Pharm- Sulfonamides

Front 1

What are Sulfonamides used for?

Back 1

antibacterial agent
chemotherapeutic agent
cures/ prevents systemic infection:
tx for: UTI, PCP, sinusitis, bronchitis, otitis, burns and inflammatory bowel dx.

Front 2

Sulfonamides are derivatives of _______?

Back 2

PABA (in sunscreen)

Front 3

What are the 3 classifications of sulfonamides?

Back 3

1. rapidly absorbed sulfonamindes-- short, intermediate and long acting
2.Poorly absorbed-- active in intestinal lumen
3. Special Uses.

Front 4

1. rapidly absorbed sulfonamides

What are the 2 short acting drugs?

Back 4

short acting- 4-8 hrs
sulfi-sox-azole
sulfa-dia-zine

Front 5

1. rapidly absorbed sulfonamides

What is the 1 intermediate acting drugs?

Back 5

intermediate-12-18hrs
Sulfa-methox-azole (Gantanol)

Front 6

1. rapidly absorbed sulfonamides

Long acting

Back 6

Long acting- 7 days

Sulfa-doxine

Front 7

2. Poorly absorbed--
SULFA-SALA-ZINE
Where is it active?
What is it converted to?
What are the adverse effects?
What is it used for?

Back 7

sulfa-sala-zine --> 5-amino-salicylate and sulfapyridine in intestinal lumen.

AE: reversible infertility

Use: inflammatory bowel and rheumatoid arthritis

Front 8

What are the 4 derivatives of 5-aminosalicylate?

Back 8

1.Pen-tasa
2. A-sa-col
3. Ol-sal-azine
4.Ro-wasa

Front 9

Pentasa
Identify release and delivery.

Back 9

controlled release
delivered to entire GI and small bowels

Front 10

Asacol
release and delivery

Back 10

Delayed release --> terminal ileum and beyond

used to treat Ulcerative Colitis

Front 11

Ol-sal-azine

Back 11

prodrug
coupled 5-ASA--> split by intestinal bacteria

Front 12

Rowasa
use?

Back 12

rectal enema and suppositories

used for proctosigmoiditis

Front 13

3. sulfonamides for Special Uses

Name 3

Back 13

1.Sulfa-cet-amine
2.Mafenide
3.Sliver sulfa-diazine

Front 14

Sulfa-cet-amide
Use?

Back 14

tx of opthalamic infections
ie. trachoma

Sulfi-sox-azole- used for topical use in eye

Front 15

Ma-fen-ide
Use?
Side effects?
How do you stop the AE?

Back 15

tx of BURNS

AE: allergy and pain
carbonic anhydrase inhibitor
(para-carboxy-benzenen-sulfonamide- CAI)

Stop Mafenide by infusing Sodium bicarbonate to prevent acidosis.

Front 16

Silver Sulfa-dia-zine
Use?
AE?

Back 16

use: prevent infection of burns and ulcers

AE: rash, itch, allergy

Front 17

What is the mechanism of action of sulfonamides?

Back 17

BACTERIOSTATIC
COMPETATIVE INHIBITOR of dihydropteroate synthase (needed to incorporate PABA > pteridine>DHFA>DHF> folic acid

Sulfonamide is chemically similar to PABA-->incorporated -->dysfn. folic folate

Final elimination- cellular and humoral

Front 18

Describe the Pharmacokinetics of sulfonamides.
absorbed?
biotransformed?

Back 18

absorbed from GI
biotransformed in liver
excreted in urine
displaces bilirubin from albumin--> CNS convulsions
decrease solubility in acidic urine --> precipitation

Can enter CNS, placenta and breast milk (avoid 3rd tri.)
Inactivated by acetylation
biodegradation can be toxic--> renal failure

Front 19

7 therapeutic uses for Sulfonamides.

