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pharm exam 2 > Antituberculotic > Flashcards

Antituberculotic Flashcards

1
Q

how is TB transmitted

A

expelled when a persion with infectious TB sneezes, speaks, sings or coughs

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2
Q

what organism causes TB?

A

mycobacterium tuberculosis

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3
Q

Name the 6 first line antituberculosis drugs

A
  1. Isoniazid
  2. Rifampin
  3. Pyrazinamide
  4. Ethambutol
  5. Streptomycin
  6. Rifabutin
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4
Q

What drugs do you use in combination to treat an active TB infection

A
  • Isoniazid
  • Rifampin
  • Pyrazinamide
  • Ethambutol

*RIPE for treatment

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5
Q

multi-drug resistant TB has become resistant to what Abx

A
  • Isoniazid
  • Rifampin
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6
Q

extreme drug resistant TB has become resistant to which Abx

A
  • Isoniazid
  • Rifampin
  • any Fluoroquinolone
  • one injectible second line drug (capreomycin, kanamycin, amikacin)
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7
Q

what is the recommended regimen of treatment for a new smear or culture positive case of TB

A
  • take the following for 2 months
    • Isoniazid
    • Rifampin
    • Pyrazinamide
    • Ethambutol
  • take the following for 4 months
    • Isoniazid
    • Rifampin
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8
Q

Which abx are used in the treatment of latent TB disease

A
  • Isoniazid

OR

  • Rifampin
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9
Q

what is the mechanism of action of Isoniazid? static or cidal

A

inhibits biosynthesis of mycolic acid (in cell wall)

  • bacteriostatic
    • INH and Rifampin combo is bactericidal
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10
Q

toxicity of Isoniazid

A
  • Hepatitis
  • Peripheral neuritis (slow acetylators)
  • Hemolysis (in patients with 6GPD deficiencty)
  • Lupus-like syndrome
  • CNS stimulation

*weight benefits of prophylaxis vs risk of hepatitis, especially in patients 35 years or older

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11
Q

route of administration of Isoniazid

A

oral

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12
Q

metabolism of Isoniazid

A
  • via acetylation (liver)
    • some people are “rapid” or “slow” metabolizers
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13
Q

what is the MOA of Rifampin

A

inhibits DNA dependent RNA polymerase

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14
Q

which antiTB drug is effective against leprosy

A

Rifampin

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15
Q

spectrum of coverage of Rifampin

A

most G+ and some G-

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16
Q

toxicities of Rifampin

A
  1. Hepatic enzyme induction- potent inducer of cytochrome P450
  2. harmless orange color to urine, sweat, tears, and contact lenses
  3. decreases effectiveness of birth control
17
Q

Rifampin is not recommended for which patient population

A

HIV treated individuals

18
Q

MOA of Ethambutol? static or cidal

A
  • inhibits arabinosyl transferases (involved in synthesis of arabinogalactan in the cell wall)
  • bacteriostatic
19
Q

important distribution of Ethambutol

A

gets into the CNS

20
Q

toxicities of Ethambutol

A
  • decrease of visual acuity
  • loss of green-red perception (usually reversible upon discontinuation of drug)
    • not recommended in children below age 13 yo
21
Q

Inside what structure are mycobacterium tuberculosis in the body

A
  • facultative intracellular parasite
  • usually of macrophages
22
Q

when does Pyrazinamide become active?

A

active at acidic pH - optimal for Mtb within macrophages

23
Q

Pyrazinamide has the greatest activity against what stage of Mtb

A

dormant organisms

24
Q

toxicities of Pyrazinamide

A

hepatic dysfunction

25
Q

MOA of streptomycin? static or cidal

A
  • protein synthesis inhibitor (30S ribosome)
  • bactericidal
26
Q

toxicities of Streptomycin

A
  • otoxicity
  • nephrotoxicity
27
Q

MOA of Rifabutin

A

inhibits DNA dependent RNA polymerase

28
Q

When is Rifabutin used

A
  • REPLACES Rigampin in HIV-TB co-infected individuals to avoid drug reactions
    • less potent inducer of P450 enzymes
29
Q

List the second line antiTB agents (lower potentcy and/or greater toxicity)

A
  • para-aminosalicylic
  • ethionamide
  • capreomycin
  • amikacin
  • fluoroquinolones
30
Q

Mycobacterium avium complex (MAC) involves which two bacteria

A
  • M. avium
  • M. intracellulare
31
Q

treatment of Mycobacterium avium complex (MAC)

A

antimicrobials for 12 months

  1. either clarithromycin or azithromycin
    1. I.V. amikacin if resistant to clarithromycin
  2. ethambutol
  3. Rifabutin, Rifampin, Or Ciprofloxacin
32
Q

Treatment of mycobacterium leprae in PB leprosy patients: 1-5 patches

A
  • treat with the following for 6 months
    • Rifampin
    • Dapsone
33
Q

Treatment of mycobacterium leprae in MB leprosy patients: > 5 patches

A
  • treat with the following for 6-12 months
    • Rifampin
    • Dapsone
34
Q

MOA of Dapsone (the most widely used and least expensive drug)

A

similar to sulfonamides

  • PABA antagonist
35
Q

route of administration of Dapsone

A

oral

36
Q

toxicities of Dapsone

A

nasal obstruction: improves in 3-6 months

37
Q

Patients with leprosy can develop erythema nodosum leprosum (ENT). What drug would you add to the treatment regimen for moderate to severe ENL?

A

Thalidomide

38
Q

Thalidomide has orphan drug status for which conditions

A
  • lepromatous leprosy
  • treatment of mycobacterium infections
39
Q

toxicities of Thalidomide

A

teratogenic

*should not be given at any time during pregnanct

pharm exam 2 (9 decks)

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