Pharmacology 1st year

1. GROUP - E

2.  UTI is a microbial invasion or presence of organism under multiplying
condition in urinary tract.
 They are mainly of two types :-
A)Upper UTI
includes pyelonephritis and ureteritis .
B)Lower UTI
cystitis and urethritis
Causative organism :
E.coli , Klebsiella , Proteus , Pseudomonas , Staph. Saprophyticus , Herpes
Simplex virus , Adenovirus , Candida spec. ,Trichomonas vaginalis .

3.  Majority of acute infections caused by E.coli while chronic & recurrent
maybe mixed infections.
 Three days regimen is considered optimal for lower UTI while Upper
UTIs require more aggressive & longer treatment
 Bacteriological investigations are important for the choice of drug for
which urine is collected before commencing therapy.
 Least toxic & cheaper AMA that doesn’t disrupt the normal gut &
perineal flora is preferred

4. RIBOSOMAL
SUBUNIT AND
INHIBIT
PROTEIN
SYNTHESIS
30S
30S
50S
50S
Tetracycline
Gentamicin
Chloramphenicol
Macrolides

5. CellWall Synthesis
Inhibitor
Penicillin Cephalosporins
3) NUCLEI ACID SYNTHESIS INHIBITOR -
• Fluoroquinololes : Inhibit DNA replication
• Cotrimoxazole : Inhibit folic acid synthesis

6.  First quinolone, nalidixic acid is seldom employed
 First generation fluoroquinolones highly effective
MOA :-
DNA Gyrase in
gram – negative and
Topoisomerase IV
in gram positive
bacteria
Nicking, formation
Of negative super-
Coils and resealing
Of strands of DNA

7. • Useful in treatment of complicated UTI
• Contraindicated in pregnancy
• ADR :
Nausea , vomiting , Abd. discomfort , headache ,
insomnia , hypersensitivity reactions ,tenosynovitis and
tendon rupture

8.  Fixed dose combination of Sulfomethoxazole &Trimethoprim in
the ratio 5:1
 MOA :
PABA
DHFA
THFA
SULPHONAMIDE
TRIMETHOPRIN
FOLATE SYNTHASE
DHF REDUCTASE
 USES: Empirically in acute UTI
 Contraindicated in pregnancy

9.  MOA:
Binds to penicillin binding protein (PBP) & thus prevents the
transpeptidation
 Ampicillin/Amoxicillin :
• Most frequently used AMA in severe complicated UTI in combination with
Clavulanic acid
 Cephalosporin :
• Third generation used especially in women with Nosocomial infections
caused by Klebsiella & Proteus.
• Used a empirical treatment of acute lower UTI

10.  Gentamicin :
o Binds to 30s ribosomal subunit
o In acute pyelonephritis, Gentamicin + Coamoxiclav used
empirically
 Chloramphenicol:
o Binds to 50s ribosomal subunit
o Use restricted to pyelonephritis due to its toxicity.

11.  METHENAMINE
MOA:
Methenamine Formaldehyde + Ammonia
 Formaldehyde inhibits both gram positive and negative
organism and produces bactericidal activity .
 Ineffective against urea splitting organisms ( proteus spec.)
 USES :- Chronic suppressive therapy in recurrent UTI
 ADR : Nausea , vomiting , diarrhea , hematuria at high dose
(Prodrug) (active antiseptic)
(mandelic acid makes
The urine acidic)
(pH < 5.5)

12. NITROFURANTOIN
MOA:
Susceptible organism reduces nitrofurantoin into active metabolite which
damages the DNA.
 Bacteriostatic but bactericidal at high concentration.
 More active in acidic ph.
 Effective for prophylaxis of UTI due to E.Coli
 ADR :
Nausea , vomiting , diarrhea , hypersensitivity reactions

13.  PHENAZOPYRIDINE
MOA :
 Is a dye and has analgesic action & provides symptomatic relief in
urinary tract.
 Makes the urine orange red which is harmless
 ADR:- Occasionally nausea and vomiting

14. THANKYOU!!