[4] PRELIMS | (P2) ANTIBACTERIAL & ANTI-INFECTIVES Flashcards
PULMONARY TUBERCULOSIS
ETIOPATHOGENESIS:
* Caused by ____
* Most common site for the development of TB is the ____ (____% of patients)
* Most infectious patients: those with ____ and ____
* Typical TB lesion: ____.
- Caused by Mycobacterium tuberculosis
- Most common site for the development of TB is the lungs (85% of patients)
- Most infectious patients: those with cavitary pulmonary disease and laryngeal TB
- Typical TB lesion: epitheloid granuloma with central caseation necrosis.
PULMONARY TUBERCULOSIS
CLINICAL MANIFESTATIONS:
* In the Philippines, cough of ____ should lead to high index of suspicion for PTB.
* Cough may be accompanied by ____, weight loss, ____, ____, chest pain, fatigue and ____
* Absence of fever (does/does not?) exclude TB
* Physical findings are of ____ utility in PTB
- In the Philippines, cough of two weeks or more should lead to high index of suspicion for PTB.
- Cough may be accompanied by night sweats, weight loss, anorexia, unexplained fever and chills, chest pain, fatigue and body malaise
- Absence of fever does not exclude TB
- Physical findings are of little utility in PTB
ANTITUBERCULAR DRUGS
DRUGS USED FOR TUBERCULOSIS
* ____ – 5 mg/kg max 300 mg
* ____ – 10 mg/kg, max 600 mg
* ____ – 25 mg/kg, max 2 g
* ____ – 15 mg/kg
* ____ – 15 mg/kg, max 1 g
- Isoniazid (H/INH) – 5 mg/kg max 300 mg
- Rifampicin (R) – 10 mg/kg, max 600 mg
- Pyrazinamide (Z) – 25 mg/kg, max 2 g
- Ethambutol (E) – 15 mg/kg
- Streptomycin (S) – 15 mg/kg, max 1 g
ANTITUBERCULAR DRUGS
ISONIAZID
* Inhibits ____ synthase and ____ synthesis
* Excellent bactericidal activity against both ____ actively dividing MTB
* ____ against slowly dividing organisms
- Inhibits fatty acid synthase and mycolic acid synthesis
- Excellent bactericidal activity against both intracellular and extracellular actively dividing MTB
- Bacteriostatic against slowly dividing organisms
ANTITUBERCULAR DRUGS
RIFAMPICIN
- Binds to and inhibits ____ thereby blocking ____
- Has both ____, both in dividing and non-dividing MTB
- Also has ____
- Most active ____ available and therefore ____ of first-line TB treatment
- Binds to and inhibits mycobacterial DNA-dependent RNA polymerase thereby blocking RNA synthesis
- Has both intracellular and extracellular bactericidal activity, both in dividing and non-dividing MTB
- Also has sterilizing activity
- Most active antimycobacterial agent available and therefore cornerstone of first-line TB treatment
ANTITUBERCULAR DRUGS
PYRAZINAMIDE
* Exact mechanism is ____ ( ____ may be the primary target).
* More active against ____ than against actively replicating organisms
* Active only in ____ environment (pH ____) and are found within ____
- Exact mechanism is unclear (fatty acid synthetase-I may be the primary target.
