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Year 2 Pharmacology > Antimycobacterial agents > Flashcards

Antimycobacterial agents Flashcards

1
Q

what is the shape of mycobacteria?

A

rod

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2
Q

what is incorporated into the cell wall of mycobacteria?

A

mycolic acids

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3
Q

what is the gram stain of mycobacteria?

A

poor gram stain, or not at all

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4
Q

what is the stain used for mycobacteria?

A

acid fast

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5
Q

which bacterial organism is stained using an acid fast stain?

A

mycobacterium

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6
Q

where do mycobacteria replicate?

A

macrophages

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7
Q

what is the route of transmission for m. tuberculosis?

A

respiratory droplets

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8
Q

what type of organism is present in patients with latent TB infection?

A

inactive, contained tubercle bacilli

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9
Q

what type of organism is present in patients with TB disease?

A

actie, multiplying tubercle bacilli

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10
Q

what organisms are included in m. avium complex (MAC)?

A

m. avium

m. intracellulare

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11
Q

what can MAC cause?

A

pulmonary disease in immuno-competent individuals, and disseminated disease in AIDS patients

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12
Q

what is the route of transmission for MAC?

A

ingestion of contaminated food and water

respiratory droplets

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13
Q

what is the most active drug used in the treatment of TB (active and latent)?

A

isoniazid

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14
Q

isoniazid shares structural similarity with what vitamin?

A

B6 (pyridoxine)

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15
Q

what is the MOA of isoniazid?

A

inhibits synthesis of mycolic acid - covalently binds with at least two proteins involved in mycolic acid synthesis

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16
Q

what are the two mechanisms of resistance in isoniazid therapy?

A

mutation in Kat G gene - lack of prodrug activation

overexpression of Inh A protein - cannot inhibit mycolic acid synthesis

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17
Q

what is essential in active TB treatment?

A

at least two antiTB agents always be used

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18
Q

how is isoniazid absorbed?

A

GI tract

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19
Q

what are the adverse effects of isoniazid?

A

hepatitis

peripheral neuropathy

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20
Q

what is the first line treatment for active TB?

A

rifampin

21
Q

rifampin is also effective against what other organisms?

A

gram positive
gram negative
chlamydia

22
Q

what is the MOA of rifampin?

A

inhibits RNA synthesis
binds to bacterial DNA dependent RNA pol
penetrates most tissues, and phagocytic cells

23
Q

what is the mechanism of resistance for rifampin?

A

point mutations in bacterial RNA pol gene

24
Q

how is rifampin absorbed?

A

GI tract

25
Q

what are the adverse reactions to rifampin?

A

GI
nervous system - headache, dizziness, fatigue
hepatitis
harmless, red-orange urine, feces, sweat, tears, saliva

26
Q

what are the important drug interactions of rifampin?

A

strong inducer of cyp450s - increases elimination of many drugs and drug classes

27
Q

in HIV patients rifampin should be replaced by what drug? why?

A

rifabutin

less potent inducer of cyp450 enzymes

28
Q

rifabutin should replace rifampin in treatment of TB for what population?

A

HIV

29
Q

what is pyrazinamide?

A

used in multidrug regimen in treating active TB

30
Q

what is the proposed MOA of pyrazinamide?

A

inhibition of mycolic acid synthesis

31
Q

what is the mechanism of resistance for pyrazinamide?

A

mutation in pyrazinamidase enzyme

32
Q

what are the adverse reactions to pyrazinamide?

A

hepatotoxicity

hyperuricemia

33
Q

what drug is used in combination therapy for active TB and m. avium infection?

A

ethambutol

34
Q

what is the MOA of ethambutol?

A

inhibits arabinosyl transferases (mycobacterial cell wall synthesis)

35
Q

what is the MOR of ethambutol?

A

point mutations in genes encoding arabinosyl transferase

36
Q

what are the adverse reactions of ethambutol?

A

retrobulbar neuritis

hyperuricemia

37
Q

what is the indication for streptomycin in TB therapy?

A

TB caused by strains resistant to other first line drugs

38
Q

what is the MOA of streptomycin?

A

interferes with bacterial protein synthesis

39
Q

streptomycin is effective against which TB organisms?

A

m. tubuerculosis

MAC species

40
Q

what is the MOR of streptomycin?

A

point mutations in ribosomal proteins

41
Q

what are the adverse reactions of streptomycin?

A

ototoxic

nephrotoxic

42
Q

what is the MOA of rifabutin?

A

inhibition of RNA polymerases

43
Q

rifabutin is more effective against what organisms?

A

MAC organisms

44
Q

what is the combination therapy for MAC organisms?

A

macrolide (clarithromycin, azithromycin)
rifampin (or rifamycin)
ethambutol
streptomycin

45
Q

what is the combination therapy for MAC disseminated disease?

A

macrolide (clarithromycin, azithromycin)
rifampin (or rifamycin)
ethambutol

46
Q

what is the treatment for prophylaxis in HIV patients?

A

clarithromycin or azithromycin

47
Q

what is the treatment for leprosy?

A

dapsone
clofazimine
rifampin

48
Q

dapsone is a structural analog of what compound?

A

PABA

49
Q

what is the MOA of dapsone?

A

competitive inhibitor of folate synthesis

Year 2 Pharmacology (70 decks)

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