{"id":627,"date":"2009-02-27T13:11:40","date_gmt":"2009-02-27T12:11:40","guid":{"rendered":"http:\/\/www.zdravstvena.info\/vsznj\/?p=627"},"modified":"2010-06-15T14:19:32","modified_gmt":"2010-06-15T13:19:32","slug":"antibiotiki-penicilin-cefalosporin-tetraciklini-kloramfenikol-penicilini-tuberkulostatiki-fungicidi","status":"publish","type":"post","link":"https:\/\/www.zdravstvena.info\/vsznj\/antibiotiki-penicilin-cefalosporin-tetraciklini-kloramfenikol-penicilini-tuberkulostatiki-fungicidi\/","title":{"rendered":"Farmakologija vaja 3.del"},"content":{"rendered":"

\"alexander_fleming-penicilin\"NAJPOGOSTEJ\u0160I STRANSKI\/NE\u017dELENI U\u010cINKI ANTIMIKROBNIH<\/strong> SNOVI<\/strong>
\n<\/strong>2.\u00a0\u00a0 Penicilini <\/strong>:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 alergijske reakcije I in III tipa,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 vsi penicilini kri\u017eno senzibilizirajo in povzro\u010dajo ko\u017eno reakcijo,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 neposredna toksi\u010dnost se ka\u017ee v dra\u017eenju prebavil (ampicilin), kationski toksi\u010dnosti (Na+, K+ soli), u\u010dinek na O\u017d in s superinfekcijami (\u0161iroko spektralni penicilin),<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 raz\u0161irjenost zdravljenja s penicilini je povzro\u010dila nara\u0161\u010danje \u0161tevilnih rezistentnih sojev bakterij in visok odstotek ljudi, ki so na peniciline preob\u010dutljivi.<\/p>\n

<\/p>\n

2. <\/strong>Aminoglikozidi: <\/strong><\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 nefrotoksi\u010dnost ,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ototoksi\u010dnost,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 vestibularna toksi\u010dnost,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 nevromi\u0161i\u010dna blokada,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pogosto povzro\u010dajo alergijo in kontaktni dermatitis,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 v visokih odmerkih zavirajo nevromi\u0161i\u010dni proces in lahko povzro\u010dijo paralizo dihalnih mi\u0161ic.<\/p>\n

3. <\/strong>Tetraciklini:<\/strong><\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 prebavne motnje, sprememba \u010drevesne flore,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pojav superinfekcije,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 kandidaza in enterokolitis,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 nose\u010dnicam in otrokom do 15 leta jih ne dajemo, ker zavirajo rast kosti in obarvajo sklenino,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 lahko povzro\u010dajo fotosenzibilizacijo, ledvi\u010dne in jetrne okvare, ter motnje v ravnote\u017eju,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 injicirani povzro\u010dajo bole\u010dine in tromboflebitise<\/p>\n

4. <\/strong>Kloramfenikol:<\/strong><\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 toksi\u010den za kostni mozeg,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 zavira zorenje eritrocitov, kar je odvisno od odmerka,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 aplasti\u010dna anemija,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pogoste prebavne te\u017eave, kandidaza sluznic ust in no\u017enice,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pri nedono\u0161en\u010dkih, pri katerih glukoriniltransferaza \u0161e ni razvita povzro\u010da sindrom sivih otrok (gray baby sindom), za katerega so zna\u010dilni cianoza , abdominalne te\u017eave in odpoved sr\u010dno \u017eilnega sistema in celo smrt,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 zaradi zavore jetrnih encimov povzro\u010da kloramfenikol interakcije z drugimi zdravili,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 vnetje o\u010desnega \u017eivca.<\/p>\n

5.\u00a0\u00a0\u00a0\u00a0\u00a0 Eritromicin<\/strong>:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 redko hepatotoksi\u010den,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 interakcija s teofilinom ,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 naglu\u0161nost pri visokih odmerkih,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 varen, GIT te\u017eave,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ko\u017eni izpu\u0161\u010daji,<\/p>\n

6. <\/strong>Klindamicin: <\/strong><\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 psevdomembranozni kolitis,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ko\u017eni izpu\u0161\u010daji.<\/p>\n