Drug used to treat UNCOMPLICATED UTI, cystitis

Back 19

Sulfi-sox-azole + Phena-zo-pyridine (pain relief)

ineffective for pseudomonas infection

Front 20

DOC in Toxoplasmosis

Back 20

Sulfa-DIA-zine + Pyrimeth-amine +folinic acid(to prevent megaloblastic anemia)

Front 21

Used to treat nocardia TRACHOMA and LGV

Back 21

short acting sulfas-
sulfa-SOX-azole
sulfa-DIA-ZINE

Front 22

used to treat UTI, RTI and PCP
combination drugs from UTI?

Back 22

Sulfa-METHOX-azole + Tri-METHO-prime (SMZ + TMP)

UTI- add phen-azo-pyridine

Front 23

prophylaxis in malaria

Back 23

Sulfa-DOXINE + Pyri-meth-amine

Front 24

Used for burns and infections

Back 24

silver sulfa-diazine

Front 25

Identify 5 adverse effects of sulfonamide.

Back 25

1. hypersensitivity
2.crystalluria
3. acute hemolytic anemia
4. kernicterus
5. displacement/ competiton of drugs

Front 26

hypersensitivity

Back 26

sensitization to sulfonamide
rash
Stevens-Johnson syndrome
focal necrosis of liver
cross reactivity

Front 27

cystalluria

Back 27

occurs with low soluable and older sulfamides.
ie. Sulfa-diazine (tx for toxoplasmosis +AIDS)

Front 28

acute hemolytic anemia

Back 28

seen in pts with G-6-PD
rarely agranulocytosis, aplastic anemia caused by myelotoxic effects

Front 29

kernicterus (convulsions and seizures)
age?

Back 29

neonates and premature babies with immature BBB.

Sulfonamides displace bilirubin from binding sites --> BBB--> brain--> seizures

Front 30

displacement/competition of drugs

Back 30

sulfonamides complete with METHO-TREX-ATE
Tol-but-amide
Warfarin
Hydantoin for binding sites

and increases plasma levels of these drugs.

Front 31

Identify the drug interactions with sulfonamide.

Back 31

Meth-en-amine
releases formaldehyde in acid mdeia of urine--> form complex with sulfonamide.

Front 32

Identify the Bacterial RESISTANCE to sulfonamides.

Back 32

1. lowered affinity/ sensitivity to dihydro-pteronate synthase

2. increased production of PABA

3. decreased permiability --> less intracellular accumulation

4. increased inactivation- rapid acetylation

Front 33

Fill in the blank:
Trimethoprim is structually similar to ______. It is a weak ____, caught in _____ media --> reaching high [ ] in ____ and _______ fluids.

Back 33

similar to folic acid
is a weak base in acid media
reach high [ ] in prostatic and vaginal fluids

Front 34

SMZ + TMP have _____ effect.
How?
Method of administration?

Back 34

synergistic effects by:
sequential blocade of DHFA and THFA synthesis.

Inhibit dihydro-pteroate synthase and dihydro-folate reductase.

ORAL ADMINISTRATION

Front 35

mechanism of action Sulfa-methox-azole trimethoprime

SMX + TMP

Back 35

sulfamethoxazole--> (-) DHpteroate synthase--?(-) DHFA

Trimethoprime --> (-) DHFreductase--> (-)THFA

leads to impaired DNA synthesis

Front 36

Identify the spectrum of activity of SMZ + TMP

Effective against...
back up drug for...
Alternative drug for...

Back 36

Effective against E.coli, salmonella, PCP & nocardia

back up drug--> strep, staph, diptheria and kelbsiella

alternative drug -->brucellosis
(DOC= Doxy + streptomycin)

alternative drug --> listeriosis
(DOC= ampicillin)

Front 37

What are the adverse effects of TMP +SMZ?

Back 37

megaloblastic anemia
leucopenia
thrombocytopenia

mnemonic- TMP- treats marrow poorly

Jaundice- allergic chol. hepatitis
skin rash, fever, SDJohnson

Front 38

Mnemoniic for TMP/SMX
T-tree
M-Mouth
Z-GIT
SX- syndrome (AIDS)

Back 38

T- tree (respiratory tree)- strep, H influenza, sinitism bronchitis

M- mouth- e.coli, salmonella, shigella --> diarrhea

P-Pee- UTI, prostatitis, urethritis

S- syndrome- AIDS, PCP, Toxoplasmosis

Front 39

Name the 5 antimicrobial agents used in UTI.

