Drugs For Tuberculosis Flashcards by Iseoluwa Ojo

Mycobacteria:

( aerobic or anaerobic?) , bacillary type bacteria that grow like _____ (___) and belong to the genus ___________ (Mycobacteriaceae)

Aerobic

fungus; Myco

Actinobacteria

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Mycobacteria

They have (thinner or thicker?) cell wall than many other bacteria.

Their cell wall is _____, ______phobic and contain _______ as well as large amount of ________ which is responsible for their __________
.

Thicker

waxy; hydro; peptidoglycan

mycolic acid

acid fastness.

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Mycobacteria consist of many species and many pathogens including those that cause _________ and ______

leprosy and tuberculosis.

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Mycobacteria infections (MI) Types:
•
– (a) __________ (_____) caused by ________
– (b)___________ (_____)

Tuberculosis (TB)

M. tuberculosis

Non-tuberculous MI

NTB

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Mycobacteria infections (MI) Types:

Non-tuberculous MI (NTB):

_________

___________

Leprosy
Atypical MI

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Atypical MI:

Those that cause _____ disease

Those that cause ___ disease

lung

skin

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Atypical MI:

Those that cause lung disease: Mycobacterium ___________ and Mycobacterium ___________

avium-intracellulare and kansasii

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Atypical MI:

Those that cause skin disease: M. ________ , M. _______, M. _____, M. ______ and M. _______

marinum; ulcerans; chelonae

fortuitum

abscessus

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Manifestation

– TB: originates as ______ infections which spread to the ______, laryngeal, pharyngeal, ____,_____, and _______ spaces.

lung

cervical lymph nodes

oral, aural and ocular

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Manifestation

– NTB: originates in ______,______,______, and ________

cervical lymph nodes, aural and ocular spaces.

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Diagnosis:l of mycobacterium

(I) ______ and ______ tests to identify the specific type of bacteria present in the lungs

(ii)_______ to image the lungs

(iii)________ to view the lung’s airways

Blood and sputum

CT scans

Bronchoscopy

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Mycobacteria infections (MI) Management:
– (a) Tuberculous: _______ anti-tuberculous chemotherapy

Systemic

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Mycobacteria infections (MI) Management:

– (b) Non-tuberculous MI: ______ + ______ + ____ until _____ culture is negative for _________

Azithromycin

ethambutol

rifampin

monthly; year

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Mycobacteria infections (MI)
Transmission:
TB: transmitted via _____ of infected aerosols generated by active TB patients when he _________________________

inhalation

coughs, sneezes, laughs, spits or talks

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Tuberculosis :Types

_______ TB
________TB
___________(MDR-TB)
____________________ (XDR-TB)
___________ tuberculosis

Latent

Active

Multidrug resistant tuberculosis

Extensively multidrug resistant tuberculosis

Extra-pulmonary

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Tuberculosis (TB)

Latent TB: Occurs when the bacteria is _____________________. And _____________.

in the body without the person developing symptoms

cannot infect others.

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Tuberculosis (TB)

Active TB: Occurs when the bacteria is ___________________.

Person with active TB can _________

in the body and the person is having symptoms

infect others.

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Tuberculosis (TB)

Multidrug resistant tuberculosis (MDR-TB): TB that is ________________________ ( ______ and ________ ).

resistant to the two most potent first line drugs

isoniazid and rifampin

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Tuberculosis (TB)

Extensively multidrug resistant tuberculosis (XDR-TB): TB infection that is _________________ and, at least, _______________________ ( _____,_______,______), and any of the __________ .

resistant to rifampin, isoniazid

one of the three injectable second-line drugs

Amikacin, kanamycin or capreomycin

fluoroquinolones

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Tuberculosis (TB)

Extra-pulmonary tuberculosis:

Tuberculosis _________ is called extra-pulmonary tuberculosis

not affecting the lungs

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Signs and symptoms tuberculosis

o Latent TB: A person with latent TB will have ___ symptoms, and ____ damage will show on a chest X-ray

However, a _______ or _______ will indicate that they have TB infection

no; no

blood test or skin prick test

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Signs and symptoms tuberculosis

o Active TB:

•a _______ lasting at least _______
•coughing ______ which may have _____ in it
•loss of appetite and weight, fatigue and being unwell
•swelling in the ____, fever, _______ , chest pain and chills.

persistent cough; 3 weeks

phlegm; blood

neck; night sweats

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Signs and symptoms tuberculosis

Symptoms of ACTIVE TB typically ______ over time, but they can also _______ and ________

worsen

spontaneously go away and return.

