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Pharmacology Exam 3 (Lauren) > Antimycobacterials > Flashcards

Antimycobacterials Flashcards

1
Q

What kind of cell does TB usually live in?

A

Macrophages

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2
Q

What is the treatment of choice for erythema nodosum leprosum?

A

Thalidomide

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3
Q

Why is ethambutol not recommended in children under 13?

A

Decrease of visual acuity and green-red perception.

However, this does not mean its contraindicated, you still need to give it for active TB. Just do regular eye exams

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4
Q

What is the mechanism of action of streptomycin?

A

Inhibits 30s ribosome (its an aminoglycoside)

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5
Q

What kinds of testing must you do on your patient before and during isoniazoid treatment?

A

Liver Function Tests

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6
Q

What is erythema nodosum leprosum?

A

Fat pockets that are the symptom of leprosy

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7
Q

What is the spectrum of ethambutol?

A

VERY narrow….it affects arabinogalactan, which is only in mycobacterium Tb

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8
Q

What is another use for rifampin?

A

Leprosy

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9
Q

What is the biggest concern with thalidomide?

A

Teratogenic**

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10
Q

Will thalidomide cure your leprosy?

A

No, it only treats the SYMPTOM of leprosy, which is the fat pockets

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11
Q

You’re trying to decide between rifabutin, rifampin, and ciprofloxacin for the third step of treating MAC, and your patient is 15 years old. Which one should you NOT use?

A

Do not use ciprofloxacin (under 18)

Fluoroquinolone

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12
Q

What drug is associated with the most whoopsie pregnancies of any other drug?

A

Rifampin, because it decreases the effectiveness of birth control

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13
Q

What are the other diseases that thalidomide has “orphan drug” status for other than the fat pockets of leprosy?

A

Kaposi’s sarcoma

HIV wasting syndrome

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14
Q

What drugs is extreme drug resistant TB resistant to?

A

Isoniazid

Rifampin

Fluoroquinolones (streptomycin)

One of the injectable 2nd line drugs

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15
Q

Who is it not recommended to give rifampin to?

A

HIV+ individuals because it messes with their HAART treatment

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16
Q

What parts of the body can mycobacterium avium complex (MAC) affect?

A

Anywhere

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17
Q

Is isoniazid in active form when you take it?

A

NO it is a prodrug that requires activation by the KatG enzyme ***

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18
Q

What is the mechanism of action of rifampin?

A

Inhibits DNA dependent RNA polymerase, specifically the rpoB subunit

(Thus, DNA transcription is prevented)

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19
Q

What do we use rifabutin for?

A

We use it instead of rifampin for HIV-Tb coinfected individuals since it is a less potent inducer of CYP3A4 and won’t have as many drug interactions

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20
Q

What is the mechanism of action for isoniazid?

A

Inhibits Synthesis of mycolic acid

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21
Q

What 2 drugs is multi drug resistant TB resistant to?

A

Isoniazid

Rifampin

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22
Q

What is an orphan drug?

A

It is one that has special financial incentives for developing it since it is used for specific and rare conditions

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23
Q

How do you treat mycobacterium avium complex (MAC)?

A
  1. Clarithromycin or azithromycin
  2. Ethambutol
  3. Another oral drug (rifabutin, rifampin, or ciprofloxacin)

Need 3 drugs

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24
Q

After what age should you be very careful with prescribing isoniazid for prophylactic treatment?

A

35 years+ due to the possibility of liver damage

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25
Q

Does rifabutin turn things orange?

A

Yes it has orange metabolites like rifampin

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26
Q

What is the only tuberculostatic drug that approaches the activity of isoniazid ?

A

Rifampin

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27
Q

Is streptomycin bacteriostatic or cidal?

A

Cidal

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28
Q

What is the biggest toxicity of pyrazinamide?

A

Liver dysfunction***

Even more hepatotoxic than isoniazid….monitoring LFTs is imperative

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29
Q

How can you tell someone has active TB disease?

A

They are coughing and showing symptoms

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30
Q

Which drug for Tb has the narrowest spectrum ever

A

Isoniazid…only effective for TB since it inhibits mycolic acid Synthesis

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31
Q

What are the main toxicities of isoniazid?

A

Hepatitis

Peripheral neuritis

Hemolysis if G6PD deficient

Lupus like syndrome

CNS stimulation (convulsions, psychosis, insomnia etc)

32
Q

Can isoniazid reach intracellular bacilli?

A

Yes

33
Q

How is TB spread?

A

Droplet nuclei

34
Q

If you are treating your Tb patient with isoniazid and pyrazinamide (and R and E, of course) and their liver just can’t handle it anymore, which drug should you stop, and what would be a good replacement?

A

Stop the pyrazinamide

Replace with streptomycin

35
Q

What is the mycobacterium avium complex (MAC)?

A

An opportunistic infection that is made up of two bacteria:

M. Avium

M. Intracellulare

36
Q

Is isoniazid static or cidal?