7. <\/strong>Cefalosporini: <\/strong><\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pogoste kri\u017ene\u00a0 alergijske reakcije med cefalosporini in tudi s penicilini ,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 povzro\u010dajo intoleranco do alkohola,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 zaradi antagonizma z vitaminom K lahko povzro\u010dijo krvavitve,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 povzro\u010dajo bole\u010dino in tromboflebitis,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 gastrointestinalne te\u017eave,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 superinfekcije,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 v kombinaciji z aminoglikozidi so bolj nefrotoksi\u010dni.<\/p>\n

Stranski in ne\u017eeleni u\u010dinki so: alergija, rezistenca, superinfekcija, toksi\u010dnost, u\u010dinki na O\u017d , krvavitve, okvare organov, bole\u010dine, kandidaze, smrt.<\/p>\n

BAKTERICIDNOST, BOKTERIOSTATI\u010cNOST; MIK, MBK<\/strong><\/p>\n

Baktericidnost <\/strong> je sposobnost snovi, da uni\u010di\u00a0 bakteriji bakteriostati\u010dnost – sposobnost snovi, da zavre rast mikoorganizmov.<\/p>\n

Baktericidnost- taki aktibiotiki uni\u010dujejo bakterije.<\/p>\n

Bakteriostati\u010dnost- zavirajo razmno\u017eevanje bakterij.\u00a0 Ne smemo jih kombinirati\u00a0 z baktericidnimi antibiotiki. Mo\u017ena\u00a0 je kombinacija bakteriostati\u010dnih antibiotikov med seboj.<\/p>\n

Baktericidni antibiotiki in kemoterapevtiki : penicilini, cefalosporini, aminoglikozidi.<\/p>\n

Bakteriostati\u010dni\u00a0 antibiotiki: eritromicin, tetraciklin, klindamicin, trimetroprin.<\/p>\n

MIK<\/strong> : minimalna inhibitorna koncentracija- najni\u017eja koncentracija antibiotika ali drugega kemoterapevtika v plazmi, ki \u017ee ustavi razmno\u017eevanje.<\/p>\n


\n<\/strong><\/p>\n

MBK<\/strong>:\u00a0 minimalna baktericidna koncentracija – najmanj\u0161a koncentracija, kjer kemoterapevtik bakterije \u017ee umori.<\/p>\n

<\/strong><\/p>\n

<\/strong><\/p>\n

PENICILINI<\/strong><\/p>\n

Njihova osnovna struktura je beta laktamski obro\u010d. Med seboj se razlikujejo po radikalih, ki dolo\u010dajo antibakterijski spekter in farmakolo\u0161ke lastnosti.<\/p>\n

\n

So baktericidni , zavirajo sintezo bakterijske stene z inhibicijo transpeptidaze. So selektivno toksi\u010dni, motijo sintezo bakterijske stene, ki je celice sesalcev nimajo. Izlo\u010dajo se z urinom, tudi s tubularno sekrecijo, ki jo lahko zavremo in tako zvi\u0161amo koncentracijo antibiotikov v plazmi.<\/p>\n

\n

SKUPINE:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 benzil penicilin je u\u010dinkovit proti streptokokom, pnevmokokom, G- kokom, G + bacilom in spirohetam.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Penicilini so odporni na kislino (dajemo oralno)<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Penicilini odporni na \u03b2 -laktamazo se uporabljajo za zdravljenje infekcij, s stafilokoki, ki tvorijo penicilazo.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0160iroko spektralni penicilini delujejo proti G – bacilom, \u03b2- laktamaza jih inaktivira.<\/p>\n

V kombinaciji z aminoglikozidi delujejo penicilini na G neg. bakterije sinergisti\u010dno.<\/p>\n

Najpogostej\u0161i stranki ne\u017eeleni u\u010dinki so alergijske reakcije prvega in tretjega tipa.<\/p>\n

Vsi penicilini kri\u017eno senzibilizirajo in povzro\u010dajo kri\u017eno alergijo. Neposredna toksi\u010dnost se ka\u017ee v dra\u017eenju prebavil (ampilicilin), kationski toksi\u010dnosti (Na +, K+ soli) u\u010dinkih na O\u017d in s supeinfekcijami (\u0161iroko spektralni penicilini). Raz\u0161irjenost zdravljenja s penicilini je povzro\u010dila nara\u0161\u010danje \u0161tevilnih rezistentnih sojev bakterij in visok odstotek ljudi (do 5%), ki so na peniciline preob\u010dutljivi.<\/p>\n

