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House Pharmacology > Drugs For Tuberculosis > Flashcards

Drugs For Tuberculosis Flashcards

1
Q

Mycobacteria:

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

A

Aerobic

fungus; Myco

Actinobacteria

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2
Q

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 __________
.

A

Thicker

waxy; hydro; peptidoglycan

mycolic acid

acid fastness.

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3
Q

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

A

leprosy and tuberculosis.

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4
Q

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

A

Tuberculosis (TB)

M. tuberculosis

Non-tuberculous MI

NTB

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5
Q

Mycobacteria infections (MI) Types:

Non-tuberculous MI (NTB):

_________

___________

A

Leprosy
Atypical MI

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6
Q

Atypical MI:

Those that cause _____ disease

Those that cause ___ disease

A

lung

skin

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7
Q

Atypical MI:

Those that cause lung disease: Mycobacterium ___________ and Mycobacterium ___________

A

avium-intracellulare and kansasii

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8
Q

Atypical MI:

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

A

marinum; ulcerans; chelonae

fortuitum

abscessus

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9
Q

Manifestation

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

A

lung

cervical lymph nodes

oral, aural and ocular

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10
Q

Manifestation

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

A

cervical lymph nodes, aural and ocular spaces.

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11
Q

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

A

Blood and sputum

CT scans

Bronchoscopy

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12
Q

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

A

Systemic

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13
Q

Mycobacteria infections (MI) Management:

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

A

Azithromycin

ethambutol

rifampin

monthly; year

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14
Q

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

A

inhalation

coughs, sneezes, laughs, spits or talks

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15
Q

Tuberculosis :Types

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

A

Latent

Active

Multidrug resistant tuberculosis

Extensively multidrug resistant tuberculosis

Extra-pulmonary

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16
Q

Tuberculosis (TB)

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

A

in the body without the person developing symptoms

cannot infect others.

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17
Q

Tuberculosis (TB)

Active TB: Occurs when the bacteria is ___________________.

Person with active TB can _________

A

in the body and the person is having symptoms

infect others.

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18
Q

Tuberculosis (TB)

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

A

resistant to the two most potent first line drugs

isoniazid and rifampin

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19
Q

Tuberculosis (TB)

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

A

resistant to rifampin, isoniazid

one of the three injectable second-line drugs

Amikacin, kanamycin or capreomycin

fluoroquinolones

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20
Q

Tuberculosis (TB)

Extra-pulmonary tuberculosis:

Tuberculosis _________ is called extra-pulmonary tuberculosis

A

not affecting the lungs

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21
Q

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

A

no; no

blood test or skin prick test

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22
Q

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.

A

persistent cough; 3 weeks

phlegm; blood

neck; night sweats

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23
Q

Signs and symptoms tuberculosis

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

A

worsen

spontaneously go away and return.

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24
Q

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).

A

10 million

1.4 million

6th; India

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25
Q

Tuberculosis : Prevention

•Getting a ______ and _________ early

•___________________________ until there is no longer a risk of infection

•wearing a _____, covering the _____, and _______ rooms

A

diagnosis and treatment

Staying away from other people

mask; mouth; ventilating

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26
Q

Tuberculosis : Prevention

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

A

bacillus Calmette–Guérin (BCG)

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27
Q

Tuberculosis: Complications

_______: Without treatment

A

Death

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28
Q

Tuberculosis: Complications

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

A

cardiovascular

metabolic

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29
Q

Tuberculosis: Complications

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

A

Sepsis

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30
Q

Tuberculosis: Complications

________
__________
__________

A

Death
Disseminated infection
Sepsis

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31
Q

TB can be fatal

T/F

A

T

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32
Q

TB can lead to sepsis

T/F

A

T

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33
Q

Antituberculous drugs

First line agents :

List all 5

A

Isoniazid, Rifamycin, pyrazinamide, ethambutol and streptomycin.

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34
Q

Antituberculous drugs

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

A

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

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35
Q

Rifamycin (______,________ or _________ )

A

rifampin, rifabutin or rifapentine

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36
Q

Antituberculous drugs

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

A

Bedaquiline

Cycloserine

Ethionamide

Fluoroquinolones

Para-aminosalicylic

Amikacin, kanamycin and capreomycin

Carbapenems; clavulanate

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37
Q

Isoniazid is a prodrug

T/F

A

T

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38
Q

Anti-TB. Drugs

Isoniazid: A synthetic derivative of _______

– Mechanism of action: Appears to ______________________, major components of the mycobacterial cell wall.