A

Static when used alone, but cidal when in combo with rifampin

37
Q

Isoniazid is a HIP drug. What does that mean?

A

It can cause drug induced SLE

Hydralazine, Isoniazid, Procainamide

38
Q

Can pyrazinamide get into the meninges?

A

Yes

39
Q

What are the 6 first line drugs used for TB

A

Isoniazid

Rifampin

Pyrazinamide

Ethambutol

Streptomycin

Rifabutin

40
Q

How does TB develop resistance to rifampin?

A

Mutated rpoB subunit

41
Q

How do you treat latent TB?

A

Isoniazid or rifampin

42
Q

How is dapsone administered?

A

Oral

(Remember the pink and green blister packs of dapsone and rifampin?

43
Q

What are the 3 drugs that are associated with causing a “lupus” like syndrome?

A

Hydralazine

Isoniazid

Procainamide

(HIP drugs)

44
Q

What is the mechanism of action of pyrazinamide?

A

It is unclear

It disrupts the plasma membrane as well as energy metabolism

45
Q

What is the main concern with rifampin?

A

It induces CYP3A4 BIG TIME

MANY drug interactions

46
Q

What is the most heavily regulated drug in the US?

A

Thalidomide

47
Q

When you’re deciding whether to use clarithromycin or azithromycin for the first step to treat MAC, which would be better if your patient was on a lot of other drugs?

A

Azithromycin- less drug interaction

48
Q

Can we give pyrazinamide by itself?

A

No, it must be used in combo due to high levels of resistance

49
Q

What is an interesting but harmless side effect of rifampin?

A

Turns all secretions orange

50
Q

How do you treat Mycobacterium Avium Complex (MAC)?

A

You need to use 3 drugs:
1. Clarithromycin or azithromycin

  1. Ethambutol
  2. Rifabutin, Rifampin, or ciprofloxacin
51
Q

Are people with latent TB infection able to spread the disease

A

No

52
Q

What is mycobacterium leprae?

A

Leprosy

53
Q

Can we treat leprosy with one drug?

A

No, it is extremely unethical to do so.

You are guaranteed resistance if you do that

54
Q

What are the 2 components in the Mtb cell wall that are unique to that microbe?

A

Mycolic acid

Arabinogalactan

55
Q

What is the main risk of isoniazid in fast acetylators?

A

Hepatitis

56
Q

What is the main risk of isoniazid for slow acetylators?

A

Peripheral neuritis

Can be given with pyridoxine to alleviate this

57
Q

What is the mechanism of action of dapsone?

A

Similar to sulfa drugs- it interferes with PABA, and therefore folic acid synthesis

58
Q

You’re trying to decide which drug you should give for the 3rd step of MAC treatment. Your patient’s germ has developed rPOB mutation. Which drug do you have to pick?

A

Must pick ciprofloxacin

Rifampin and rifabutin wont be effective

59
Q

Does mycobacterium tuberculosis generate fast?

A

No, 15-20 hours, which gives them a good opportunity to form drug resistance

60
Q

Is rifampin static or cidal?

A

Static

61
Q

Does ethambutol get into the CNS/

A

Yes, which would be good for Tb that is causing dementia or meningitis *

(Tb is not just respiratory)

62
Q

How does leprosy start?

A

Skin patches

63
Q

How do genes affect the metabolism of isoniazid/

A

There are fast and slow acetylators

(50% of white and black people are slow

Most Eskimos, native Americans, and Asians are rapid)

64
Q

What is one of the most annoying side effects of dapsone and how long does it last?

A

Severe nasal obstruction. Improves in 3-6 months.

65
Q

What are the main side effects of streptomycin?

A

Ototoxicity

Nephrotoxicity

(Its an aminoglycoside)

66
Q

Can PAs prescribe thalidomide?

A

No, must be obtained through specially registered physicians and pharmacies

67
Q

What is the mechanism of action of ethambutol?

A

Inhibits arabinogalactan synthesis by targeting arabinosyl transferases

68
Q

What are the 2 classifications for leprosy?

A

PB leprosy- 1-5 patches

MB leprosy- 6+ patches

69
Q

What is the enzyme that is required to be in the bacillus in order for isoniazid to be active?

A

KatG

70
Q

What is the duration of treatment for active Tb?

A

RIPE for 2 months

Rifampin and Isoniazid for 4 months

71
Q

What can you give with isoniazid to reduce the side effect of peripheral neuritis?

A

Pyridoxine

72
Q

Is ethambutol static or cidal?

A

Static

73
Q

What do you need to know about the 2nd line Tb agents?

A

Lower potency and/or more toxic

74
Q

What is a common co-infection with MAC?

A

HIV

75
Q

How do you treat leprosy (mycobacterium leprae)?

A

Rifampin and Dapsone

6+ skin patches will mean you treat longer

Pharmacology Exam 3 (Lauren) (8 decks)

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