Pharmacology

Question 1

Amoxicillin (Augmentin)

Answer 1

Tx for bacterial sinusitis

Question 2

Azithromycin

Answer 2

Tx for bacterial sinusitis, bacterial bronchitis

Question 3

Penicillin

Answer 3

Tx for Strep Pyogenes Pharyngitis (if allergic use erythromycin)

Question 4

Erythromycin

Answer 4

Tx for Strep Pyogenes pharyngitis if allergic to erythromycin
Tx for bacterial bronchitis

Question 5

Isoniazid

Answer 5

Bactericidal cell wall synthesis inhibitor, a PRODRUG
-FASII (fatty acid synthase II), Mycolic acid
AE: N/V, peripheral neuopathy, can cause B6 deficiency

Depends if the patient is a FAST or SLOW acytylators - can cause liver damage if fast**

Also must supplement with vit B6**

Used for latent TB infection, daily for 9 months

Question 6

Rifampin

Answer 6

Blocks DNA dependent RNA polymerase
-Activates P450 enzymes** (hepatic metabolism)
AE: Rash, N/V, fatigue, diarrhea, RED TEARS, induces P450 enzymes, hepatic metabolism (can cause LIVER TOXICITY***)

Used for latent TB infection, daily for 4 months

Question 7

Pyrazinamide

Answer 7

Inhibits RPSA and translation, decreases pH of environment (acidifies) FAS-1

AE: malaise, N/V, anorexia, myalgia

Question 8

Ethambutol

Answer 8

Inhibits arabinosyl transferase and decreases my colic acid, increases permeability

AE: gout, anorexia, N/V, color blindness/vision problems (RED/GREEN color blindness) so CONTRAINDICATED IN CHILDREN* (dose related)

Question 9

Streptomycin (aminoglycosides)

Answer 9

Inhibits 30S ribosome/translation (FAS1 and RpsA)
AE: Hypotension, neuro/nephro/otto toxicity, HA, rash, N/V, arthralgia
TERATOGEN** (never give to pregnant woman)

Does not get into cells so only works to treat the extracellular forms of TB

Question 10

RIPE regimin

Answer 10

Treatment for active TB

-positive PPD, clinical symptoms, and abnormal CXR

Question 11

Treatment for latent TB?

Answer 11

Isoniazid X 9mo is the GOLD STANDARD.

Rifampin X 4mo.

Question 12

Treatment for active TB?

Why use FOUR drugs?

Answer 12

RIPE
Rifampin
Isoniazid
Pyridoxine
Ethambutol

Because TB is multi resistant - there are approximately 10^12 bacteria in a person with extensive pulmonary TB
- In order to account for the resistant forms COMBINATION therapy greatly reduces the chances of multi-drug resistant TB

Question 13

What is an important bodily system to monitor while treating a patient with TB?

Answer 13

LIVER
AST, ALT

Acetylation is associated with liver damage and the risk increases with age - The metabolites are toxic. Slow acetylators (people) don’t accumulate as much toxic metabolite and have much LESS liver toxicity

Question 14

Why is the treatment time so long for TB?

Answer 14

Because it is a SLOW grower and exists intracellular and extracellulary. Must treat through a series of replications.

Question 15

Pyridoxine

Answer 15

Given with isoniazid

mechanism unknown.