Back 39

1. Flouroquinolones 4 generations
2. meth-en-amine mandelate
3. SMZ +TMP
4. sulfonamides
quinolones

Front 40

Fluoroquinolones (4 generations)

Generation 1:
name drugs
spectrum
use

Back 40

nalidixic acid
norfloxacin

used for pathogen of urinary tract

narrow spectrum

Front 41

2nd generation antimicrobials used in UTI

Back 41

cipro-floxacin
o-floxacin-

good for gram neg, gonococcal, mycobac, mycoplasma pneumonia

Front 42

3rd generation

Back 42

lome-floxacin
gati-floxacin
spar-floxin

good against Gram +, MRSA, enterococci

Front 43

4th generation

Back 43

moxi-floxacin
trova-flocacin

broadest spectrum
+ against anerobes

Front 44

Quinolones: mechanism of action

Back 44

inhibits gyrase mediated supercoiling of DNA
post antibiotic effect

effective against gram neg, pos, anaerobic infection.

used on skin, tissue RTI & GI

Front 45

What drugs are used to tx PROSTATITIS?

Back 45

Nor-floxacin
Cipro-floxacin
O-floxacin

Front 46

Drugs Tx for STD

Back 46

Cipro-floxacin
O-floxacin
Fluoroquintalones- gonoccocal and non-(chlamydia)

Front 47

PID Tx drugs

Back 47

O-floxacin + Clindamycin
Metronidazole (anaerobes)

Front 48

name all the therapeutic uses of sulfanimides.

Back 48

prostatitis
STD
PID
Diarrhea
RTI
Travelers diarrhea
anthrax

Front 49

identify the locations of quinolone distribution

Back 49

urine
kidney
lungs
prostate
stool
bile> CSF>bone

Front 50

antiacids can cause ______.
Elimination via ___________.
_________ ---> Obstruction

Back 50

antiacids interfere with adsorption
elimination viw tubular secretion
Probenecid --> obstruction --> toxic [ ] in plasma

Front 51

What causes sulfonamide drug resistance?

Back 51

change in porins
change in reflux pumps
decreased accumulation
change in sensitivity of enzymes
point mutation

Front 52

Identify the adverse effects of sulfonamides.

Back 52

GI irritation
skin rash
PHOTOSENSITIVITY
H/Dizzy
hallucination/ delirium
seizurs
arthalgia
joint swelling (in kids +Fquinolones)
tendinitis

Sparfloxacin --> prolonged QT wave
Trovafloxacin--> hepatotoxic
Fluroquinalones--> increase [plasma] of theophyilline

Front 53

What is methe-namine mandelate used for?
How?
AE?

Back 53

Urinary antiseptic activity
by liberating formaldehyde (pH <5.5)

NO effect at alkaline pH.

AE: gastritis, cystitis,hematuria, frew. peeing

Front 54

Nitrofurantoin
mechanism
excretion
use?
AE?

Back 54

mechanism- reactive intermediates --> damage DNA
Excreted in urine
Use- UTI e.coli

AE:
gastritis, photosensitivity, peripheral neuritis. acute pulm. rxn--> pneumonitis, pulm. fibrosis
hemolysis (G6PD), hepatocellular damage, brown urine

Front 55

Phen-azo-pyridine
use?
overdose?
combination of drugs?

Back 55

used with urinary antiseptics
NO antibacterial agents
Urinary analgestic effect- relieve pain
red and orange pee
overdose--> methemoglobinemia

Phenazo-pyridine combined with sulfisoxazole or sulfamethoxazole and sulfadiazine

Front 56

what are the AE ???
what drugs are involved?

Back 56

cross rxn with penicillin

INHIBIT VIT K --> HYPOTHROM
ce-fa-man-dole
ce-fote-tan
ce-fo-perazone

hemolytic anemia
nephrotixicity