Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM 865 > Exam 4 - Tuberculosis > Flashcards

Exam 4 - Tuberculosis Flashcards

1
Q

what bug causes tuberculosis?

A

mycobacterium tuberculosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

gram stain of mycobacterium tuberculosis?

A

Aerobic
non-spore forming
bacillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are factors associated with MDR-TB?

A 
inadequate therapy (monotherapy or suboptimal dose)
Cavitary lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what drug combo is most commonly used for active TB treatment?

A

RIPPE

Rifampin, Isoniazid, Pyrazindamide, Pyridoxine (B6), Ethambutol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mycobacterium tuberculosis:

_____ rich cell wall that contains _______ and is _______ to many durgs

A

Lipid rich
contains mycolic acid
impermeable to many drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Transmission of Tb:

Only _____ Tb infections can be transmitted

A

active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Transmission of Tb:

spread by __________

A

aerosol droplets (speaking, coughing, spitting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the extrapulmonary tuberculosis things that can happen?

A

genitourethral tuberculosis
TB w/ arthritis or osteomyelitis
TB menigitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Issues with HIV and diagnosis of TB?

A

HIV patients have weak immune systems —- they wont have a positive response to skin testing as easily (high false negative rate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical presentation for TB in healthy patients?

A 
Fever/chills
NIGHT SWEATS
anorexia
wt loss 
cough
hemoptysis/SOB
malaise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical presentation of TB in HIV patients?

A

if early HIV — kinda similar… extrapulmonary at higher risk
if late HIV — v high extrapulmonary disease risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

2 main ways to screen for TB?

A

PPD (purified protein derivative)

IGRAs (interferon gamma release assays)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

when to do IGRA over PPD for diagnosis?

A

when pts have rcvd BCG vaccinated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T or F: only need to do drug susceptibility for TB when i HIV pts?

A

false — do it for every isolate!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Someone is deemed noninfectious when receiving effective therapy, improving clinically, and ??

A

pt has negative sputum smear results for 3 CONSECUTIVE days (each sputum collected on a different day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the 2 phases for TB treatment?

A

intensive phase then continuation phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If pts have HIV and you want to treat TB….

  • If pts have CD4 < 50 cells/uL start ART within ______ of TB therapy
  • If pts have CD4 >/= 50 cells/uL start ART within ______ of TB therapy
A

< 50: within 2 weeks

> 50: delay ART until 8 - 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Rifampin is a hella _______ of CYP

A

inducer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

_________ is the most active FQ against M. tuberculosis

A

Moxifloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

For MDR-TB:

Treat any patient with ______ resistant TB (or if _____ resistance is absent or unknown with a MDR-TB regimen

A

rifampin resistant; INH resistance unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

For MDR-TB:

Must include what 3 drugs for sure for treatment?

A 
A FQ (Levo or moxi)
\+
Bedaquiline
\+
Linezolid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment options for latent TB infection?

A

Rifampin QD x 4 mos
INH + Rifapentine once weekly x 12 weeks
INH daily x 6 - 9 mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

INH: how metabolized?

A

by liver — N-acetyltransferase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

INH: into CSF?

