _______ of ________ and prevent normal bacteria
utilization of it for synthesis of ________________, ploA (Folic acid).

structural analogues and competitive antagonists

PABA

pteroy/glutanic acid

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SULFONAMIDES

MECHANISM OF ACTION

Suphonamides are (competitive or non-competitive?) inhibitors of the bactieral enzyme responsible for the _______ of _______ into ____________

competitive

incorporation of PABA

dihydropletroci acid

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dihydropletroic acid is the immediate precursor of ________

folic acid.

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____________ is the immediate precursor of folic acid.

dihydropletroic acid

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SULFONAMIDES

Sensitive microorganisms are those that _______________, bacteria that can ______________ are not affected.

must synthesize their own PHA

utilize proformed PGA

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Bacterio______ induced by sulfonamides is counter acted by ______ (competitively or non-competitively?)

stasis

PABA

competitively

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sulfonamides

Trimethoprim exerts _____ effect with sulfonamides, it is a potent & selective competitive inhibitor of _________

synergistic

dihydrofolate reductase

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Trimethoprim - inhibitor of dihydrofolate reductase

dihydrofolate reductase Reduces _______ to _________ which is required for _________ reactions, hence sequential blockage.

dihydrofolate

tetralydrofolate

one-carbon transfer

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Antagonists of sulfonamide are ———-, ___________ e.g. _______

PABA

local anesthetic

procain

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procaine is an ______ of _______

ester of PABA

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sulfonamides

Mech of resistance, an altered enzymatic constitution of the _____________ bs(i) an alteration in the _______ that ______ ———-

2) an increased capacity to _______ or ___________

(3) an alternative __________ for ____________

4) an increased production of _________ or ____________

bacterial cell

enzyme that utilizes PABA,

destroy or inactivate the drug

metabolic pathway for synthesis of an essential metabolite

an essential metabolite or drug antagonist.

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ABSORPTION, FATE & EXCRETION of sulfonamides

•It is rapidly absorbed for ______% of an oral dose except for those _____________.

•In urine ______ after a ingestion, variable & unreliable absorbtion from ______,_______,———

70 – 100

designed for their local effect in the GIT

30 mins

vagina, respiratory track, abraded skin.

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All sulfonamides are bound to _______ in variable degree particularly _______.

plasma protein

albumin

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Sulfonamides are distributed throughout _____ tissues and readily _______,______, and _________ fluid up to 50-80% of the simultaneously determined concentration in blood

all

outer pleural peritoneal , synovial, ocular

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Sulfonamides readily attain concentration in foetal tissues sufficient to cause _______________________

both antibacterial and toxic effects

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Sulfonamides The metabolic product, the _______ forms have _____ antibacterial activity but are ________ compared to the ___________ form.

acetylated no equally toxic un acetylated

acetylation of sulfonamides is a function of ________ function and time

hepatic

Sulfonamides __________ is a major factor of excretion of both the acettlated and unacetylated form The rate of excretion ____eases as their pKA ____eases . Tubular reabsorption and secretion also play their role

Glomerular filtration incr; decr

Sulfilsoxazole diolamine in 4% solution or ointment for ______ use in the ____. Sulfamethoxazole – precautions to avoid ________ because of high % of _______, relatively (soluble or insoluble?) form in the urine.

topical; eye crystallnurial; acetylated ; insoluble

Sulfadiazine – _________ urine to decrease tubular reabsorption and increase renal clearance. Sulfasalazine – used in _________ and _______ but recurrence in 1/3 of patients, 1 to 3g dly.

Alkalinize ulcerative colitis & regional enlevitis

___________ in 4% solution or ointment for topical use in the eye. ___________– precautions to avoid crystallnurial b/c of high % of acetylated, relatively insoluble form in the uiwine.

Sulfilsoxazole diolamine Sulfamethoxazole

Sulfasalazine – There is evidence that it alters the intestinal microflra of persons with ulcerative colitis. T/F

F There is no evidence that it alters the intestinal microflra of persons with ulcerative colitis.

Sulfacetamide. It is the ____ - _______ – sublitered derivative •aqueous solubility (1:140) is 90* that of _________. • Used in _________ infections.

