Drugs to Treat Pulmonary TB

Question 1

What are the first line agents for treating TB?

Answer 1

Rifampin

Isoniazid (INH)

Pyrazinamide

Ethambutol

sometimes Streptomycin

Question 2

What should be monitored when receiving TB tx?

Answer 2

Liver!

Monitor serum bilirubin, AP, ALT, AST

Question 3

Goals of TB tx?

Answer 3

1. Decrase disability and death

2. Decrease active spread of disease

Question 4

What is the acronym for TB drugs?

Answer 4

RIPE:

Rifampin

Isoniazid

Pyrazinamide

Ethambutol

Question 5

What TB tx is also indicated in meningococcal carriers?

Answer 5

Rifampin

Question 6

Why is rifampin contraindicated in a patient receiving ritonavir-boosted saquinavir?

Answer 6

hepatocellular toxicity

Question 7

Why should rifampin not be taken with receiving atazanavir, darunavir, fosamprenavir, saquinavir, or tipranavir?

Answer 7

Rifampin can decrease plasma concentration of receiving atazanavir, darunavir, fosamprenavir, saquinavir, or tipranavir

• the can cause loss of antiviral efficacy

Question 8

What is a warning in rifampin use?

Answer 8

liver dysfunction

Fatalities associated with jaundice have occurred in patients with liver disease and in patients taking rifampin with other hepatotoxic agents

Question 9

What enzyme can be induced by rifampin?

Answer 9

• Rifampin is known to induce certain cytochrome P-450 enzymes
• Administration of rifampin with drugs that undergo biotransformation through these metabolic pathways may accelerate elimination of co-administered drugs.

Question 10

What TB drug inhibits the synthesis of essential bacterial cell wall component mycoloic acids?

Answer 10

isoniazid

At therapeutic levels isoniazid is bactericidal against actively growing intracellular and extracellular Mycobacterium tuberculosis organisms

Question 11

What is the black box warning of isoniazid?

Answer 11

• Severe and sometimes fatal hepatitis

- may develop even after many months of treatment.

Question 12

What drug is indicated for the initial tx of active tuberculosis in adults and children when combined with other antituberculosis agents?

Answer 12

Pyrazinamide

Question 13

What is the current CDC recommendation for initial tx of active TB?

Answer 13

RIP for 2 months (rifampin, isoniazid, and pyrazinamide) followed by RI for 4 months (rifampin, isoniazid)

Question 14

What TB drug is contraindicated in a patient with severe hepatic damage and acute gout who has shown hypersensitivity?

Answer 14

Pyrazinamide

Question 15

What TB drug is an oral chemotherapeutic specifically effective against actively growing microorganisms of genus mycobacterium?

Answer 15

Ethambutol

Question 16

What drug is contraindicated when there are visual side effects or changes in vision?

Answer 16

Ethambutol

Question 17

What TB drug could cause optic neuritis and decrease visual acuity?

Answer 17

Ethambutol

Question 18

What TB drug can cause vestibular and auditory dysfunction (ototoxicity)

Answer 18

Streptomycin

Question 19

When do you use streptomycin?

Answer 19

strongly suspect super imposed bacterial infection

Question 20

Streptomycin can cause severe neurotoxic reactions in what patients?

Answer 20

Patients with impaired renal function or pre-renal azotemia