Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.

Sulfonamides(1)

11.670 Aufrufe

Veröffentlicht am

  • DOWNLOAD FULL BOOKS, INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... ,DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ,DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ,DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ,DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ,DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ,DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • About 2 years ago, I developed a severe case of vaginal yeast infection that would not let up. The itching, burning and swelling of my labia were simply unbearable. I have purchased several over-the-counter treatments, including Monistat cream to subside the symptoms. While it worked initially, eventually things wore off and left me with an even worse infection than before. The same goes for the antibiotics I took with the advice of my doctor. I felt horrible. After doing some research online, I guessed I had a yeast infection and purchased your program. The results were almost instantaneous. In less than 7 hours, I felt a tremendous relief. Two weeks later and I became completely free from the unbearable vaginal itching, burning, swelling and discharge. Using your methods, I have kept my chronic yeast infection at bay ever since. No more drugs or OTC�s for me. ▲▲▲ https://tinyurl.com/y3flbeje
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • I am so thankful and thrilled to know that someone had found a solution to such a disturbing problem in this country! There are too many women and men that are suffering from this horrendous disease! Before I ordered your program, I used to itch and scratch constantly sometimes all night long. Above all the annoyance it was very embarrassing, especially at work. Since I started your system, I don't use drugs or creams anymore to bring me through the nightmare of yeast infections that was my reality for too long! The constant itching and rashes that sometimes continued for mouths are completely gone. Additionally, the lack of energy and heartburn which I now know were caused by candida overgrowth have also disappeared in a matter of weeks. I feel so rejuvenated and lucky to have found your system. I am also amazed and thankful that your product worked so fast and well. ●●● https://tinyurl.com/y3flbeje
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier

Sulfonamides(1)