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Mycobacteria infection

Epidemiology: In 2019, Estimated __________ active TB global cases with _______ deaths were reported. And Nigeria (4.4%) ranked ______ behind ____ (26%), Indonesia (8.5%), China (8.4%), Philippines (6.0%) and Pakistan (5.7%) - (WHO, 2020).

10 million

1.4 million

6th; India

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Tuberculosis : Prevention •Getting a ______ and _________ early •___________________________ until there is no longer a risk of infection •wearing a _____, covering the _____, and _______ rooms

diagnosis and treatment Staying away from other people mask; mouth; ventilating

Tuberculosis : Prevention TB vaccination: In some countries, children receive an anti-TB vaccination {the ___________ vaccine — as part of a regular immunization program}.

bacillus Calmette–Guérin (BCG)

Tuberculosis: Complications _______: Without treatment

Death

Tuberculosis: Complications Disseminated infection: If it spreads throughout the body, the infection can cause problems with the _______ system and _______ function.

cardiovascular metabolic

Tuberculosis: Complications _______: TB can also lead to this, a potentially life threatening form of infection.

Sepsis

Tuberculosis: Complications ________ __________ __________

Death Disseminated infection Sepsis

TB can be fatal T/F

TB can lead to sepsis T/F

Antituberculous drugs First line agents : List all 5

Isoniazid, Rifamycin, pyrazinamide, ethambutol and streptomycin.

Antituberculous drugs Second line agents: are used when there is _________,_________, or __________ to _________

there is intolerance, drug resistance or contraindication to the first line agents.

Rifamycin (______,________ or _________ )

rifampin, rifabutin or rifapentine

Antituberculous drugs Second line drugs: They include _______, Clofazimine, _______, Delamanid, ______,_________ (levofloxacin or moxifloxacin), Linezolid, ________ acid, Pretomanid, Thioacetazone and Injectable-only agents (______,_______, and ———— ), _______ plus _________

Bedaquiline Cycloserine Ethionamide Fluoroquinolones Para-aminosalicylic Amikacin, kanamycin and capreomycin Carbapenems; clavulanate

Isoniazid is a prodrug T/F

Anti-TB. Drugs Isoniazid: A synthetic derivative of _______ – Mechanism of action: Appears to ______________________, major components of the mycobacterial cell wall.

nicotinic acid block the synthesis of mycolic acids

Isoniazid Uses: Used with ______ for latent TB. And combined with ______,________ and either ———— or ________ for active TB.

Nothing rifampicin, pyrazinamide and either ethambutol or streptomycin

Isoniazid Adverse effects: ________ due to ______ depletion ___________ due to raised ______ and ____ nausea and vomiting Blood ________

Peripheral neuritis; pyridoxine Hepatotoxicity; ALT and AST dyscrasia

Isoniazid is recommended in pregnancy. T/F

F Not recommended in pregnancy.

Antituberculous drugs Rifampicin: – Mechanism of action: It _________________

inhibits RNA synthesis

Antituberculous drugs Rifampicin: – Uses: ________, Mycobacterium ______,_______, and ________disease.

Tuberculosis avium complex, leprosy, and Legionnaires’

Rifampicin: – Adverse effects: •Nausea, vomiting, diarrhea, and loss of appetite. •It often turns _____,_____,_____ into a ______ or _______. _____ problems or ______ reactions may occur

urine, sweat, and tears red or orange color Liver; allergic

Rifampin May be used in pregnancy. T/F

Antituberculous drugs Pyrazinamide: – Mechanism of action: ________

Unknown

Antituberculous drugs Pyrazinamide: – Uses: used with _______,________ and either __________ or __________ for active TB.

rifampicin, isoniazid, and either streptomycin or ethambutol

Pyrazinamide can be used for latent TB. T/F

F Not recommended for latent TB.

Antituberculous drugs Pyrazinamide: – Adverse effects: •Common: nausea, loss of appetite, _______ and _____ pains, and _____. •Rare and more serious side effects: ______, _____ toxicity, and sensitivity to _______.

muscle and joint ; rash Gout; liver ; sunlight

pyrazinamide is safe in pregnancy T/F

F Safety in pregnancy unclear.

Antituberculous drugs Ethambutol: – Mechanism of action: interfers with __________

bacteria metabolic process.

Antituberculous drugs Ethambutol: – Uses: used with ______,______, and —— for active TB.

rifampicin, isoniazid, and pyrazinamide

Ethambutol is Not recommended for latent TB

Antituberculous drugs Ethambutol: – Adverse effects: Common: ______ problem, ____ pain, nausea, headaches, and feeling tired. Rare and more serious side effects: _____ problems and ____ reactions.

vision; joint liver; allergic

Ethanbutol May be used in pregnancy. T/F

Streptomycin: Class: First line antituberculous drug except in ____. Mechanism of action: blocks the ability of ________ to _______, which results in bacterial death.