N1 – a cetyl sulfadiazine opththalmic

Silver sulfadiazine to silver is released (slowly or rapidly?) from the prep in concentrations that are ________ to the microorganism. •Little ______ is absorbed but _______ concentration may reach toxic levels. •It is used to decrease microbial colonization &incidence of infections of _______ from ______

Slowly selectively toxic Silver ; sulfadiazine wounds from burns.

_________ is used to decrease microbial colonization &incidence of infections of wounds from burns.

Silver sulfadiazine

The trimethoprim- Sulfamethoxazole combination ( ____________) •Trimethoprim is a ____________. •Trimethoprim is __________times more potent than Sulfamethoxazole and effective against gram positive and negative microorganisms although resistance can occur if used alone.

co-trimoxazole di-amino pyridine 20 to 100

The trimethoprim- Sulfamethoxazole combination Which is more potent, Trimethoprim or Sulfamethoxazole

Trimethoprim is 20 to 100 times more potent than Sulfamethoxazole and effective against gram positive and negative microorganisms although resistance can occur if used alone.

The trimethoprim- Sulfamethoxazole combination ( co-trimoxazole) the most efficient ratio against the greatest number of microorganisms is ____ parts Sulfamethoxazole to ___ part trimethoprim

20 One

The trimethoprim- Sulfamethoxazole combination The combination is bacterio____ for some organisms . Resistance formation is (lower or higher?) than to either substances alone

cidal Lower

The combination(co-trimoxazole ) appears to ______ the absorption of ________, PPC of trimethoprim in ______ while sulfamethoxazole takes _______

slow down sulfamethoxazole 2 hours; 4 hours

Sulphonamides therapy is useful in the following cases -______ -_________ -_________ -_______

UTI Bacillary Dysentary Meningococcal Nocardiosis

- Meningococcal : N.meningitidis Rx now with ________,________, or _________ ( _________ for some sensitive strains) because of ____________ to sulfonamides except if ———— to sulfonamides

Penicillin or ampicillion or Cephalosporins chloramphenicol resistance formation sensitivity

PRINCIPLE OF UTI DRUG TREATMENT Pylonephitis + Bacteremia/septiceamia= ___________, __________. ________ (or other quinolones) or other drugs to which the organisms are sensitive for example ________,_________etc

Amoxicill/clavulanic acid cephalosporins Ciprofloxacin gentamicin, sulfonamides

PRINCIPLE OF UTI DRUG TREATMENT ____________+ ________/________= Amoxicill/clavulanic acid, cephalosporins. Ciprofloxacin(or other quinolones) or other drugs to which the organisms are sensitive for example gentamicin, sulfonamides etc

Pylonephitis Bacteremia/septiceamia

PRINCIPLE OF UTI DRUG TREATMENT Mixture of microorganism of organisms can occur also, then sulfonamide may be useful as ________________ when indicated

a co- administered drug

PRINCIPLE OF UTI DRUG TREATMENT _________/________ (Re-infectioin or Bacteraemia) in some cases may justify the use of sulfonamides

Chronic /Recurrent

PRINCIPLE OF UTI DRUG TREATMENT CHRONIC OR RECURRENT CAN BE CAUSED BY __________,______________ , ABNORMALITY OF ______, _________ AND __________

Urolithiasis/Nephrolithiasis, Obstruction TRACT, DIABETES DECREASED URINATION

PRINCIPLE OF UTI DRUG TREATMENT Acute Lower tract INFECTION: pending sensitivity _____________ __________ especially in pregnancy, for nonpregnant, quinolones, sulfonamide, genticin also when indicated.

Amoxicillin/clavulanic acid cephalosporins

Methenamine – URINARY tract antiseptic owes it activity to ________. ____________ of urine promotes its antibacterial action.

formaldehyde Acidification

Methenamine – ________ decomposes in the blood & tissues so no ___________ from aminoria or formaldelyde. Various substances given in addition to keep urine pH _______ e.g _______,_______,_______

So little; systemic toxicity below 5.5 Ascorbic acid, mandelic, lippuric acid.

