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Pharmacology > Antituberculotics > Flashcards

Antituberculotics Flashcards

1
Q

what are the first line antiTB drugs?

A 
isoniazid
rifampin
pyrazinamide
ethambutol
streptomycin
rifabutin
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2
Q

What is the first line combination treatment for active TB?

A

INH, Rif, EMB, PZA

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3
Q

What is the course of treatment for latent TB?

A

either…

INH + RPT q once weekly for 3 months

OR

RIF q daily for 4 months

OR

INH q daily or twice weekly for 6-9 months

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4
Q

what does INH inhibit?

A

mycolic acid synthesis

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5
Q

when INH is given alone, is it static or cidal?

A

static

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6
Q

combination with what drug makes INH cidal?

A

rifampin

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7
Q

When considering prophylactic therapy, INH associated hepatitis should be considered especially in patients above what age?

A

> 35

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8
Q

Describe the metabolism of INH

A

metabolism in the liver via acetylation

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9
Q

What are five major toxicities of INH?

A

hepatitis, peripheral neuritis, hemolysis, lupus like syndrome, CNS stimulation

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10
Q

who should you consider for INH induced hepatitis?

A

older persons, fast acetylators

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11
Q

who should you consider for peripheral neuritis when administering INH?

A

slow acetylators

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12
Q

who should you consider for risk of hemolysis when adminstering INH?

A

G6PD deficiency

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13
Q

what is the mechanism of action for rifampin?

A

inhibition of DNA dependent RNA polymerase

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14
Q

what confers resistance to rifampin?

A

rpoB mutation

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15
Q

which tuberculo-static drug comes closest to the activity of INH?

A

rifampin

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16
Q

Why is rifampin not recommended for HIV treated individuals?

A

CYP450 induction can cause drug interactions w/ HAART

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17
Q

A patient takes oral contraceptives and rifampin. what should you caution them on?

A

rifampin decreases birth control effectiveness via CYP450 induction

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18
Q

how does ethambutol work?

A

inhibition of arabinosyl transferases

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19
Q

is ethambutol cidal or static?

A

static

20
Q

is ethambutol given for prophylaxis of TB?

A

no

21
Q

Where is ethambutol well absorbed?

A

most tissues, and into the CNS

22
Q

do you need to adjust the dose of ethambutol in renal failure?

A

yes

23
Q

Describe the major adverse effect of ethambutol…

A

decreased visual acuity, loss of red/green perception

reversible upon discontinuation

24
Q

is ethambutol recommended for children under 13?

A

no due to adverse effect on vision. This is NOT a contraindication. monitor closely

25
Q

at what pH is pyrazinamide active?

A

acidic pH

26
Q

do you change dosage if your patient is showing signs of fast or slow acetylation of INH?

A

No

27
Q

what do you give in addition to INH to prevent peripheral neuritis?

A

Pyridoxine

28
Q

does rifampin cause hepatotoxicity?

A

no

29
Q

does pyrazinamide reach the meninges?

A

yes!

30
Q

If a patient w/ active TB is experiencing hepatic dysfunction, which drug do you take them off of first? INH or PZA?

A

PZA and replace with a second line drug

31
Q

When is streptomycin used for TB?

A

as a second line in MDR, XDR

32
Q

What differentiates rifabutin from rifampin?

A

less potent induction of P450s

33
Q

when do you use rifabutin instead of rifampin?

A

in HIV-TB co-infected individuals

34
Q

when do you use rifapentine?

A

preferred regimine + INH for latent TB

35
Q

describe the drug interactions with rifapentine…

A

moderate P450 induction

36
Q

what 2 bacteria make up the mycobacterium avium complex?

A

m. avium and m. intracellulare

37
Q

how is MAC treated and for how long?

A

12 months,

clarithromycin/azithro + ethambutol + rifabutin/rifampin/cipro

38
Q

why does m. leprae require multidrug therapy?

A

monotherapy will always result in resistance to that drug

39
Q

what constitutes PB leprosy?

A

1-5 patches

40
Q

how do you treat PB leprosy?

A

rifampin + dapsone for 6 mo

41
Q

what constitutes MB leprosy?

A

> 5 patches

42
Q

how do you treat MB leprosy?

A

rifampin + dapsone for 6-12 months

43
Q

what is the mechanism of dapsone?

A

PABA antagonist, similar to sulfa

44
Q

describe the rate of excretion of dapsone…

A

slow

45
Q

what is the most serious side effect of dapsone?

A

serious nasal obstruction interfering with patient compliance

Dapsone? DatNoseDoe!

46
Q

why is thalidominde used in treatment of leprosy?

A

it is the DOC for moderate to severe erythema nodosum leprosum

Pharmacology (6 decks)

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