A

nicotinic acid

block the synthesis of mycolic acids

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39
Q

Isoniazid

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

A

Nothing

rifampicin, pyrazinamide and either ethambutol or streptomycin

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40
Q

Isoniazid

Adverse effects:
________ due to ______ depletion

___________ due to raised ______ and ____

nausea and vomiting

Blood ________

A

Peripheral neuritis; pyridoxine

Hepatotoxicity; ALT and AST

dyscrasia

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41
Q

Isoniazid is recommended in pregnancy.

T/F

A

F

Not recommended in pregnancy.

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42
Q

Antituberculous drugs
Rifampicin:

– Mechanism of action: It _________________

A

inhibits RNA synthesis

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43
Q

Antituberculous drugs
Rifampicin:

– Uses: ________, Mycobacterium ______,_______, and ________disease.

A

Tuberculosis

avium complex, leprosy, and Legionnaires’

44
Q

Rifampicin:

– Adverse effects:
•Nausea, vomiting, diarrhea, and loss of appetite.

•It often turns _____,_____,_____ into a ______ or _______.

_____ problems or ______ reactions may occur

A

urine, sweat, and tears

red or orange color

Liver; allergic

45
Q

Rifampin May be used in pregnancy.

T/F

A

T

46
Q

Antituberculous drugs
Pyrazinamide:

– Mechanism of action: ________

A

Unknown

47
Q

Antituberculous drugs
Pyrazinamide:

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

A

rifampicin, isoniazid, and either streptomycin or ethambutol

48
Q

Pyrazinamide can be used for latent TB.

T/F

A

F

Not recommended for latent TB.

49
Q

Antituberculous drugs
Pyrazinamide:

– Adverse effects:
•Common: nausea, loss of appetite, _______ and _____ pains, and _____.

•Rare and more serious side effects: ______, _____ toxicity, and sensitivity to _______.

A

muscle and joint ; rash

Gout; liver ; sunlight

50
Q

pyrazinamide is safe in pregnancy

T/F

A

F

Safety in pregnancy unclear.

51
Q

Antituberculous drugs
Ethambutol:

– Mechanism of action: interfers with __________

A

bacteria metabolic process.

52
Q

Antituberculous drugs
Ethambutol:

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

A

rifampicin, isoniazid, and pyrazinamide

53
Q

Ethambutol is Not recommended for latent TB

A

T

54
Q

Antituberculous drugs
Ethambutol:

– Adverse effects:

Common: ______ problem, ____ pain, nausea, headaches, and feeling tired.

Rare and more serious side effects: _____ problems and ____ reactions.

A

vision; joint

liver; allergic

55
Q

Ethanbutol May be used in pregnancy.

T/F

A

T

56
Q

Streptomycin:

Class: First line antituberculous drug except in ____.

Mechanism of action: blocks the ability of ________ to _______, which results in bacterial death.

A

US

30S ribosomal subunits; make proteins

57
Q

Streptomycin:

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

A

rifampicin, isoniazid, and pyrazinamide

58
Q

Streptomycin is recommended for latent TB.

T/F

A

F

Not recommended for latent TB

59
Q

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

A

Streptomycin

60
Q

Streptomycin is administered by _______ or _____.

A

i/m or i/v injection

61
Q

Streptomycin is Contraindicated in pregnancy.

T/F

A

T

62
Q

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

A

deafness

63
Q

Standard treatment for active TB:

(Short or Long?) course treatment:

______(along with ______) + _____ + _______ + _______ for ————-

then

________ and ______ alone for a further ______

A

Short

isoniazid; pyridoxal phosphate

rifampicin; pyrazinamide; ethambutol; two months

isoniazid and rifampicin ; four months

64
Q

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

A

Six to nine months; isoniazid

Three; 12; isoniazid/rifapentine

Isoniazid, rifampicin, and pyrazinamide; two ; isoniazid and rifampicin; four

Ethambutol

65
Q

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

A

2

pregnancy

HIV

66
Q

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 _______

A

age

latent or active

location; drug resistant

67
Q

Multidrug resistant tuberculosis (MDR-TB):

They are treated with _______ antituberculous drugs including bedaquiline, delamanid, linezolid and pretomanid.

A

second line

68
Q

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

A

second line drugs.

69
Q

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

A

Half

HIV

70
Q

TB is the main AIDS-defining illness.