CEFALOSPORINI<\/strong><\/p>\n

Po kemijski zgradbi so sorodni penicilinom. Njihovo jedro je 7-aminocefalosporanska\u00a0 kislina, ki vsebuje \u03b2- laktamski obro\u010d. Delujejo tudi na stafilokoke, ki tvorijo \u03b2- laktamazo, u\u010dinkoviti so tudi proti G neg bakterijam, E.Coli in Klebsieli.<\/p>\n

SKUPINE:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 prva generacija cefalosporinov (cefadroksil, cefaleksin, cefazolin) se uporablja pri me\u0161anih infekcijah in profilakti\u010dno pred te\u017ejimi operacijami.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Druga generacija (Cefaklor, cefamandol, cefuroksin) za G- bakterije ,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tretja generacija (ceftibuten, cefotaksim, cefpiramid) za G – bakterije,<\/p>\n

Cefolosporine dajemo peroralno, najve\u010dkrat pa parenteralno. Izlo\u010dajo se v urinu s filtracijo in tubularno sekrecijo. Cefalosporini tretje generacije prehajajo v mo\u017egane v zadostni koli\u010dini,da so u\u010dinkoviti pri bakterijskem meningitisu.<\/p>\n

STRANSKI U\u010cINKI:\u00a0 <\/strong><\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pogoste kri\u017ene\u00a0 alergijske reakcije med cefalosporini in tudi s penicilini ,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 povzro\u010dajo intoleranco do alkohola,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 zaradi antagonizma z vitaminom K lahko povzro\u010dijo krvavitve,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 povzro\u010dajo bole\u010dino in tromboflebitis,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 gastrointestinalne te\u017eave,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 superinfekcije,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 v kombinaciji z aminoglikozidi so bolj nefrotoksi\u010dni.<\/p>\n

KLORAMFENIKOL; SINDROM SIVIH OTROK<\/strong><\/p>\n

Je \u0161iroko spektralni bakteriostati\u010dni antibiotik:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ve\u017ee se na 50 S ribosomsko podenoto,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 zavira peptidiltransferazo in s tem moti sintezo beljakovin,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 odpornost nastane s tvorbo acetil transferaze, ki razgradi kloramfenikol.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Indikacije za uporabo so huj\u0161e infekcije s salmonelo in hemofilusom, z meningokoki, z nekaterimi soji bakteriodesov in rikecij.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dajemo ga oralno in parenteralno,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dobro prodira v tkiva, v oko in centralno \u017eiv\u010devje,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zanj je pomemben enterohepati\u010den obtok,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V jetrih se presnavlja z glukuroniltransferazo in se kot glukuronit izlo\u010da v urinu. Pribli\u017eno<\/p>\n

10 %\u00a0 se ga izlo\u010di nespremenjenega.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Toksi\u010den je za<\/span> : kostni mozeg, zavira zorenje eritrocitov, redkej\u0161e aplasti\u010dno anemijo, ki je lahko ireverzibilna, pogoste\u00a0 prebavne te\u017eave, kandidoza sluznice ust in no\u017enice, zaradi zavore jetrnih encimov povzro\u010da kloramfenikol interakcije z drugimi zdravili.<\/p>\n

\n

STRANSKI U\u010cINEK kloramfenikola pri nedono\u0161en\u010dkih, kjer glukuroniltransferaza \u0161e ni razvita povzro\u010da\u00a0
\n<\/strong><\/p>\n


\n<\/strong><\/p>\n

SINDROM SIVIH OTROK<\/strong>. Zanj so zna\u010dilne:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 cianoza,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 abdominalne te\u017eave,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 kardiovaskularni kolaps (odpoved sr\u010dno \u017eilnega sistema)-\u00a0 kar lahko povzro\u010di smrt.<\/p>\n

