41-Antimycobacterial Agents

Question 1

Which dz is known to claim lives every 10 seconds?

Answer 1

TB

Question 2

What are the risk factors for TB?

Answer 2

Foreign born, Immunosuppressed, poverty and malnutrition, IDU, age and gender (male>female), prisons, contact with infected pt

Question 3

What plays a major role in treatment failure for TB?

Answer 3

drug resistance

Question 4

The best treatment for TB is _________ and ________?

Answer 4

Dx and prevention

Question 5

How much dose do you use for a PPD skin test?

Answer 5

0.1cc , circle the spot and will be read 2 days later

Question 6

What is 1/3 of the world infected with?

Answer 6

Latent TB

Question 7

What is the main goal in treatment of TB?

Answer 7

Kill the tubercle bacilli rapidly, prevent resistance, prevent relapse and prevent transmission

Question 8

Would you place a patient with active TB in the general ward?

Answer 8

No, isolation in negative pressure ventilated room is essential.

Question 9

What can immunocompetant patients with emphysema get?

Answer 9

MAC

Question 10

Who else commonly gets MAC?

Answer 10

AIDS patients get MAC and also PNA, bacteremia and lymphadentitis

Question 11

What is leprosy? a.k.a Hansen’s dz

Answer 11

It is a slow progressive chronic dz over decades caused by mycobacterium leprae.

Question 12

Do you have to wait for cx to come back before you start treatment?

Answer 12

No, it takes long for cx to come back. Tx with daily dapsone, clofazamine and monthly Rifampin for 6months

Question 13

What are some ADRs of Dapsone?

Answer 13

Gi disturbances, peripheral neuropathy, optic neuritis, blurred vision, lupus like symptoms and nephrotic syndrome

Question 14

If a leper has G6PD and on dapsone what is this patient at risk to have?

Answer 14

hemolytic anemia

Question 15

What are the first line of drugs you would use for TB?

Answer 15

INH, Ethambutol, Pyrazinamide, Rifampin

Question 16

Second line drugs for TB?

Answer 16

Rifabutin, Rifapentine, Fluoroquinolones, cycloserine

Question 17

Properties of INH?

Answer 17

Taken PO qd, extensively metabolized

Question 18

ADRs of INH?

Answer 18

liver damage, fatal hepatitis (avoid ETOH), peripheral neuropathy (treat with Vit B6)

Question 19

Properties of Enthambutol

Answer 19

Given PO, well distributed and renal adjusted

Question 20

ADRs of Enthambutol?

Answer 20

Optic neuritis, impaired red-green color discrimination, hyperuricemia, gout, hepatitis

Question 21

Properties of Pyrazinamide)

Answer 21

Given PO, Rapid cidal effects, can reduce treatment length to 6months as opposed to 9months

Question 22

ADRs of Pyrazinamide?

Answer 22

Hyperuricemia, gout, Hepatitis, fever, hematologic toxicity

Question 23

Properties of Rifampin?

Answer 23

Given PO, hepatic ally metabolized, undergoes enterhepatic cycling (30% unchanged in urine).

Question 24

Rifampin can be given prophylactically to prevent___?

Answer 24

TB, meningococcal dz, H. flu

Question 25

Why would you never see someone on Rifampin alone?

Answer 25

Because resistance happens rapidly

Question 26

What are some ADRs of Rifampin?

Answer 26

Increased LFTs and hepatitis, renal dz leukopenia, Reddish orange/brown discoloration of saliva, tears and urine, stains contact lens

Question 27

Is Rifampin and inducer or inhibitor of cytochrome P450?

Answer 27

It is an inducer and it increases metabolism of the drug.

Question 28

Properties of Rifapentine?

Answer 28

similar to rifampin and treats TB

Question 29

What can you tell me about Rifabutin?

Answer 29

Active against MAC/TB, used in combo with macrocodes plus enthambutol for 16wks to treat MAC in HIV

Question 30

What combination therapy is necessary to treat MAC?

Answer 30

Clarithromycin, azithromycin, enthambutol, rifabutin, amikacin, streptomycin and quinolones

Question 31

Which two drugs give a metallic taste?

Answer 31

Clarithromycin and metronidazole

Question 32

What do you know about Clofazamine?

Answer 32

Anti-MAC and anti-inflammatory.

Treats TB, MAC and leprosy, prevents erythama nodosum. Highly lipophilic and has a 1/2 life of 70 hrs.

Question 33

ADRs of Clofazamine?

Answer 33

GI distress, photosensitivity, skin discoloration, MM, teratogenic