A

yas – super well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
INH: good or bad oral bioavail?
good
26
ADEs of INH?
Hepatitis | Neurotoxic = PERIPHERAL NEUROPATHY --- give Vit. B6
27
Dose adjustments for INH?
when severe hepatic insufficiency or renal failure
28
why supplement B6 with INH therapy?
INH increases pyridoxine excretion --- need it to prevent peripheral neuropathy
29
INH: inducer or inhibitor of P450?
inhibitor
30
ADEs of rifampin?
``` Hepatoxicity discolored urine (sweat and tears)/(orange color) -- can permanently stain contact lenses ```
31
ADEs of Pyrazinamide?
Hepatoxicity Hyperuricemia Joint pain - arthralgias (MCMP notes)
32
ADEs of Ethambutol?
``` Peripheral neuropathy Optic neuritis (can be irreversible if not discontinued) ```
33
ADEs of streptomycin?
otoxicity nephrotoxicty (it is a aminoglycoside!!)
34
Do you renal dose adjust for Pyrazinamide or Ethambutol?
Ethambutol
35
ADE with PAS (P-aminosalicylic acid)
GI!! -take with meals
36
ADEs of Cycloserine?
"PSYCHO-serine" | depression/personality changes/psychosis/seizures
37
INH has to be activated by the ______ protein
KatG (comes M.tb)
38
INH forms adducts with _______ and ______
NAD+ and NADP+
39
what enzymes are inhibited by the INH/NAD+/NADP+?
InhA and KasA (inhibits mycolic acid synthesis) | DHFR (dihydrofolate reductase)
40
Activated INH inhibits _______ which is a component of ________ synthase
``` inhibits: InhA FAS II (fatty acid synthase) ``` (overall affects arabino-galactan -- part of mycobacterium
41
Overall INH leads to a ________ (why it is good at killing Tb)
leads to defective cell wall
42
INH resistance happens via what?
by over expression of InhA | and somehow activation of INH by KatG is stopped (Tb probs stops making Katg)
43
INH is metabolized how?
acetylated by N-acetyltransferase
44
INH Toxicity Mechanism: | Acetylisoniazed can become _________ (which I think is a toxic metabolite...)
acetylhydrazine
45
INH Toxicity Mechanism: | _______ converts to hepatotoxic metabolites
CYP2E1
46
INH Toxicity Mechanism: | _____ can acetylate acetylhydrazine to nontoxic diacetyhdrazine
NAT2
47
what does AFB stand for
acid fast bacteria
48
what does it mean to be AFB?
the bug stains SUPER well and cannot be decolorized
49
Pathology of Tb: 1. bacteria phagocytosed by alveolar macrophages in the lung/ cause proinflammatory response 2. Recruited cells (such as _______ cells) will form a _______
recruited cells = mononuclear cells | form a granuloma (tubercle)
50
Pathology of Tb: 3. Granuloma forms a _________ with fewer ________ in later stages 4. When immune status change containment fails 5. The granuloma ________ and spills viable/infectious bacilli into airways
forms a fibrous sheath; fewer penetrating blood vessels in later stages granuloma caseates/decays/ruptures
51
Always a 10% lifetime risk of developing active infection when pt has latent Tb but what things increase risk of activation of Tb?
Diabetes HIV Old age malnutrition
52
INH Toxicity Mechanism: (fast or slow) acetylators will lead to toxic metabolites (fast or slow) acetylators will remove acetylhydrazine
``` slow = toxic fast = removes the toxic metab ```
53
INH Toxicity Mechanism: | Induction of CYP________ leads to toxic metabolites
CYP2E1
54
INH Toxicity Mechanism: | _______ induces CYP2E1 and potentiates INH hepatotoxicity
rifampin
55
MCMP reason why we need to supplement B6 with INH therapy?
INH inhibits metabolism of pyridoxine to pyridoxal phosphate....
56
How is Pyrazinamid activated?
by pncA which is a nicotinamidase from M.Tb | gets converted to pyrazinoic acid
57
Pyrazinamide (PZA) is structurally similar to ________
nictinamide
58
Pyrazinamide (PZA): | facts about it being active in relation to pH?
NOT active at neutral pH/ | WILL BE active if pH < 5.5
59
3 ideas of how Pyrazindamide works?
- inhibition of trans-translation - inhibition of aspartate decarboxylase PanD - Acidification of cytoplasm followed by disruption of energy metabolism
60
Pyrazinamide MOA Guess: Trans-Translation: | It gets converted to pyrazinoic acid and will bind and inhibit ______________
ribosomal protein S1 (RpsA) = proteins won't fold correctly
61
``` PZA = ? POA = ? ```
``` PZA = pyrazinamide POA = Pyrazinoic Acid ```
62
Pyrazinamide MOA Guess: inhibit PanD | panD normally converts ________ to ______
L-aspartate to alanine
63
Pyrazinamide MOA Guess: inhibit PanD | (PZA or POA) binds to PanD
POA (the activated form) does bind | wont bind to mutant panD tho = resistance
64
Pyrazinamide MOA Guess: inhibit PanD overall will reduce the accumulation of ________ after the panD step which will increase levels of _______
coA precursors; free fatty acids
65
``` MOA of Ethambutol: Inhibits __________ (which is involved in _________) ``` this causes a build up of ________
mycobacterial arabinosyl transferases; polymerization of arabinogalactan; build up of arabinan
66
Ethambutol: | is synergistic with _______
rifampin (increases penetration into cell)
67
Resistance to Ethambutol happens how?
over expression of or mutations of arabinosyl transferase
68
INH: | active against latent, growing or both forms of Tb?
JUST growing forms
69
Rifampin: | active against latent, growing or both forms of Tb?
both!!
70
Rifampin is most effective when the cell is _______
dividing
71
MOA of Rifampin: | Binds to ________ deep within the ________
to RNA pol | within DNA/RNA channel
72
Bacteriocidal or Bacteriostatic? Rifampin? Ethambutol?
Rifampin:cidal Ethambutol: static
73
Rifapentine: is a derivative of rifampin it is more _______ and has a ______ half life
lipophilic | longer 1/2 life
74
Which aminoglycoside can be used for Tb?
Streptomycin (idk if others cant but they talk about streptomycin...)
75
Streptomycin and Tb: | most active against ______ forms
extracellular
76
Streptomycin and Tb: | used mainly when severe tuberculosis (ex: _______ or _______0
meningitis or disseminated
77
Bedaquiline: Given PO or IV? cidal or static? active against latent, growing or both forms of Tb?
PO cidal both!
78
Bedaquiline MOA?
inhibits ATP synthase
79
what are some 2nd line agents fro Tb?
``` FQs Ethionamide para-aminosalicylic acid Cycloserine Carpreomycin ```
80
when to consider 2nd line agents for Tb?
if resistant to 1st line... failure of clinical response to first line agents intolerance of first line have expert guidance available to deal with toxic side effects
81
why are the 2nd line agents for Tb used as 2nd line?
less well tolerated/greater incidence of side effects.....(SHOCKING)

PHRM 865 (59 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions