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Pharmacology > Antimycobacterial Drugs > Flashcards

Antimycobacterial Drugs Flashcards

1
Q

Test the TB EXPOSURE

A

Mandoux (Mendel-Mantoux) Test/ Tuberculin Skin Test/ Purified Protein Derivative

TYPE IV HYPERSENSITIVITY

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2
Q

MOA of Rifampicin

A

(-) DNA-dependent RNA polymerase –> (-) RNA production

BACTERICIDAL

NUCLEIC ACID

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3
Q

Side effects of Rifampicin

A

Red-orange body fluids

Hepatotoxic

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4
Q

Mechanism of Resistance in Rifampicin

A

rPOB gene

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5
Q

MOA of Isoniazid

A

(-) mycolic acid synthesis

BACTERICIDAL

CELL WALL

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6
Q

Side effects of Isoniazid

A

hepatitis
neurotoxic (peripheral neuropathy) - give PYRIDOXINE (B6)
drug induced lupus

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7
Q

Mechanism of Resistance in Isoniazid

A

KATG gene

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8
Q

MOA of Pyrazinamide

A

Converted to PYRAZINOIC ACID (active form) under the acidic conditions of macrophage lysosomes

BACTERIOSTATIC
BACTERICIDAL - actively dividing cells
STERILIZING AGENT

INTRACELLULAR

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9
Q

Mechanism of Resistance in Pyrazinamide

A

pnCA gene

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10
Q

Side effects of Pyrazinamide

A

MOST HEPATOTOXIC

HYPERURICEMIA

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11
Q

MOA of Ethambutol

A

(-) ARABINOSYL TRANSFERASE
involved in the synthesis of arabinogalactan in mycobacterial cell wall

BACTERIOSTATIC

CELL WALL

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12
Q

Mechanism of Resistance in Ethambutol

A

embCAB gene

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13
Q

Side effects of Ethambutol

A

visual disturbances - optic neuropathy

RED-GREEN color blindness

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14
Q

MOA of Streptomycin

A

(-) protein synthesis by (-) 30s subunit

EXTRACELLULAR

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15
Q

Side effects of Streptomycin

A

nephrotoxic
ototoxic
congenital deafness
VESTIBULOTOXIC

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16
Q

Kills actively multiplying organisms

A

Bactericidal

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17
Q

All 1st line are bactericidal EXCEPT

A

ETHAMBUTOL - bacteriostatic

18
Q

Ability to KILL all remaining organisms

A

STERILIZING

steRiliZing

RIFAMPICIN
PYRAZINAMIDE

19
Q

Last resort in the treatment of MDR-TB

A

Clofazimine

20
Q

Novel anti-TB meds that (-) mycobacterial ATP synthase (complex V of ETC)

A

Bedaquiline

21
Q

Novel anti-TB meds that (-) mycolic acid synthesis

A

Delamanid

22
Q

MOA of Dapsone

A

(-) folic acid synthesis

BACTERIOSTATIC

leprosy, PCP

23
Q

Most active drug against M. leprae

A

Dapsone

24
Q

Binds to GUANINE bases in bacterial DNA

A

Clofazimine

BACTERICIDAL

25
Q

Treatment for atypical mycobacterium

A

Azithromycin or Clarithromycin
PLUS
Ethambutol AND
Rifabutin

26
Q

Prophylaxis for atypical mycobacterium

A

Azithromycin or Clarithromycin
+/-
Rifabutin (in px CD4 <50)

27
Q

A 45-year-old homeless man presents to the emergency department with fever, weight loss, and a productive cough. Chest x-ray shows right apical infiltrate and TB is suspected. He is started on empiric INH, rifampin, and pyrazinamide.

The primary reason for the use of drug combinations in the treatment of this patient’s TB is:

(A) Delay or prevent the emergence of resistance
(B) Ensure patient compliance with the drug regimen
(C) Increase antibacterial activity synergistically
(D) Provide prophylaxis against other bacterial infections
(E) Reduce the incidence of adverse effects

A

(A) Delay or prevent the emergence of resistance

28
Q

On her release from the hospital, the patient is advised not to rely solely on oral contraceptives to prevent pregnancy because they may be less effective while she is being maintained on antimycobacterial drugs.

