10 - Antimycobacterials Flashcards

1
Q

What are some examples of mycobacterial diseases?

A

TB - M. tuberculosis

Leprosy - M. lebprae

Pulmonary, intestinal, lymph nodes - M. avium intracellulare (MAI or MAC)

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2
Q

What are the challenges of mycobacterial therapy?

A

Difficult to kill - only vulnerable to cidal drugs when active

Slow growth - hampers identification/susceptibility testing

Lengthy therapy

Intracellular forms

Chronic disease established before symptomatic

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3
Q

Why might multiply drugs be needed to treat mycobacterial infections?

A

Spontaneous drug resistance can occur and requires multi-drug therapy with cidal drugs to cure.

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4
Q

Describe the cell envelope of mycobacterium?

A

They have a cytoplasmic membrane, a cell wall, and an outer membrane.

The outer membrane contains mycolic acid and arabinogalactan.

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5
Q

What are the first line drugs for TB therapy in the US?

A
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
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6
Q

What drug is cidal for actively growing cells and inhibitors synthesis of mycolic acid? How does it work?

A

Isoniazid (INH)

Activated by the catalase-peroxidase (KatG protein) and targets the enoyl-acyl carrier protein reductase (InhA protein)

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7
Q

What is resistance to isoniazid caused by?

A

Mutations in KatG

Mutations in InhA

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8
Q

When should isoniazid be used?

A

All patients infected with INH-sensitive strains should receive INH if possible.

For treatment of active TB, always given in combination.

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9
Q

What polymorphisms are associated with isoniazid metabolism?

A

Slow and fast acetylators exist.

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10
Q

What are adverse effects of isoniazid?

A

Neurotoxicity, esp/ peripheral neuritis (but can be improved with pyridoxine (VitB6))

Hepatotoxicity (10-20%)

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11
Q

What drug works by binding RNA polymerase B and thereby inhibiting bacterial RNA synthesis?

A

Rifampin

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12
Q

What are adverse effects of Rifampin?

A

Hepatotoxicity

Potent inducer of multiple CYPs, causing increased metabolism of other drugs.

Orange-red color or urine, feces, saliva, and tears

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13
Q

What drug works by interfering with arabinosyl transferase and thereby blocking cell wall synthesis? What is another characteristic of this drug?

A

Ethambutol

It’s tuberculostatic, but doens’t interfere with the cidal effects of other drugs.

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14
Q

What are side effects of Ethambutol? Describe its distribution.

A

Gets to adequate levels in the CSF.

Can cause optic neuritis (5-15%)

NOT hepatotoxic

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15
Q

What drug blocks mycolic acid synthesis by inhibiting fatty acid synthase I? What are important characteristics of this drug?

A

Pyrazinamide (PZA)

Cidal

Important component of short-term therapy, well absorbed-particularly useful for CNS involvement.

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16
Q

What are adverse effects of pyrazinamide?

A

Hepatic damage, especially when combined with rifampin

17
Q

What drug binds to several ribosomal sites to stop initiation and cause mRNA misreading? What is this drug used for?

A

Streptomycin

Usually reserved for the most serious forms of TB

18
Q

What are adverse effects of streptomycin?

A

Ototoxicity - affects both balance and hearing

Nephrotoxicity

19
Q

What are the reasons for simultaneous use of 4 or more drugs to treat TB?

A

Known exposure to drug-resistant strains.

20
Q

What bactericidal drugs are used to treat conventional intracellular and extracellular TB?

A

Isoniazid
Rifampin
Pyranizamide

These are commonly used together because these are -cidal AND intracellular.

21
Q

Describe an atypical mycobacterial infection and how it differs from TB infections?

A

MAC: M. avium-intracellulare complex

MAS is less fatal than TB, so if you find an acid-fast bacilli (AFB) institute an anti-TB regimen until the agent is identified

22
Q

What drug is is used for single-agent prophylaxis of M. avium-intracellulare (MAC) in AIDs patients? What else can this be used for?

A

Rifambutin

Can also be used as an alternate for rifampin in multi-drug treatment of MAC

23
Q

What are the adverse effects of Rifambutin?

A

Similar to rifampin but less frequent.

Drug interactions similar to rifampin, but to a lesser extent (less potent CYP inducer)

24
Q

What cidal drug is part of a multi-drug regimen for treatment of M. avium-intracellulare (MAC) in AIDs patients and can also be used for MAC prophylaxis?

A

Clarithromycin

Cidal

25
What should you do if you have a patient who presents with leprosy (Hansen's disease)?
Consult the national Hansen's Disease Program in Baton Rouge Louisiana - only specialists should treat leprosy
26
What drug is a structural analog of para-aminobenzioc acid (PABA) and inhibits folic acid synthesis? What is this drug used for?
Dapsone Bacteriostatic; used in combo with other drugs. Alternative for prophylaxis and treatment of pneumocystis jiroveci in AIDs pts.
27
What is the metabolism of dapsone?
Similar to isoniazid, there's slow and fast acetylators.
28
What are adverse effects of dapsone?
Hemolytic anemia and methemoglobinemia.
29
What drug binds to DNA and interferes with reproduction and growth? What is the use of this drug and an adverse effect?
Clofazimine Used in combination therapy Can cause red-brown pigment of the skin
30
What is the use of rifampin?
Widely used in combination therapy.
31
What drugs can be used to treat leprosy?
Dapsone Clofazimine Rifampin