TETRACIKLINI IN AMINOGLIKOZIDNI ANTIBIOTIKI<\/strong><\/p>\n

TETRACIKLINI
\n<\/strong><\/p>\n

So bakteriostati\u010dni \u0161irokospektralni antibiotiki, ki imajo enoto strukturo \u0161tevilnih\u00a0 bencenskih obro\u010dev. Ve\u017eejo se na 30 S ribosomsko podenoto, onemogo\u010dajo pri\u010drvstitev aminoacilne prena\u0161alne RNK in zavirajo proteinsko sintezo.<\/p>\n

Tetraciklini so u\u010dinkoviti pri infekcijah z :<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 mikoplazmo pnevmonije,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 infekcije s klamidijo, rikecijo<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 so alternativni antibiotiki pri zdravljenju gonoreje in sifilisa<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 u\u010dinkoviti pri zdravljenju respiratornih infekciji in klini\u010dnega bronhitisa<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 zdravljenje aknavosti<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 enteritis (doksiciklin)<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 meningokoknem meningitisu (minociklin)
\n
\n\u0160tevilni bakterijski soji so na tetracikline odporni, kar je posledica pre\u0161iroke uporabe. Odpornost, ki se prena\u0161a s plazmidi je posledica zmanj\u0161ane prepustnosti bakterijske membrane za tetracikline in zmanj\u0161anega privzema antibiotika v bakterijo. Prehajajo skozi placento, v mleko, ne pa tudi v mo\u017egane. Izlo\u010dajo se z \u017eol\u010dem, zato je zanje pomemben enterohepati\u010dni obtok.<\/p>\n

Najpogostej\u0161i neza\u017eeleni u\u010dinki so:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 prebavne motnje,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 sprememba \u010drevesne flore,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pojav superinfekcije<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 kandidoza,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 enterokolitis,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 injicirani povzro\u010di bole\u010dine in tromboflebitise,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 nose\u010dnicam in otrokom do 15 let jih ne dajemo, ker zavirajo rast kosti in obarvajo sklenino.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lahko povzro\u010dajo fotosenzibilizacijo, ledvi\u010dne in jetrne okvare ( i.v.) ter motnje v ravnote\u017eju (minociklin)<\/p>\n

AMINOGLIKOZIDNI ANTIBIOTIKI
\n<\/strong><\/p>\n

Zanje\u00a0 je zna\u010dilna glikozidna vez z aminosladkorjem.<\/p>\n

Kopi\u010dijo se v bakterijah, delno s transportom, ki je odvisen od kisika.<\/p>\n

Ve\u017eejo se na specifi\u010dno receptorsko mesto, ki je na 30 S ribosomski podenoti. Zavirajo sintezo beljakovin, motijo razbijanje kode in lo\u010devanje polisomov.<\/p>\n

Odpornost nanje se pojavi s spremembo prepustnosti membrane\u00a0 ali s spremembo receptorjev. Najpomembnej\u0161a\u00a0 je tvorba ( s plazmidi) acetil, adenil, ali fosforiltransferaz, ki inaktivirajo aminoglikozidne antibiotike.<\/p>\n

Z NJIMI ZDRAVIMO:<\/p>\n

-G- bakterijske infekcije,<\/p>\n

-E. coli, entero bakterije, klebsiele, proteus, psevdomonas, in seraciji (gentamicin, tobramincin, amikocin),<\/p>\n

-Streptokokne infekcije (streptomicin+ penicilin), tuberkuloza in kuga,<\/p>\n

-Alternativno zdravilo za gonokokne infekcije (aminociklitol)<\/p>\n

Aminoglikozidi so topni v vodi, peroralno se ne absorbirajo, te\u017eje prehajajo v tkiva in se ne metabolizirajo. Izlo\u010dajo se z urinom in glomerularno filtracijo.<\/p>\n

STRANSKI U\u010cINKI:<\/p>\n

-so toksi\u010dni za\u00a0 VIII. mo\u017eganski \u017eivec – ototoksi\u010dni,<\/p>\n

-nefrotoksi\u010dni,<\/p>\n

-v visokih odmerkih zavirajo nevromi\u0161i\u010dni prenos in lahko povzro\u010dijo paralizo dihalnih mi\u0161ic,<\/p>\n

-pri bolnikih z obolelimi ledvicami moramo spremljati koncentracijo aminoglikozidnih antibiotikov v plazmi,<\/p>\n