The agent most likely to interfere with the action of oral contraceptives is

(A) Amikacin
(B) Ethambutol
(C) Isoniazid
(D) Pyrazinamide
(E) Rifampin
A

(E) Rifampin

Rifampin induces the formation of several microsomal drugmetabolizing enzymes, including cytochrome P450 isoforms.

This action increases the rate of elimination of a number of drugs, including anticoagulants, ketoconazole, methadone, and steroids that are present in oral contraceptives. The pharmacologic activity of these drugs can be reduced markedly in
patients taking rifampin

29
Q

A patient with AIDS and a CD4 cell count of 100/µL has
persistent fever and weight loss associated with invasive pulmonary disease due to M avium complex (MAC).

Optimal management of this patient is to

(A) Choose an antibiotic based on drug susceptibility of the cultured organism
(B) Initiate a two-drug regimen of INH and pyrazinamide
(C) Prescribe rifabutin because it prevents the development of MAC bacteremia
(D) Start treatment with the combination of azithromycin, ethambutol, and rifabutin
(E) Treat with trimethoprim-sulfamethoxazole

A

(D) Start treatment with the combination of azithromycin, ethambutol, and rifabutin

30
Q

A 10-year-old boy has uncomplicated pulmonary tuberculosis. After initial hospitalization, he is now being treated at home with isoniazid, rifampin, and ethambutol.

Which statement about this case is accurate?

(A) A baseline test of auditory function test is essential
before drug treatment is initiated
(B) His mother, who takes care of him, does not need INH prophylaxis
(C) His 3-year-old sibling should receive INH prophylaxis
(D) Polyarthralgia is a potential adverse effect of the drugs the boy is taking
(E) The potential nephrotoxicity of the prescribed drugs warrants periodic assessment of renal function

A

(C) His 3-year-old sibling should receive INH prophylaxis

31
Q

Which statement about antitubercular drugs is accurate?

(A) Antimycobacterial actions of streptomycin involve inhibition of arabinosyltransferases
(B) Cross-resistance of M tuberculosis to isoniazid and
pyrazinamide is common
(C) Ocular toxicity of ethambutol is prevented by thiamine
(D) Pyrazinamide treatment should be discontinued immediately if hyperuricemia occurs
(E) Resistance to ethambutol involves mutations in the
emb gene

A

(E) Resistance to ethambutol involves mutations in the

emb gene

32
Q 
Once-weekly administration of which of the following antibiotics has prophylactic activity against bacteremia caused by M avium complex in AIDS patients?
(A) Acedapsone
(B) Azithromycin
(C) Clarithromycin
(D) Kanamycin
(E) Rifabutin
A

(B) Azithromycin

Because of its long elimination half-life (3–4 d), weekly
administration of azithromycin has proved to be equivalent to daily administration of clarithromycin when used for prophylaxis against M avium complex in AIDS patients.

Acedapsone is a repository form of dapsone used in leprosy

33
Q

Risk factors for multidrug-resistant tuberculosis include

(A) A history of treatment of tuberculosis without rifampin
(B) Recent immigration from Asia and living in an area of over 4% isoniazid resistance
(C) Recent immigration from Latin America
(D) Residence in regions where isoniazid resistance is known to exceed 4%
(E) All of the above

A

(E) All of the above

34
Q

Rifampin derivative that is NOT absorbed in the GIT thus used for the PREVENTION of HEPATIC ENCEPHALOPATHY, TRAVELLER’S DIARRHEA

A

Rifaximin

35
Q

Preferred anti TB for AIDS patients

A

Rifabutin

36
Q

Most hepatotoxic anti TB drug

A

Pyrazinamide

37
Q

Used in Drug Resistant TB

Administered IM

A

Streptomycin

38
Q

(-) folic acid synthesis
bacteriostatic

for leprosy, PCP pneumonia (backup)

MOST ACTIVE DRUG AGAINST M. LEPRAE

A

Dapsone

Acedapsone

39
Q

Binds to guanine bases in bacterial DNA
bactericidal

for sulfone resistance leprosy

A

Clofazimine

40
Q

Used for LATENT TB

A

Isoniazid

Rifampicin

Pharmacology (72 decks)

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