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Antimicrobials > Mycobacterial Treatment > Flashcards

Mycobacterial Treatment Flashcards

1
Q 
Characteristics of Mycobacteria
Shape
Stain
Replication location
Growth pace
May form?
Cell walls are rich in?
A 
Rod shaped
Acid fast stain...they don't gram stain
Replicate within macrophages
Generally slow growing
May form filaments
Lipid-rich cell walls
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2
Q

Most infected individuals have what kind of infections?

A

Latent infections

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3
Q

Transmission is primarily through

A

Respiratory droplets

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4
Q

When may TB become disseminated?

A

In immunocompromised individuals

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5
Q 
Features of latent TB infections 
activation state
chest xray
sputum and cultures
symptom presentation
infectious state
case or not
A 
Inactive and non-replicating
Chest xray normal
Sputum and cultures are negative
Asymptomatic
Not infectious
Not a case of TB
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6
Q 
Features of TB disease
activation state
chest xray
sputum and cultures
symptom presentation
infectious state
case or not
A 
Active and replicating
Abnormal chest xray
Sputum and cultures MAY be positive
Symptomatic 
Often infectious before treatment
A case of TB
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7
Q

Obstacles to TB Treatment

A

organism grows slowly
organism remains viable but dormant
rapid development of resistance
toxicity with treatment–encourages non-compliance

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8
Q

Solutions to obstacles

A

Regimens contain multiple drugs
Drugs taken regularly
Drug therapy continues for long time

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9
Q

Rifamycin MOA

A

Inhibits RNA synthesis

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10
Q

Streptomycin MOA

useful for

A

Inhibition of protein synthesis at 30S

Used for combination treatment of RESISTANT TB

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11
Q

Isoniazid and ethionamide MOA

A

inhibit mycolic acid synthesis

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12
Q

Ethambutol MOA

A

Inhibits cell wall synthesis

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13
Q

Pyrazinamide MOA

A

Inhibits membrane synthesis

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14
Q

M. avium complex (MAC) causes pulmonary disease and disseminated disease in which populations

A

Pulmonary disease in immunocompetent patients

Disseminated disease in immunocompromised patients, mainly AIDS patient population

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15
Q

MAC primarily acquired through which route?

A

Ingestion of contaminated food and water

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16
Q

Preferred Regimen (4 drugs)

A

Isoniazid
Rifamycin
Pyrazinamide
Ethambutol

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17
Q

Continuation Regimen (2 drugs)

A

Isoniazid

Rifamycin

18
Q

Treatment Regimen for Latent TB (3 drugs)

Which one is drug of choice for latent TB?

A

Isoniazid* drug of choice
Rifapentine
Rifampin

19
Q

INH is bactericidal for?
Penetrates which cell type?
One reason it can cause peripheral neuropathy

A

Bactericidal for actively growing bacilli
Penetrates macrophages
Structurally similar to pyridoxine

20
Q

INH MOA
Delivered as a…?
What activates INH

A

Inhibits synthesis of mycolic acid (essential component of cell wall)
Delivered as a prodrug and is activated by mycobacterial catalase-peroxidase enzyme (Kat G)

21
Q

INH microbial activity

A

considered one of the safest and msot effective antimycobacterial agents available

22
Q

Two reason for resistance against INH

A
  1. mutation in Kat G gene (no longer activated)

2. Overexpression of the InH A protein (involved in mycolic acid synthesis)

23
Q

What group of people are more prone to develop toxicity from INH?

A

Slow acetylators (inactivators)

24
Q

The risk of INH induced hepatitis increases with (blank) and is greater in individuals with (blank)

A

Increases with age and alcoholics

25
Q

Peripheral neuropathy most commonly seen in (5)

A
  1. Slow metabolizers
  2. Malnourished
  3. Alcoholics
  4. Diabetic
  5. AIDS
26
Q

Rifampin MOA

A

Inhibits RNA synthesis by binding to bacterial DNA-dependent RNA polymerase
Penetrates most tissues as well as phagocytic cells

27
Q

Most common side effect with Rifampin use in those with liver disease?

A

Hepatitis

28
Q

HIV patients and rifampin use

A

Rifabutin should be substituted for rifampin

29
Q

Pyrazinamide is used almost exclusively in…

A

combination therapy

30
Q

Pyrazinamide activated by

A

bacterial pyrazinamidase enzyme

31
Q

Pyrazinamide is highly effective against

A

intracellular mycobacteria

32
Q

Most common side effect associated with Pyrazinamide

A

Hyperuricemia/gout issues

33
Q

Ethambutol used almost exclusively for…

But also used for

A

Part of the 4 drug combinations used to treat active TB

Also used to treat MAC bacteria

34
Q

Ethambutol MOA

A

Inhibits arabinosyl transferases which are involved in mycobacterial cell wall synthesis

35
Q

Ethambutol resistance

A

Point mutations in genes coding for arabinosyl transferases

36
Q

Ethambutol adverse reactions (2)

A
  1. Retrobulbar neuritis/color blindness

2. Hyperuricemia (less frequent that pyrazinamide)

37
Q

Streptomycin current use

A

Treatment of TB caused by resistant strains

38
Q

Streptomycin MOA

Works well against…

A

Interferes with bacterial protein synthesis

Works on extracellular organisms

39
Q

Rifabutin use (2)

A
  1. Greater activity against MAC organisms that rifampin

2. Substituted for rifampin in the treatment of HIV patients who also have TB

40
Q

MAC treatment (3…maybe 4)

A
  1. Macrolide
  2. Rifampin (or other rifamycin)
  3. Ethambutol
  4. May use streptomycin
41
Q

Multidrug regimen of leprosy (3)

A

Dapsone
Clofazimine
Rifampin

Antimicrobials (5 decks)

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