Methenamine – is a primary drug for UTI is a secondary drug for chronic suppressive Rx. T/F

F F is not a primary drugs for UTI but for chronic suppressive Rx.

Microorganisms develop resistance to formaldehyde. T/F

F Microorganisms do not develop resistance to formaldehyde.

The Quinolones: This & _________ inhibit ________ during bacteria replication.

Nalidixic acid DNA synthesis

Nalidixic acid is bacteri_____ to most gram-negative bacteria in UTI.

cidal

Nalidixic acid : (Poorly or Well?) absorbed from GIT (high or low ?) conc of Nalidixic acid & metabolite (hydroxynalidixic acid) in urine. _______ and _______ are necessary if Treatment last longer than 2 weeks.

Well High LFT & blood tests

Nalidixic acid : ADRs include ____ toxicity, ____ disturbances occasionally

CNS GIT

Which is more potent, oxolinic acid or nalidixic acid.

Oxolinic acid 2 to 4 x more potent than nalidixic acid.

Norfloxacin, ciprofloxacin & perfloxacin good activities against gram-positive and negative orgs. Norfloxacin, ciprofloxacin & perfloxacin can be used for systemic diseases. T/F

T T

________ acid similar in structure to oxolinic acid.

Cinoxacin

Nitrofuratoin. It is a ( natural or synthetic ?) nitrofuran in prevention & treatment of UTI. It is bacteri______ for most susceptible microorganisms at conc of 32 ug/ml or less. (Poorly or Well?) absorbed from GIT. _________ing urine decreases antibacterial activity

synthetic; ostatic Well; Alkalinizing

Nitrofuratoin. Side effects Nausea, vomiting and diarrhoea. _________ is uncommon but a serious side effect.

Chronic active hepatitis

Phenazopyridine HCl – is not a ________ but ________ on the urinary tract & alleviates _____ and _________ (irritation induced)

urinary antiseptic an analgesic dysuria; frequency of urination

Phenazopyridine HCl It colors the urine _______ or _______. GIT upset in ____% of patients.

orange or red 10

Phenazopyridine HCl . Combination available with __________ and _________

sulfisoxazole & sulfamethoxazole.

SULPHONES They are derivatives of ___________________________________ (dapsone, DDS), all of which have certain __________ in commons. They are related chemically to the ———————. E.g. _______ and _______

4, 4-diaminodiphenylsulfone pharm properties sulfonamides Dapsone & sulfoxone sodium.

much of action of sulphones are similar to sulfonamides. T/F

SULPHONES Secondary resistance can occur to Dapsone by ______ especialy __________ particularly with _____ drug therapy. Primary resistance also occurs which can be ______________

M leprae; lepromatous leprosy; single partial or complete

SULPHONES UE – ________ is commonest. ___________ deficiency predisposes to _______. ______________ is also common.

Hemolysis Glucose-6-P04 dehydrogenese hemolysis Methemoglobineria

SULPHONES UE – Anorexia, nausea & vomiting, CNS manifestation, exacerbation of lemomatous leprosy “ __________ ” 5 to 6/52 after start therapy in malnourished people. ________ of treatment may be necessary in the course of treatment

sulfone syndrome Stoppage

Dapsone is (slowly or rapidly?) and almost ________ absorbed from the GIT.

Slowly completely

Sulfoxone is (completely or incompletely ?) absorbed from GIT & (small or large?) amount are excreted in feces.

Incompletely; large

DAPSONE A total of ____% of Dapsone is bound to plasma potency. It is retain in _______ and ______. They are retained in the circulation for a (short or long?) time because of ______________________ hence __________________ is advisable.

70 skin and muscle Long ; intestinal reabsorption from the bile periodic interruption of treatment

Dapsone is ______ in the line & then is genetically determined

acetylated

DAPSONE Dosage: treatment with Dapsone is usually started with (small or large?) amounts & increase, when serious gastric irritation occurs, ________ is given instead.

small sulfoxae Na

Sulfones are active against P. faciparium T/F

Sulfones are active against P. faciparium even used in P falciparium resistant cases combined with __________.

pyrimethamine