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Pharm Test 5 > Antimycobacterial Agents > Flashcards

Antimycobacterial Agents Flashcards

1
Q

Antimycobacterial Agents are drugs for

A

tuberculosis

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2
Q

Micobacteria are

A

Slow growing microbes

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3
Q

infections Micobacteria cause

A

require prolonged treatment

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4
Q

prolonged therapy of micobacteria leads to

A

drug toxicity, poor patient compliance with treatment, and the emergence of drug-resistant mycobacteria

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5
Q

how many people are infected worldwide of TB

A

2 billion people

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6
Q

how many people die form TB each year

A

About 2 million (more than any other infectious disease)

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7
Q

when talking about TB how is the US compared to the rest of the world

A

In US new cases have declined since 1992, but in rest of world, new cases on the rise

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8
Q

In US how many people have latent TB

A

In US 9-14 million have latent TB

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9
Q

how many new cases of TB each year

A

9 million new cases each year, most in developing countries

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10
Q

Reasons for increase in TB number

A

AIDS with compromised immune system, increased incidence of crowded living conditions in urban areas, and multidrug-resistant mycobacteria

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11
Q

Those susceptible to TB

A

Alcohol addiction and IV drugs; Debilitative condition (malnourished, severe chronic disorder, cancer) ; AIDS

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12
Q

Tuberculosis caused by

A

by acid-fast bacillus Mycobacterium tuberculosis or tubercle bacillus

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13
Q

Tuberculosis transmitted

A

from one person to another by droplets dispersed in air through coughing & sneezing

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14
Q

The tubercle bacilli are inhaled

A

into the alveoli and can migrate to other organs via the blood and lymphatic system (so not just in the lungs, can go to other organs ex. kidneys but primarily in the lungs)

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15
Q

If body’s immune system is strong

A

phagocytes will stop the multiplication of the tubercle bacilli and the spread

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16
Q

Symptoms of Active TB

A

Anorexia and weight loss; Cough and sputum production; Increased fever; Night sweats; Positive acid-fast bacilli in the sputum ** (diagnostic qualifier)

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17
Q

In most cases of TB bacteria lie

A

dormant and the infected person has no symptoms

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18
Q

what will define the presence of TB

A

Sputum evaluation: microscopic smear and culture; Chest X-Ray

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19
Q

Latent TB is

A

Tubercle bacilli that are present, lying dormant but giving no evidence of signs & symptoms

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20
Q

Who should be tested for Latent TB?

A

hose who have had contact with TB patients; Residents & staff of high-risk populations: (prisons, nursing homes, hospitals, homeless shelters, residential facilities for AIDS patients); Persons who in last 5 years immigrated from country where TB is prevalent; Staff of mycobacteriology labs; Children & adolescents exposed to high-risk adults; Children under age of 4; Those at high risk of progression from latent to active TB

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21
Q

Those at high risk of progression from latent to active TB

A

HIV-infected persons; IV drug abusers; Patients on immunosuppressive drugs for 1 month or more; Patients with CXR findings indication changes consistent with prior TB; Patients with high-risk medical conditions (diabetes, chronic renal failure, leukemia or lymphoma); Clinical conditions associated with weigh loss, intestinal bypass surgery, chronic peptic ulcer disease, malabsorption syndromes, cancer of oropharynx & Upper GI tract, any disorder that inhibits nutritional intake

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22
Q

How Do We test for Latent TB?

A

Tuberculin Skin Test: purified protein derivative (PPD) - an antigen derived from M. tuberculosis

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23
Q

positive TB test information

A

If individual has an intact immune system and has been exposed to M. tuberculosis, the PPD will elicit a local immune response: a region of induration (hardness) around injection site within 48 – 72 hours

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24
Q

Before starting treatment for latent TB,

A

must rule out active TB with sputum, and CXR; Because Active TB requires multi-drug treatment to prevent drug resistance

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25
Q

Latent TB can be treated with

A

with one or two medications

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26
Q

Major impediment to successful therapy of TB:

A

Drug resistance

27
Q

Drug resistance

A

some bacilli are resistant to just one drug; others to multiple drugs

28
Q

Infection with a resistant organism may be acquired through:

A
  1. Contact with person who harbors a resistant bacillus 2. Repeated ineffectual course of therapy (didn’t finish therapy, sloppy technique, took meds longer than should have)
29
Q

How bad is the problem of multi-drug resistance?