  1. 1. SULFONAMIDES Recognized since 1932. In clinical usage since 1935. First compounds found to be effective antibacterial agents in safe dose ranges. Mainstay of therapy before penicillins.
  2. 2. SULFONAMIDES Now largely superceded by antibiotics and trimethoprim-sulfamethoxazole. They continue to occupy a small place in therapy.
  3. 3. Gram-negative Wheel of Bugs Neissseria spp H. influenzae E. Coli (coliforms) Bacteroides spp AnaerobicP. aeruginosa Clostridium spp S. aureus Enterococcus spp Streptococcus spp Gram-positive
  4. 4. FOLIC ACID BIOSYNTHESIS DIHYDROPTERIDINE 2 ATP PYROPHOSPHATE DERIVATIVEDihydropteroate 2HN COOHSynthetase HN SO2NH2 DIHYDROPTEROIC ACID 2 Glutamic Acid DIHYDROFOLIC ACID
  5. 5. BLOOD Protein Bound Kidney MetabolitesOral Other-Sweat, Free Saliva,X Topical Prostatic fluid,Parenteral Stool Body Fluids & Tissues CSF
  6. 6. KERNICTERUS IN THE NEWBORN Displacement of bilirubin from plasma protein binding sites.
  7. 7. METABOLISM O H3 HC C N SO2N RAcetylated sulfonamides-inactive, toxic,and less soluble
  8. 8. EXCRETION They are excreted in the urine partly as the parent and partly as the metabolite. Some sulfonamides are very insoluble in the acid urine.
  9. 9. EXCRETION Half life of the sulfonamides depends on renal function. Dosage should be modified or the sulfonamides should not be used in renal failure.
  10. 10. SULFONAMIDE PREPARATIONS Rapidly absorbed and rapidly eliminated (prototype- sulfisoxazole). Poorly absorbed sulfonamides (sulfasalazine). Topical sulfonamides (sulfacetamide, silver sulfadiazine). Long-acting sulfonamides (sulfadoxine)
  11. 11. CONTRAINDICATIONS
  12. 12. DRUG-DRUG INTERACTIONS Inhibit metabolism of some drugs. Displace certain drugs from plasma albumin.
  13. 13. TRIMETHOPRIM-SULFAMETHOXAZOLE OCH3 2 HN CH OCH3 2 OCH3 80 mg TRIMETHOPRIM 2 HN SO2NH N CH3 O 400 mg SULFAMETHOXAZOLE
  14. 14. COTRIMOXAZOLE Optimal ratio of the two drugs is 5:1 sulfa :trimethoprim.
  15. 15. Synergism
  16. 16. ADVANTAGES Expanded number of organisms inhibited. Bactericidal . Decreased resistance. Decreased toxicity.
  17. 17. THERAPEUTIC USES
  18. 18. hcd2.bupa.co.uk/.../ html
  19. 19. PNEUMOCYSTIS PNEUMONIA(PCP)
  20. 20. PNEUMOCYSTIS PNEUMONIA(PCP) www.learningradiology.com/
  21. 21. PNEUMOCYSTIS PNEUMONIA (PCP) The most common opportunistic infection in advanced AIDS (80% of AIDS patients have at least one episode). Now considered a fungus (P.jurovecii). Multiple infections are often present simultaneously with the PCP.
  22. 22. PROPHYLAXIS Routine prophylaxis has been successful in improving survival. PCP prophylaxis is indicated if the patient has a CD4 T lymphocyte count lower than 200 cells/mm3, or has oral candidiasis regardless of the CD4 count.
  23. 23. TREATMENT OF PCP Early therapy is essential as success of therapy is related to severity of the disease at the time of initiation of therapy.
  24. 24. TMP-SMX Treatment of choice. Oral form used for mild-moderate cases or after initial response to IV therapy and for prophylaxis.
  25. 25. TMP-SMX Excellent tissue penetration. Produces a rapid clinical response.
  26. 26. DRUG INTERACTIONS Same as with sulfonamides
  27. 27. other sulphonamides Sulphonylureas (anti-diabetic agents) Carbutamide Acetohexamide Chlorpropamide Tolbutamide Tolazamide Glipizide Gliclazide Glibenclamide (glyburide) Glibornuride Gliquidone Glisoxepide Glyclopyramide Glimepiride
  28. 28.  Anticonvulsants Acetazolamide Ethoxzolamide Sultiame Zonisamide Dermatologicals Mafenide
  29. 29.  Other Celecoxib (COX-2 inhibitor) Darunavir (Protease Inhibitor) Fosamprenavir (Protease Inhibitor) Tipranavir (Protease Inhibitor) Probenecid (PBN) Sotalol (Beta-blocker) Sulfasalazine (SSZ) Sumatriptan (SMT)
  30. 30.  Diuretics Acetazolamide Bumetanide Chlorthalidone Clopamide Dorzolamide Furosemide Hydrochlorothiazide (HCT, HCTZ, HZT) Indapamide Mefruside Metolazone Xipamide
  31. 31. Viable organisms 6 control 4 sulfonamide 2 0 1 2 3 4 5 6 7 8 9 Time of incubation (hrs)
  32. 32. RESISTANCE Results from multiple mechansims. Altered dihydropteroate synthetase. Cross-resistance among all sulfonamides.
  33. 33. PABA + PteridineDihydropteroate SULFONAMIDESynthetase DIHYDROPTEROIC ACIDDihydrofolate Synthetase DIHYROFOLIC ACID Dihydrofolate Reductase TRIMETHOPRIM TETRAHYDROFOLIC ACID
  34. 34. ADVERSE EFFECTS Hypersensitivity reactions -common  allergic rashes  photosensitivity  drug fever  Stevens-Johnson syndrome
  35. 35.  hypersensitivity reaction to sulfa drugs are rash and hives. However, there are several life-threatening manifestations of hypersensitivity to sulfa drugs, including Stevens–Johnson syndrome, toxic epidermal necrolysis, agranulocytosis, hemolytic anemia, thrombocytopenia, and fulminant hepatic necrosis, among others.
  36. 36.
  37. 37. CRYSTALLINEAGGREGATES,HEMATURIA,OBSTRUCTION
  38. 38. ADVERSE EFFECTS Headache, nausea, vomiting and diarrhea. Hematological effects -anemia, agranulocytosis.
  39. 39. ADVERSE REACTIONS Dermatological reactions including skin rashes. GI (nausea and vomiting).

×