-njihova toksi\u010dnost nara\u0161\u010da z hkratno uporabo diuretikov, ki delujejo na Henlejevo pentljo,<\/p>\n

-pogosto povzro\u010dajo alergijo in kontaktni dermatitis.<\/p>\n

MAKROLIDNI ANTIBIOTIKI <\/strong><\/p>\n

Imenujejo se 12- ,14-, 15- ali 16- \u010dlenskem laktonskem obro\u010du na katerega\u00a0 sta vezana dva aminoskladkroja in nevtralni sladkor.<\/p>\n

Delujejo na\u00a0 G + bacile in koke, na nekatere G- bacile, na nekatere anaerobne in na parazite toksoplazma, kriptosporidio in plazmodije. U\u010dinkoviti so tudi pri mikoplazmi, ureaplazmi in koksieli. Zavirajo sintezo bakterijskih beljakovin tako, da se reverzibilno ve\u017eejo na 50 S ribosomsko podenoto. So bakteriostati\u010dni, v viskoih koncentracijah pa bakteriocidni. Njihov\u00a0 antibakterijski u\u010dinek traja 5 do 9 ur. Makrolidi z izjemo klaritromicina- v nose\u010dnosti niso \u0161kodljivi (skupina b).<\/p>\n

Najpomembnej\u0161i makrolidni antibiotik je ERITROMICIN:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 zavira sintezo proteinov,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 deluje bakteriostati\u010dno in v visokih odmerkih baktericidno,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 odpornost se prena\u0161a s plazmidi in je posledica metilacije receptorja na\u00a0 ribosomski RNK, kar prepre\u010duje vezavo antibiotika.<\/p>\n

–\u00a0\u00a0\u00a0 iz prebavil se nepopolno absorbira.<\/p>\n

–\u00a0\u00a0\u00a0 po telesu se razporeja enakomerno.<\/p>\n

–\u00a0\u00a0\u00a0 izlo\u010da se z \u017eol\u010dem.<\/p>\n

UPORABLJA SE PRI:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 infekcijah z G +koki,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 neiserijo,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 mikoplazmo,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 legionelo,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 deluje na stafilokoke, ki tvorijo beta laktamazo.<\/p>\n

STRANSKI U\u010cINKI:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 prebavne motnje,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 alergijski holostati\u010dni hepatitis,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 vro\u010dina,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 eozinofilija,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ko\u017eni izpu\u0161\u010daji,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 za paciente ,ki so preob\u010dutljivi na penicilin.<\/p>\n

TUBERKULOSTATIKI <\/strong><\/p>\n

So kemoterapevtiki za zdravljenje TBC, jih kombiniramo in tako prepre\u010dujemo rezistentnost in pove\u010dujemo u\u010dinkovitost zdravljenja.<\/p>\n

Zdravljenje tuberkuloze je zahtevno, ker se hitro pojavi odpornost zaradi intraceli\u010dne lege bakterij, predvsem v kazeoznem delu lezije. Zato je treba dajati velike odmerke zdravil. Tuberkolostatike kombiniramo in tako prepre\u010dujemo razvoj rezistence ter pove\u010dujemo u\u010dinkovitost zdravljenja.<\/p>\n

Tuberkulostatitki prvega reda:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 izoniazid ,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 rifampicin,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 etambutol,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 streptomicin,<\/p>\n

Tuberkulostatitiki drugega reda:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 so bolj toksi\u010dni,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 uporabljamo pri infekcijah z mikobakterijam, ki so odporne na tuberkulostatike prvega reda,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 etionamid (pri visokih koncentracijah v plazmi povzro\u010da prebavne\u00a0 in nevrolo\u0161ke motnje),<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 PAS -para amino salicilna\u00a0 kislina (se ne uporablja ve\u010d- stranski u\u010dinki),<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pirazinamid (je u\u010dinkovit vendar hepatotoksi\u010den).<\/p>\n


\n<\/strong><\/p>\n

FUNGICIDI; LOKALNI, SISTEMSKI <\/strong><\/p>\n

Uporabljamo za zdravljenje glivi\u010dnih obolenj. Zdravljenje glivi\u010dnih obolenje je zapleteno, ker so zdravila iz te skupine zelo toksi\u010dna in je zdravljenje dolgotrajno.<\/p>\n

