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RS > Pharm 2 > Flashcards

Pharm 2 Flashcards

1
Q

what is the goal of tb treatment

A

prevent tb spread
know where tb has spread
return patient to well being and normal weight

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2
Q

what is used for treatment of latent tb

A

INH for 9 mths daily (300mg)
rifampin or rifabutin for 4 mths daily
INH and rifapentine for weekly for 12 weeks DOT

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3
Q

What is used for active tb treatment

A

3-4 first line (isoniazid, ethambutol, pyrazinamide and rifampin ) for 6 mths

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4
Q

what is the shortest duration for active tb treatment and when

A

4mth in culture negative 2

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5
Q

how much can tb treatment last in MDR-TB

A

2 years

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6
Q

when can we use second line drugs

A

if patients cannot tolerate 1st line and resistant tb

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7
Q

when can you use monotherapy and when multiple drug therapy

A

monotherapy for latent tb

multiple for active ( monotherapy doesnt work)

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8
Q

Mycobacterium tb has small number of naturally resistant mo but when do they increase in number

A

inadequate treatment with monotherapy causing resistant tb

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9
Q

active disease require treatment with multi drug therapy

A

true

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10
Q

are patients in latent tb infectious

A

no not infectious

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11
Q

no isolate can be taken from latent tb infections so we cant perform susceptibility test so treatment based on most likely source of infection

A

true

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12
Q

what can replace rifampin

A

rifabutin or rifapentine

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13
Q

clinical improvement can occur in first weeks of treatment but you should continue

A

eradicate persistent organism

prevent relapse

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14
Q

course of tb treatment ( 2 phases)

A 
intensive phase ( all 4 for 2 mths) 
continuation phase (rifampin and INH for 4 mths)
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15
Q

what are second line regimens for MDR TB

A 
injectable aminoglycoside (amikacin, streptomycin, kanamycin and capreomycin) 
florouquinolones , one of active 1st line and cycloserine, ethionamide and p-aminosalicylic acid
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16
Q

treatment for XDR-TB

A

linezolid or clofazimine

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17
Q

what is XDR-TB

A

resistant to two imp 1st line
resist floroquinolone
resist one of injectable

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18
Q

DOTS plus pilot program by who and for what

A

WHO representative

strengthen DOT program

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19
Q

what is special about doses in pediatric

A

doses of INH an rifampin on mg /kg basis is higher than adults ( dosing is higher but not dose)

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20
Q

can you use it in pregnancy

A

yes

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21
Q

extended therapy for 9mth is pediatric is recommended by some protocols

A

true

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22
Q

what drugs are prodrugs

A

isoniazid and pyrazinamide

23
Q

how is isoniazid converted to active form and what is its MOA

A

by mycobacterial catalase peroxidase

target enzyme for mycolic acid synthesis disrupting cell wall

24
Q

what is the resistance in isoniazid and rifampin and pyrazinamide

A

isoniazid chromosome mutation
rifampin mutation in affinity of DNA dependent RNA pol
pyrazinamide lack pyrazinamidase enzyme

25
cross resistance can occur with what two drugs
isoniazid and ethionamide
26
what drug absorption is impaired when taken with food (high fat)
isoniazid
27
drug conc in CSF in INH and rifampin and ethambutol
INH have same conc in drug and plasma rifampin has 10-20% of blood conc in CSF ethambutol CSF conc is minimal
28
what happens to isoniazid in liver
N acetylation and hydrolysis giving rise to inactive product
29
rapid acetylator of INH and slow acetylator of INH difference
rapid has short t1/2 almost 1 hour | slow has longer t1/2 almost 3 hours
30
excretion of INH through what
filtration and secretion
31
slow acetylators excrete what
parent compound and metabolite
32
side effects of INH
hepatitis (increased risk in chronic alcoholics , age more than 35 and those who take also rifampin) peripheral neuropathy
33
peripheral neuropathy of INH due to what and how treated
pyrodoxine def | 25-50mg per day should be given
34
rifampin, rifabutin and rifapentine from what family
rifamycin
35
rifampin should never be given as single agent in active tb
true
36
rifampin, ethambutol and streptomycin penetrate BBB in what case
inflamed meninges
37
what drug induces CYP450 and autoinduction
rifampin
38
shortened half life over the 1st 1-2 weeks of taking rifampin
true
39
what should be done to solve cyp450 induction
higher the dose of co administered drugs switch to drugs less affected by rifampin replace rifampin with rifabutin
40
what are the color of fluids due rifampin
orange red
41
when to use rifabutin
TB patients who are also HIV positive that are recieving PI and NNRTI
42
Rifabutin is 40% less inducer to CYP450 compared to rifampin
true
43
which rifamycin has the greatest activity and longer half life
rifapentine
44
when is rifapentine used
in HIV negative patients with pulmonary TB
45
How is pyrazinamide converted to active and what is the active called
pyrazinamidase | pyrazinoic acid
46
pyrazinamid is taken orally
true
47
MOA of ethambutol
bacteriostatic
48
main S/E of ethambutol
optic neuritis | diminished visual acuity and loss of ability to differentiate between red and green
49
visual acuity and color discrimination should be tested before starting treatment and periodically after
true
50
S/E of pyrazinamide
hyperurecemia (gout) and hepatitis
51
S/E of flroquinolone
achilles tendon rupture ( tendonitis) | C/I in patients less than 8 and in pregnant
52
ethionate and p-aminosalicylic acid S/E
Hypothyroidism and hepatotoxicity
53
macrolide S/E
tinnitus
54
aminoglycoside S/E
ototoxic and nephrotoxic

RS (13 decks)

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