US 30S ribosomal subunits; make proteins

Streptomycin: Uses: used with ____,_____,______ for active TB.

rifampicin, isoniazid, and pyrazinamide

Streptomycin is recommended for latent TB. T/F

F Not recommended for latent TB

__________ first line drug is Also for Mycobacterium avium complex, endocarditis, brucellosis, Burkholderi infection, plague tularemia, and rat bite fever.

Streptomycin

Streptomycin is administered by _______ or _____.

i/m or i/v injection

Streptomycin is Contraindicated in pregnancy. T/F

Streptomycin Adverse effects: Common: vertigo, vomiting, numbness of the face, fever, and rash Rare and more serious side effects: Causes _______ in neonates if used during pregnancy

deafness

Standard treatment for active TB: (Short or Long?) course treatment: ______(along with ______) + _____ + _______ + _______ for ————- then ________ and ______ alone for a further ______

Short isoniazid; pyridoxal phosphate rifampicin; pyrazinamide; ethambutol; two months isoniazid and rifampicin ; four months

Standard treatment for latent TB: 3 ways •_______ to ______ of daily ______ alone or •_____ months of weekly (____ doses total) of ______/______ combination or •_____,______, and _______ for ____ months, followed by _____ and ______ for _____ months. _______ need not be used

Six to nine months; isoniazid Three; 12; isoniazid/rifapentine Isoniazid, rifampicin, and pyrazinamide; two ; isoniazid and rifampicin; four Ethambutol

Standard Treatment of tuberculosis is Not for child < __yrs, _____ and people living with _____.

2 pregnancy HIV

Choosing right type of antibiotic and length of treatment will depend on: the person’s ____ and overall health whether they have _____ or _____ TB , the ____ of the infection, and whether the strain of TB is _______

age latent or active location; drug resistant

Multidrug resistant tuberculosis (MDR-TB): They are treated with _______ antituberculous drugs including bedaquiline, delamanid, linezolid and pretomanid.

second line

Extensively multidrug resistant tuberculosis (XDR-TB): Treated with effective _________

second line drugs.

In sub-Saharan Africa about ___ of all people with ______ are infected with M. tuberculosis

Half HIV

TB is the main AIDS-defining illness. T/F

Mycobacteria are (obligate or facultative ?) (aerobes or anaerobes?)

Obligate Aerobes

M. Tuberculosis is spore forming T/F

M. Tuberculosis is motile T/F

Transmission of M. Tuberculosis The tiny droplets dry (slowly or rapidly?) ; the smallest (<____µm) may ____________________ and may reach the terminal air passages when inhaled.

Rapidly 5–10 remain suspended in the air for several hours

Pathogenesis of M.tuberculosis Inhalation of droplet nuclei _______ by ___________ ________ within _____ for ______ (Primary pulmonary tuberculosis)

Engulfed; alveolar macrophages Replicate; macrophages; 2-3 weeks

Pathogenesis of M. Tuberculosis In ____% of cases, infection is _________, _______ disease ________ become (active or dormant ?) and sealed off by _______ (latent tuberculosis infection – LTBI)

95; contained no apparent Granuloma Dormant; scar tissue

Pathogenesis of M.tuberculosis Surviving bacilli may be ___________ _______ of ________ and surrounding tissue Bacilli spread through _______ from _____ to other parts of the lung (reactivation tuberculosis)

reactivated years later Erosion of granuloma air passages; cavities

Pathogenesis of M.tuberculosis Spread beyond the pulmonary system – direct, ________, _______, swallowing of _______ (extrapulmonary tuberculosis)

haematogenous Lymphatic sputum

______ + ______ = Ghon complex

Ghon focus Lymph node

PULMONARY TUBERCULOSIS Primary pulmonary TB ______ are asymptomatic Symptoms (mild or severe?) , including ___-grade fever Radiography –_____ lymphadenopathy, __________ lung field pulmonary infiltrates

⅔ Mild, low hilar mid and lower

Postprimary (reactivation) TB 90% of TB cases in (children or adults?) _____, cough, ____,________ Chest pain, dyspnea, haemoptysis

Adults Fever; weight loss, night sweats

Postprimary (reactivation) TB CXR- ____________ lung infiltrates, cavities with air-fluid levels, nodules, effusions, hilar adenopathy

