2. Antimycobacterial drugs Flashcards

1
Q

1st line Tuberculosis treatment

A

**“RIPE” - “4 FOR 2 AND 2 FOR 4”

R**
ifampin
Isoniazide
Pyrazinamide
Ethambutol

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2
Q

Rifampin

A
  • rifampin activated CYP P450
  • rifampin bind to bacterial DNA dependent RNA polymerase deactivates it - this is where resistance will develop if used alone.
  • Rifampin prophylactic monotherapy in close contacts of H. FLU and N. Meningitides
  • Hepatotoxic in RIPE therapy
  • Rifampin may produce orange body fluids
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3
Q

Isoniazide

A
  • INH inhibits cytochrome P450
  • primary TB (often presents as middle lobe cavity)
  • INH can be used alone to treat latent TB infections
  • administration of INH and pyridoxine (vitB6) prevents peripheral neuropathy

-INH is activated by catalase-peroxidase (KatG)
(tail makes a G Shape)

  • resistance to INH by downregulating KatG
  • INH works at the bacterial cell wall inhibiting mycolic acid production
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4
Q

Isoniazide

side effects

A
  • INH promotes excretion of Vit B6 causing peripheral Neuropathy is caused by a Vit B6 deficiency
  • INH may cause seizures
  • hepatotoxicity associated with all RIPE therapy drugs
  • INH causes an asymptomatic rise in aminotransferases
  • INH may cause drug induced lupus
  • INH may cause anion gap metabolic acidosis
  • INH metabolized by the liver enzyme N acetyltransferase – slow acetylators have higher risk of side effects
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5
Q

Ethambutol

A
  • blocks arabinosyl transferase, inhibiting carbohydrate formation at the cell wall
  • ethambutol is bacteriostatic
  • optic neuritis (red -green blindness)
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6
Q

Pyrazinamide

A
  • moa same as Isoniazide
  • pyrazinamide may cause hyperuricemia and needle shaped uric acid crystal formation

Yell ball on toe: pyrazinamide may precipitate gout attacks

  • can be hepatotoxic
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7
Q

2nd line treatment

A

**“C-PEARL” (F)

C**
ycloserine

  • *P**as ( para amino salicylic acid)
  • *E**thionamide
  • *A**mikacin
  • *R**ifabutin
  • *L**inezolid

Fluoroquinolones

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8
Q

Mycobacterium avium treatment

A
  • a macrolide (azithromycin or clarithromycin) combined with ethambutol for MAC infections
  • MAC is a common cause of disseminated disease in AIDS patients
  • macrolide prophylaxis for MAC when CD4 <50

-Rifabutin
(may be added as a third agent to combat MAC infections)

  • rifampin and rifabutin activate CYP450
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9
Q

Mycobacterium Leprae - LEPROSY

A

Dapsone
Rifampin
Clofazamine

——————————————————————————-
- agranulocytosis

  • hemolytic anemia in G6PD deficiency
  • bite cells and Heinz bodies seen in RBC’s
  • leonine facies seen in lepromatous leprosy
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