SISTEMSKI FUNGICIDI:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 amfotericin B – ve\u017ee se z ergosterolom, specifi\u010dnim sterolom glivi\u010dnih membram in spremeni prepustnost membran. Uspe\u0161en je pri infekcijah z blastomicetami, kokcidoidi in kriptokokozami,\u00a0 histoplazmo in candido albicans. Dajemo ga i.v. Toksi\u010dni u\u010dinki\u00a0 so pogosti: vro\u010dina, motnje v elektrolitskem ravnote\u017eju, hipotenzija, nevrolo\u0161ki izpadi, okvare ledvic in srca.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flucitozin je predzdravilo, ki postane z\u00a0 deaminacijo aktivno \u0161ele v glivicah. U\u010dinkuje na RNK. Uporabljamo pri sistemskih infekcijah s kriptokoki in candido albicans. Najhuj\u0161i stranski u\u010dinek je reverzibilna toksi\u010dnost za kostni mozeg.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ketokonazol: zdravilo je aktivno pri sistemskih infekcijah z blastomicetami, kokcidoidi, histoplazmozo in candido albicans.Absorbira se iz prebavil, vro\u010dina, mrzlica, po\u0161kodbe jeter in hormonske motnje zaradi motene sinteze steroidov.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mikonazol je imidazol in se uporablja i.v.<\/p>\n

FUNGICIDI PROTI POVR\u0160INSKIM GLIVI\u010cNIM INFEKCIJAM:<\/strong><\/p>\n

a) Sistemski: grizeofulvin:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 u\u010dinkovit pri dermatofitijah in infekcijah s candido albicans,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 prepre\u010duje mitoze, saj se ve\u017ee na mikro molekule,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 iz prebavil se dobro absorbira, njegovo absorcijo pove\u010da hrana bogata z ma\u0161\u010dobami,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 kopi\u010di se v kreatinu, poro\u017eenelem delu ko\u017ee,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 stranski u\u010dinki so glavobol, zmedenost, dra\u017eenje prebavil in okvare jeter,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 je teratogen in kancerogen.<\/p>\n

b) Lokalni: nistatin:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 po\u0161koduje membrane glivic tako, da se ve\u017ee z ergosterolom,<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 pri infekcijah s candido albicans se uporablja lokalno, pri pacientih, ki imajo oslabljen imunski sistem tudi peroralno<\/p>\n

Lokalno uporabljamo naslednje imidazolne fungicide: mikonazol, klotrimazol, tolnaftat, haloprogin, undecilensko kislino.<\/p>\n","protected":false},"excerpt":{"rendered":"

NAJPOGOSTEJ\u0160I STRANSKI\/NE\u017dELENI U\u010cINKI ANTIMIKROBNIH SNOVI 2.\u00a0\u00a0 Penicilini : –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 alergijske reakcije I in III tipa, –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 vsi penicilini kri\u017eno senzibilizirajo in povzro\u010dajo ko\u017eno reakcijo, –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 neposredna toksi\u010dnost se ka\u017ee v dra\u017eenju prebavil (ampicilin), kationski toksi\u010dnosti (Na+, K+ soli), u\u010dinek na O\u017d in s superinfekcijami (\u0161iroko spektralni penicilin), –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 raz\u0161irjenost zdravljenja s penicilini je povzro\u010dila nara\u0161\u010danje … Preberi ve\u010d o Farmakologija vaja 3.del<\/span><\/a><\/p>\n","protected":false},"author":336,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[705],"tags":[728,730,706,3665,735,732,729,733,731,734,736],"class_list":["post-627","post","type-post","status-publish","format-standard","hentry","category-2letnik-farmakologija","tag-antibiotiki","tag-cefalosporin","tag-farmakologija","tag-2letnik-farmakologija","tag-fungicidi","tag-kloramfenikol","tag-penicilin","tag-penicilini","tag-tetraciklini","tag-tuberkulostatiki","tag-vaja-iz-farmakologije"],"_links":{"self":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/627","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/users\/336"}],"replies":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/comments?post=627"}],"version-history":[{"count":0,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/627\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/media?parent=627"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/categories?post=627"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/tags?post=627"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}