A

Increases risk of death from TB (especially among AIDS patients)

30
Q

Cost of treating multi-drug resistant TB

A

$180,000 compared to $12,000 for nonresistant TB

31
Q

biggest problem with treating TB

A

drug resistance

32
Q

Drug combinations w/ treatment of latent TB

A

decrease risk of resistance and decrease incidence of relapse

33
Q

Isoniazid and rifampin

A

very effective against actively dividing bacilli

34
Q

Pyrazinamide

A

most active against intracellular, quiescent bacilli

35
Q

By using combinations of drugs for treatment of TB

A

we increase chances of killing all bacilli, whether they are actively multiplying or dormant

36
Q

Treatment for Active TB usually initiated w/

A

with a FOUR –DRUG regimen: Isoniazid and rifampin WITH pyrazinamide and ethambutol

37
Q

Treatment for Active TB

A

Treatment includes an initial phase (Induction) to eliminate actively dividing bacilli (2 months long) and then a second phase to eliminate “persisters” (4 months) with 2 drugs isoniazid & rifampin

38
Q

Treatment for multi-drug resistant TB

A

Treatment requires at least 3 drugs (maybe 5, 6 or 7); and should continue for 12 to 24 months after sputum converts to normal

39
Q

Primary agent for treatment and prophylaxis of TB

A

isoniazid (INH) Laniazid, Nydrazid

40
Q

isoniazid (INH) Laniazid, Nydrazid

A

Inhibits mycolic acid which necessary for building the mycobacterial cell wall; Bactericidal to mycobacteria that are actively dividing; Given orally or IM

41
Q

Adverse effects of isoniazid (INH) Laniazid, Nydrazid **

A

Peripheral neuropathy: paresthesias (tingling, numbness, burning, pain in hands and feet) clumsiness, unsteadiness and muscle aches also occur (happens because INH induces a deficiency in pyridoxine, vitamin B6) * may need to supplement with Vitamin B6 (50 – 200 mg daily); Hepatotoxicity: due to production of a toxic metabolite; see in older population; Optic neuritis: blurred vision, constriction of visual field, disturbance of color discrimination *report any visual changes; Anemia

42
Q

Use Ionizasid (INH) for

A

9 months for latent TB

43
Q

combination of isoniazid and rifampim take

A

weekly for 3 months; both equally effective; combination is newer and has better response

44
Q

pyriodoxine =

A

B6

45
Q

optic neuritis

A

optic nerve become inflamed

46
Q

INH: Drug Interactions

A

Phenytoin (Dilantin): INH can interfere with metabolism of phenytoin causing phenytoin to accumulate to toxic levels.; Concurrent use of ALCOHOL, Rifampin, & pyrazinamide increase risk of hepatotoxicity

47
Q

if too much Dilantin then become

A

overly sedated and quit breathing, cardiac dysrythmias

48
Q

if urine turns dark yellow then could be problem with

A

liver

49
Q

AST and ALT both involved with

A

liver

50
Q

INH-Teach patients to:

A

Be seen by MD if s/s of hepatitis: anorexia, fatigue, nausea, yellowing of skin or eyes-jaundice; Have serum aspartate aminotransferase (AST) levels drawn monthly; Take vitamin B6

51
Q

Rifampin [Rifadin]

A

Broad spectrum antibiotic;inhibits protein synthesis of bacilli-bacteriocidal

52
Q

Rifampin [Rifadin] best absorbed on

A

empty stomach; given po

53
Q

Rifampin [Rifadin] eliminated by

A

hepatic metabolism; is a powerful inducer of P450 enzymes and can DECREASE levels of many other drugs

54
Q

Rifampin [Rifadin] uses

A

Tuberculosis; Leprosy; Haemophilus influenzae; Legionella

55
Q

Rifampin [Rifadin] adverse effects

A

Hepatotoxicity & Hepatitis (see MD if symptoms; check liver enzymes, avoid alcohol & hepatoxic drugs); Discoloration of body fluids: red-orange color to urine, sweat, saliva, tears, staining of soft contact lens

56
Q

Rifampin [Rifadin] interactions

A

Through enzyme induction, may reduce effects of: oral contraceptives, warfarin, protease inhibiors & non-nucleoside reverse transcriptase inhibitors

57
Q

woman on Rifampin [Rifadin] should

A

use a non-hormonal form of birth control; because it speeds up the metabolism of birth control, so more likely to become pregnant

58
Q

for pt on Rifampin [Rifadin] coumadin dose may need to be

A

increased

59
Q

Ethambutol [Myambutol]

A

bacteriostatic

60
Q

Ethambutol [Myambutol] uses

A

tuberculosis ( active against bacilli that are resistant to INH & rifampin; must use WITH other anti-tubercular drugs

61
Q

Ethambutol [Myambutol] adverse effects

A

Optic neuritis - blurred vision, constriction of visual field, disturbance of color discrimination *report any visual changes; Allergy; Hyperuricemia; gout; May take with food if GI upset occurs

62
Q

Pyrazinamide used in

A

combination therapy

63
Q

Pyrazinamide adverse effects

A

Hepatotoxicity-monitor Aspartate aminotransferase (AST) levels and alanine aminotransferase (ALT) levels; s/s of hepatitis; use with caution in patients taking other hepatotoxic drugs or alcohol

Pharm Test 5 (7 decks)

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