Anti Tuberculosis Flashcards
Medium for TB culture
Lowenstein Jensen
TB characteristic in colony
Serpentine growth
TB Drugs
Isoniazid Rifampicin Pyrazinamide Ethambutol Streptomycin
Isonicotinic acid hydrazide
Isoniazid
Inhibits mycolic acid
Inhibits the enzyme desaturase (bacilli cell wall synthesis)
Isoniazid
Isoniazid absorption impaired by
intake of antacid
Isoniazid is an enzyme
inhibitor
Isonizid inhibits CYP450 and increases concentration of
Phenytoin
Warfarin
Benzodiazepine
Isoniazid adverse effects
SLE Hepatotoxicity Neurotoxicity (Peripheral neuritis) Rashes Crosses placenta and can cause peripheral neuritis
Antidote for Isoniazid-induced peripheral neuritis
Vitamin B6 Pyridoxine
Metabolites of isoniazid
Acetylisoniazid
Acetylhydrazine
Hydrazine
Most active agent of the TB regimen
Rifampin
Obtained from streptomyces mediterranei
Inhibits B subunit of DNA depedent RNA polymerase
Inhibits RNA/protein synthesis
Rifampin
Rifampin is an enzyme
inducer of CYP450
Used in meningococci, leprosy, Legionnaire’s disease
Rifampin/Rifampicin
Causes red orange urine and tears
Rifampin
Rifampicin SE
Red orange urine and tears
Rash, fever, flulike symptoms
Used for prophylaxis of meningococcemia
Rifampicin
Firstl line for short term TB treatment
Pyrazinamide
Pyrazinecarboxamide
Adverse effect of Pyrazinamide
Hepatotoxicity
Must be enzymatically hydrolyzed to pyrazinoic acid its active form
Pyrazinamide
Unknown mechanism
Bacteriostatic
Inhibition of mycobaterial arabinosyl transferase enzyme
Inhibits arabinoglycan (important for bacilli cell wall synthesis)
Ethambutol
Ethambutol can cause
Optic neuritis and
Loss of ability to discriminate between red and green
Structural analog of isoniazid
Ethionamide
Used in treatment of isoniazid resistant TB
Ethionamide
Ethionamide AE
Gastric irritation
Helatotoxicity
Peripheral neuropathy
Optic neuritis
2nd line anti-TB drug that is a structural analog of isoniazid
Ethionamide
Rifampicin Major SE
Red orange secretion and urine
Isoniazid Major SE
Peripheral neuritis
Pyrazinamide Major SE
Inc uric acid
Hepatotoxicity
Ethambutol Major SE
Visual problems
Streptomycin Major SE
Ototoxic
Only aminoglycoside used for TB
First antibiotic effective in the treatment of tuberculosis
Bactericidal for actively dividing intracellular mycobacteria
Streptomycin
Streptomycin AE
Ototoxicity
Nephrotoxicity
Drugs used in the treatment of Leprosy
Dapsone
Clofazimine
Rifampicin
PABA antagonist
Sulfonamide
Dapsone
Dapsone SE
GI irritation
Methemoglobinemia
Hemolytic anemia (G6PD deficiency)
Basic red dye used in the treatment of leprosy including dapsone-resistant forms
Clofazimine
All first line TB meds are bactericidal
EXCEPT
Ethambutol (Bacteriostatic)
Only IV antiTB first line drug
Streptomycin
Resistance to more than one drug but not the combination isoniazid and rifampicin
Poly-resistant
Second line anti TB drugs
Ethionamide* Prothionamide Cycloserine Fluoroquinolone* Terizadone Para-aminosalicylic acid Thiacetazone Clofazimine Amikacin* Kanamycin* Capreomycin *
Nove generation anti TB
Delamanid
Pretomanid
Bedaquiline
Enzyme required for cel wall synthesis inhibited by isoniazid
Desaturase
Isoniazid side effect
Iron accumulates in mitochondria (Sideroblastic anemia)
Neuritis/neuropathy (Vit B6 Pyridoxine supplement)
Hepatitis
Psychosis and other CNS symptoms
Drug induced Lupus
Arthritis Rash Photosensitivity Fever Myalgia
Drug induced Lupus
Drug induced lupus associated with antibodies
Antihistone antibody
Drug Induced Lupus
HIP POP MCS
Hydralazine Isoniazid Procainamide Phenytoin Oxcarbazepine Propafone Minocyclin Carbamazepine Sulfonamide
Ethambutol dose
15mg/kg/day
Ethambutol SE
Retrobulbar optic neuritis
Optic neuritis
Barrel vision
Red oranfe Blindness
Ethambutol dose related optic neuro
15 mg 1% optic neuropathy
25 mg 5% optic neuropathy
50 mg 15% optic neuropathy
Onset in 1 month
Recovery on discontinuing of drug; rarely permanent
Pyrazinamide Mechanism
Pyrazinamidase deaminates pyrazinamide into pyrazinoic acid killing mycobacteria and inhibits Fas (inhibit growth mycobacteria)
Nicotinamide analog
Bactericidal for actively dividing intracellular mycobacteria
Main effect occur in a few months
Pyrazinamide
Binds 30s ribosomes
False pair of codon:anticodone
False reading of genetic cord
Inhibit protein synthesis
Streptomycine
Derived from nitro-dihydroimidazooxazole class of compounds that inhibits mycolic acid synthesis of bacterial cell wall
Treatment of MDRTB and extensively drug resistant TB
Delamanid
Treatment of multidrugresistant TB
Inhibits mycobacterial adenosine triphosphate synthase
Bedaquiline
