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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
Q

cross resistance can occur with what two drugs

A

isoniazid and ethionamide

26
Q

what drug absorption is impaired when taken with food (high fat)

A

isoniazid

27
Q

drug conc in CSF in INH and rifampin and ethambutol

A

INH have same conc in drug and plasma
rifampin has 10-20% of blood conc in CSF
ethambutol CSF conc is minimal

28
Q

what happens to isoniazid in liver

A

N acetylation and hydrolysis giving rise to inactive product

29
Q

rapid acetylator of INH and slow acetylator of INH difference

A

rapid has short t1/2 almost 1 hour

slow has longer t1/2 almost 3 hours

30
Q

excretion of INH through what

A

filtration and secretion

31
Q

slow acetylators excrete what

A

parent compound and metabolite

32
Q

side effects of INH

A

hepatitis (increased risk in chronic alcoholics , age more than 35 and those who take also rifampin)
peripheral neuropathy

33
Q

peripheral neuropathy of INH due to what and how treated

A

pyrodoxine def

25-50mg per day should be given

34
Q

rifampin, rifabutin and rifapentine from what family

A

rifamycin

35
Q

rifampin should never be given as single agent in active tb

A

true

36
Q

rifampin, ethambutol and streptomycin penetrate BBB in what case

A

inflamed meninges

37
Q

what drug induces CYP450 and autoinduction

A

rifampin

38
Q

shortened half life over the 1st 1-2 weeks of taking rifampin

A

true

39
Q

what should be done to solve cyp450 induction

A

higher the dose of co administered drugs
switch to drugs less affected by rifampin
replace rifampin with rifabutin

40
Q

what are the color of fluids due rifampin

A

orange red

41
Q

when to use rifabutin

A

TB patients who are also HIV positive that are recieving PI and NNRTI

42
Q

Rifabutin is 40% less inducer to CYP450 compared to rifampin

A

true

43
Q

which rifamycin has the greatest activity and longer half life

A

rifapentine

44
Q

when is rifapentine used

A

in HIV negative patients with pulmonary TB

45
Q

How is pyrazinamide converted to active and what is the active called

A

pyrazinamidase

pyrazinoic acid

46
Q

pyrazinamid is taken orally

A

true

47
Q

MOA of ethambutol

A

bacteriostatic

48
Q

main S/E of ethambutol

A

optic neuritis

diminished visual acuity and loss of ability to differentiate between red and green

49
Q

visual acuity and color discrimination should be tested before starting treatment and periodically after

A

true

50
Q

S/E of pyrazinamide

A

hyperurecemia (gout) and hepatitis

51
Q

S/E of flroquinolone

A

achilles tendon rupture ( tendonitis)

C/I in patients less than 8 and in pregnant

52
Q

ethionate and p-aminosalicylic acid S/E

A

Hypothyroidism and hepatotoxicity

53
Q

macrolide S/E

A

tinnitus

54
Q

aminoglycoside S/E

A

ototoxic and nephrotoxic

RS (13 decks)

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