Apical-posterior

____ % of patients with active post primary primary TB have normal CXR

EXTRAPULMONARY TUBERCULOSIS Can present in any organ system Common presentations: 1) Tuberculous _________ 2)______ Tuberculosis 3)____ involvement 4)______ tuberculosis 5)_______ tuberculosis

lymphadenitis Pleural CNS skeletal Miliary

EXTRAPULMONARY TUBERCULOSIS Can present in any organ system Common presentations: 1) Tuberculous lymphadenitis _____% of cases (Acute or Chronic?) , ___lateral (tender or non-tender?) lymphadenopathy: ______ and _______ lymph nodes. Also mediastinal and axillary

40 Chronic; uni; non-tender cervical and supraclavicular

EXTRAPULMONARY TUBERCULOSIS 2) Pleural tuberculosis ___% of cases Pleuritic ______, ________ cough P/E: _____ to percussion, ____eased breath sounds CXR- ___lateral pleural effusion Pleural fluid analysis – lymphocyte predominance, low glucose, low pH (<7.2), protein concen (4 – 6g/dl)

4; chest pain non-productive Dullness; Decr uni

EXTRAPULMONARY TUBERCULOSIS 3) CNS involvement: ___% of cases TB meningitis _______– 2 to 3 weeks of malaise, headache, ___ grade fever _______ phase – fever, ___ rigidity, altered _______ ______ phase – stupor, _____, ____, death

I Prodrome; low Meningitic; nuchal; mental status Paralytic; coma; seizure

EXTRAPULMONARY TUBERCULOSIS 3) CNS involvement: I% of cases CNS tuberculoma __________ in the brain ______ neurological symptoms, signs of ____________

Caseous foci Focal raised intracranial pressure

EXTRAPULMONARY TUBERCULOSIS 4) Skeletal tuberculosis Most commonly ________ (_____ disease)

thoracolumbar spine; Pott’s

EXTRAPULMONARY TUBERCULOSIS 5) Miliary tuberculosis ______ or _______ spread Other sites are: - peritoneum - pericardium

Lymphatic or haematogenous

Diagnosis – latent infection Established by: Positive result on either ___ Test or _____

Skin; blood

Diagnosis – latent infection __________-Skin or _______________- Blood, In (presence or absence?) of features of active TB

Tuberculin Skin Test (TST); Interferon gamma release assay (IGRA) Absence

Tuberculin skin test/ Mantoux test Intradermal 0.1ml of 5 Tuberculin units of ____________ into the _____ (_____) surface of the forearm

Purified Protein Derivative (PPD) volar; palmar

PPD invokes a _____________ reaction Diameter of induration is measured after _______ Induration of _____ mm is interpreted as positive depending on clinical risk factors

delayed hypersensitivity 48 – 72 hours 5 – 15

Interferon gamma release assay (IGRA) ______ based tests of ________ or ______ which measure ____ release after _____ stimulation by M. tuberculosis.

ELISA whole blood or mononuclear cells IFN-gamma T-cell

Clinical specimens – pulmonary TB spontaneously expectorated sputum ( ____ specimens are required in ____ visits for ____ days ; Spot – _____ –Spot)

3 2 two days Morning

Gold standard for laboratory confirmation of TB is ??

By Culture

A person with LTBI Has small amount of TB in their body TB is dead in their body Can spread TB bacteria to others Positive for TB skin test Radiography is typically abnormal

T F( alive , but inactive) F( cannot) T F( normal)

A person with LTBI Sputum smears are positive Culture is negative Should not consider LTBI treatment Does not require respiratory isolation Is a TB case

F T F( should, to prevent TB disease) T F( not)

Person with TB disease Large amount of TB bacteria in their body Active Tb in their body Can spread TB to others Does not feel sick or have symptoms Negative for skin test

T T T F F(positive)

Person with TB disease Radiography may be abnormal Sputum smears are negative for TB Cultures are positive for TB Needs treatment for TB disease Does not require respiratory isolation Is a TB case

T F T T F T

multidrug resistant TB is a TB that is Resistant to ___________________

at least isoniazid and rifampicin

For MDR TB, use ______

2nd line antibiotics

2nd line TB Drugs, compared to 1st line More or less toxic More or less effective

More Less

1st line TB Drugs, compared to 2nd line More or less toxic More or less effective

Less More

ATYPICAL MYCOBACTERIA Has ___________ animal host

No animal

ATYPICAL MYCOBACTERIA No evidence for human-to-human transmission (T/F) Human infection probably results from ________________ Cause _______ infections Infections associated with Immunosuppression, Trauma, surgical wounds Can be detected by microscopy

T inhalation or ingestion of bacilli from the environment. opportunistic