- More active against slowly replicating organisms than against actively replicating organisms
- Active only in acidic environment (pH <6.0) and are found within phagocytes or granulomas
ANTITUBERCULAR DRUGS
ETHAMBUTOL
* Inhibits ____ involved in cell wall synthesis, which probably inhibits the formation of ____ and ____
* ____ agent which provides synergy with other drugs
* ____ potent against MTB
- Inhibits arabinosyltransferases involved in cell wall synthesis, which probably inhibits the formation of arabinogalactan and lipoarabinomannan
- Bacteriostatic antimycobacterial agent which provides synergy with other drugs
- Least potent against MTB
ANTITUBERCULAR DRUGS
STREPTOMYCIN
* Inhibits ____ by binding at a site on ____
* ____ against dividing MTB but has only ____ activity
- Inhibits protein synthesis by binding at a site on 30S mycobacterial ribosome
- Bactericidal against dividing MTB but has only low-level early bactericidal activity
ANTITUBERCULAR DRUGS
Treatment Regimen for PTB - Catergory I
* New PTB (____ or ____)
* New extra-PTB (bacteriologically-confirmed or clincally-diagnosed), except ____
- New PTB (bacteriologically-confimrmed or clinically diagnosed)
- New extra-PTB (bacteriologically-confirmed or clincally-diagnosed), except CNS/bones or joints
ANTITUBERCULAR DRUGS
Treatment Regimen for PTB - Catergory I
* Initial Phase - ____
* Continuation Phase - ____
- Initial Phase - 2 HRZE
- Continuation Phase - 4 HR or 4 HRE
ANTITUBERCULAR DRUGS
Treatment Regimen for PTB - Catergory Ia
* New extra-PTB (____)
- New extra-PTB (CNS/bones or joints)
ANTITUBERCULAR DRUGS
Treatment Regimen for PTB - Catergory Ia
* Initial Phase - ____
* Continuation Phase - ____
Treatment Regimen for PTB - Catergory Ia
* Initial Phase - 2 HRZE
* Continuation Phase - 10 HR
ANTITUBERCULAR DRUGS
Treatment Regimen for PTB - Catergory II
- Pulmonary or extra-pulmonary, previously treated ____ (whether bacteriologically-confirmed or clinically-dIagnosed), except ____
- Relapse
- Treatment after failure
- ____ (TALF)
- ____ (PTOU)
- Pulmonary or extra-pulmonary, previously treated drug-susceptible TB (whether bacteriologically-confirmed or clinically-diagnosed), except CNS/bones or joints
- Relapse
- Treatment after failure
- Treatment after Lost to Follow-Up (TALF)
- Previous Treatment Outcome Unknown (PTOU)
ANTITUBERCULAR DRUGS
Treatment Regimen for PTB - Catergory II
* Initial Phase - ____
* Continuation Phase - ____
Treatment Regimen for PTB - Catergory II
* Initial Phase - 2 HZRES and 1 HRZE
* Continuation Phase - 5 HRE
ANTITUBERCULAR DRUGS
Treatment Regimen for PTB - Catergory IIa
* Extra-PTB (____), previously treated, drug susceptible TB (wheter bacteriologically-confimred or clnically diagnosed)
- Extra-PTB (CNS/bones or joints), previously treated, drug susceptible TB (wheter bacteriologically-confimred or clnically diagnosed)
ANTITUBERCULAR DRUGS
Treatment Regimen for PTB - Catergory IIa
* Initial Phase - ____
* Continuation Phase - ____
- Initial Phase - 2 HRZES and 1 HRZE
- Continuation Phase - 9 HRE
ANTITUBERCULAR DRUGS
DRUG-RESISTANT TB
* Standard Regimen Drug-Resistant (SRDR) - ____ or ____
* ____ - exclusively drug-resistant TB
* Alternate TB Treatment Regimen - individualized based on ____ and ____
- Standard Regimen Drug-Resistant (SRDR) - rifampacin-resistant or multi-drug resistant TB
- XDR TB Regimen - exclusively drug-resistant TB
- Alternate TB Treatment Regimen - individualized based on previous treatment courses and drug sensitivity testing
ANTITUBERCULAR DRUGS
Side Effects and Management - Rifampacin
* Gastrointestinal intolerance - give medication at ____
* ____ urine - reassure the patient
* Flu-like symptoms (e.g., fever, muscle pain) - give ____
* ____ - discontinue and refer
- Gastrointestinal intolerance - give medication at bed time
- Orange/Red-colored urine - reassure the patient
- Flu-like symptoms (e.g., fever, muscle pain) - give anti-pyretics
- Thrombocytopenia, anemia, and shock - discontinue and refer
ANTITUBERCULAR DRUGS
Side Effects and Management - Pyrazinamide
* Arthralgia due to ____ - give ____; if symptoms persist, consider ____
- Arthralgia due to Hyperuricemia - give aspirin or NSAID; if symptoms persist, consider gout
hyperuricemia - high uric levels in blood
ANTITUBERCULAR DRUGS
Side Effects and Management - Isoniazid
* Burning sensation in feet (____) - give ____ (vitamin B6) ____ daily for treatment; ____ daily for prevention
* ____ - discontinue and refer
- Burning sensation in feet (peripheral neuropathy) - give Pyridoxine (vitamin B6) 100-200 mg daily for treatment; 10 mg daily for prevention
- Psychosis and convulsion - discontinue and refer
ANTITUBERCULAR DRUGS
Side Effects and Management - Streptomycin
* Pain at injection site - apply ____
* Hearing impairment, ____, and dizziness due to damage of ____ - ____ and refer
- Pain at injection site - apply warm compress
- Hearing impairment, tinnitus, and dizziness due to damage of CN VIII - discontinue and refer