T/F

A

T

71
Q

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

A

Obligate

Aerobes

72
Q

M. Tuberculosis is spore forming

T/F

A

F

73
Q

M. Tuberculosis is motile

T/F

A

F

74
Q

Transmission of M. Tuberculosis

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

A

Rapidly

5–10

remain suspended in the air for several hours

75
Q

Pathogenesis of M.tuberculosis

Inhalation of droplet nuclei
_______ by ___________

________ within _____ for ______

(Primary pulmonary tuberculosis)

A

Engulfed; alveolar macrophages

Replicate; macrophages; 2-3 weeks

76
Q

Pathogenesis of M. Tuberculosis

In ____% of cases, infection is _________, _______ disease

________ become (active or dormant ?) and sealed off by _______

(latent tuberculosis infection – LTBI)

A

95; contained

no apparent

Granuloma

Dormant; scar tissue

77
Q

Pathogenesis of M.tuberculosis

Surviving bacilli may be ___________

_______ of ________ and surrounding tissue

Bacilli spread through _______ from _____ to other parts of the lung

(reactivation tuberculosis)

A

reactivated years later

Erosion of granuloma

air passages; cavities

78
Q

Pathogenesis of M.tuberculosis

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

A

haematogenous

Lymphatic

sputum

79
Q

______ + ______ = Ghon complex

A

Ghon focus

Lymph node

80
Q

PULMONARY TUBERCULOSIS
Primary pulmonary TB

______ are asymptomatic

Symptoms (mild or severe?) , including ___-grade fever

Radiography –_____ lymphadenopathy, __________ lung field pulmonary infiltrates

A

⅔
Mild, low

hilar

mid and lower

81
Q

Postprimary (reactivation) TB

90% of TB cases in (children or adults?)

_____, cough, ____,________
Chest pain, dyspnea, haemoptysis

A

Adults

Fever; weight loss, night sweats

82
Q

Postprimary (reactivation) TB

CXR- ____________ lung infiltrates, cavities with air-fluid levels, nodules, effusions, hilar adenopathy

A

Apical-posterior

83
Q

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

A

5

84
Q

EXTRAPULMONARY TUBERCULOSIS
Can present in any organ system
Common presentations:

1) Tuberculous _________
2)______ Tuberculosis
3)____ involvement
4)______ tuberculosis
5)_______ tuberculosis

A

lymphadenitis

Pleural

CNS

skeletal

Miliary

85
Q

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

A

40
Chronic; uni; non-tender

cervical and supraclavicular

86
Q

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)

A

4; chest pain

non-productive

Dullness; Decr

uni

87
Q

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

A

I

Prodrome; low

Meningitic; nuchal; mental status

Paralytic; coma; seizure

88
Q

EXTRAPULMONARY TUBERCULOSIS

3) CNS involvement: I% of cases

CNS tuberculoma

__________ in the brain

______ neurological symptoms, signs of ____________

A

Caseous foci

Focal

raised intracranial pressure

89
Q

EXTRAPULMONARY TUBERCULOSIS

4) Skeletal tuberculosis
Most commonly ________ (_____ disease)

A

thoracolumbar spine; Pott’s

90
Q

EXTRAPULMONARY TUBERCULOSIS

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

A

Lymphatic or haematogenous

91
Q

Diagnosis – latent infection

Established by:
Positive result on either ___ Test or _____

A

Skin; blood

92
Q

Diagnosis – latent infection

__________-Skin or
_______________- Blood,

In (presence or absence?) of features of active TB

A

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

Absence

93
Q

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

A

Purified Protein Derivative (PPD)

volar; palmar

94
Q

PPD invokes a _____________ reaction
Diameter of induration is measured after _______

Induration of _____ mm is interpreted as positive depending on clinical risk factors

A

delayed hypersensitivity

48 – 72 hours

5 – 15

95
Q

Interferon gamma release assay (IGRA)

______ based tests of ________ or ______ which measure ____ release after _____ stimulation by M. tuberculosis.

A

ELISA

whole blood or mononuclear cells

IFN-gamma

T-cell

96
Q

Clinical specimens – pulmonary TB

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

A

3

2

two days

Morning

97
Q

Gold standard for laboratory confirmation of TB is ??

A

By Culture

98
Q

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

A

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

99
Q

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

A

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

100
Q

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

A

T

T

T

F

F(positive)

101
Q

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

A

T

F

T

T

F

T

102
Q

multidrug resistant TB is a TB that is Resistant to ___________________

A

at least isoniazid and rifampicin

103
Q

For MDR TB, use ______

A

2nd line antibiotics

104
Q

2nd line TB Drugs, compared to 1st line

More or less toxic

More or less effective

A

More

Less

105
Q

1st line TB Drugs, compared to 2nd line

More or less toxic

More or less effective

A

Less

More

106
Q

ATYPICAL MYCOBACTERIA

Has ___________ animal host

A

No animal

107
Q

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

A

T

inhalation or ingestion of bacilli from the environment.

opportunistic

House Pharmacology (50 decks)

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