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Pharm > TB > Flashcards

TB Flashcards

1
Q

Mycobacteria species

rod shaped aerobic bacteria

A

Cell wall with:
peptidoglycan
mycolic acids
Fatty acids and waxes
responsible for slow growth, acid fastness, resistance to detergents and common antibiotics
do not stain very well

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2
Q

mycobacteria species that are pathogens

A
  1. Mycobacterium Tuberculosis
    * pulmonary
    * disseminated tuberculosis
  2. Mycobacterium leprae
    * leprosy (hansen’s disease)

mycobacterium bovis- tuberculosis like and rare

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3
Q

mycobacteria POTENTIALLY pathogenic

A
  1. Mycobacterium Avium complex (MAC)
    * disseminated and pulmonary infections
    * AIDS population
    * reservoir in soil, water, birds, swine, cattle, environment

mycobacterium Kansasii- pulmonary like TB, grows slower

mycobacterium ulcerans- subcutaneous nodules and ulcers-> waterborne skin pathogen

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4
Q

Targets for MOA of Antimycobacterial agents

A
  1. ATP synthase
  2. NADH dehydrogenase
  3. Intracellular acidification
  4. Ribosome
  5. RNA polymerase
  6. DNA gyrase
  7. Folate metabolism
  8. Peptidoglycan
  9. ARabinoglactan
  10. Mycolic acids
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5
Q

Tuberculosis treatments

depends on if pt has active or latent tb infection

A

Latent:
* monotherapy
* no symptoms and cannot spread the disease

Active TB:
* minimum of two drug therapy
* can spread the disease

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6
Q

Latent TB infection drugs

A
  • Isoniazid (INH)
  • Rifapentine (RPT)
  • Rifampin (RIF)
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7
Q

Isoniazid (INH)

GOOD IN PREGO AND PEDS

A

Bactericidal if actively growing-> otherwise inhibitory
MOA: inhibits cell wall biosynth by interfering with lipid and dna synthesis
Various resistance
Dosage: Injection of Oral
GI absorption
PREGO SAFE, PEDS SAFE, AND USED FOR LATENT OR ACTIVE TB

adverse effects: severe and fatal hepatitis within 3 months of treatment
* hepatitis- 1% liver metabolism
* sputum cultures monthly until 2 consecutive cultures
* rashes, SLE
* DECREASE DOSE IN CHRONIC ALCOHOLISM
* PERIPHERAL NEUROPATHY AT HIGHER DOSES= tx with pyridoxine (vit B6)
* at high risk: pregnancy, breastfeeding infants, HIV, chronic renal filure, DM

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8
Q

Rifampin

A

MOA: binds to RNA polymerase
Hepativ metabolism
POLYPHARMACY FOR ACTIVE TB TO PREVENT EMERGENCE OF RESISTANT STRAINS
Porphyrias

Adverse effects:
affect BG in Diabetes
Bloody dyscrasias
proteinuria
flu like illness
thrombocytopenia
RED ORANGE BODY FLUIDS- urine, breast milk, stool, tears, sweat
RARE- hypersensitivity reactions- hypotension, anaphylaxis, fever

cheaper than isoniazid

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9
Q

Rifampin drug interactions

is an enzyme inducer

A

Major interactions: methadone, protease inhibitors (HIV), steroids, oral contraceptives, warfarin, dogoxin, calcium channel blockers, ondansetron, simvastatin

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10
Q

Rifapentine

similar to rifampin

A

Hepatotoxicity
potential hypersensitivity
discoloration of body secretions
C. diff diarrhea - resistant to rifapentine
AVOID IN PT WITH PORPHYRIAS
Watch CBCS for white/red cell anomalies-

AVOID IN PREGO, TAKE WITH FOOD

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11
Q

Latent TB infxn tx regimen factors

A
  1. drug susceptibility results of the presumed source case
  2. Coexisting medical conditions-> Pregnancy status and HIV status
  3. Potential for drug-drug interactions

SIC

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12
Q

Schedule for tx of latent tb

A
  1. Isoniazid and Rifapentine
    * 3 months
    * NOT GOOD FOR PREGO OR HIV
  2. Isoniazid and Rifampin
    * 3 months
    * not good for HIV
    * Allowed for Pregnancy
  3. Rifampin- first line
    * 4 months
    * not for HIV
  4. Isoniazid
    * 6 months
    * ALLOWED IN PREGNANCY
    * NEEDS EXACT DIRECT OBSERVATION TX
  5. Isoniazid
    * 9 months
    * PREFERRED FOR PREGNANT WOMEN WITH PYRIDOXINE
    * DIRECT OBSERVATION
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13
Q

DOT- direct observation tx

A

whenever possible to reduce tx failures and selection of drug resistance
meets with healthcare worker every day
Takes TB med while being watched
Discuss problems
Noncompliance rates are as high as 89% with TB therapy

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14
Q

Preferred tx for latent tb

A

Short course Rifamycin based 3-4 months regimens
Effective, safe, higher completion rates, than isoniazid monotherapy

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15
Q

Active TB

core drugs

A
  1. Rifampin RIF
  2. Isoniazid INH
  3. Pyrazinamide PZA
  4. Ethambutol EMB
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16
Q

Ethambutol (EMB)

A

Cell wall drug but bacteriostatic
absorbed orally well
reduced dose in renal failure

AE: optic neuritis, RED/GREEN discrimination, visual acuity

17
Q

Pyrazinamide PZA

A

MOA: taken up by macrophages and penetrates lysosomes
Phase 1 hepatic, then renal clearance
AE: HYperuricemia, liver, GI, rash, monitor uric acids and LFTs
MOA: inhibit fatty acid synthetase enzyme of M. tuberculosis
MOR: NOT USED AS A MONOTHERAPY

USUALLY TX BY ID

SHOULD NOT BE USED IN PREGNANCY AS EFFECTS ON FETUS UNKNOWN

18
Q

Active TB regimens

A

Intensive phase 2 months:
* INH, RIF, PZA, EMB (RIPE)
Continuation phase 4-7 months:
* INH, RIF

4 round regimen

19
Q

Additional TB drugs- Streptomycin

A

Aminoglycoside- for more severe disease
AE: nephro/ototoxic, get audios, BUN
CONTRAINDICATED IN PREGNANCY

20
Q

Drugs sometimes used

A

Capreomycin
* MOA: cyclic polypeptide antimicrobial
* AE: ototoxicity, nephrotoxicity
* NOT FOR PEDS/PREGNANCY

Cycloserine
* MOA: inhibits bacterial cell wall synthesis by ocmpeteing with aminod acid to be incorporated into cell wall
* USED FOR MULTIDRUG RESISTANCE TB
* AE: CNS effects- seizures, psychosis, depression, confusion
* pyridoxine to prevent cns
* vitamin b12 and folic acid supplementation

21
Q

Additional drugs sometimes used

A

Ethionamide
* inhibits mycolic acid synthesis
* AE: diabetes, hepatotoxicity, thyroid dysfunction

Para-aminosalicylic acid (aminosalicylate)
* MOA: structurally related to PABA
* AE: Pericarditis, vasculitis, rashes, GI
* CI: ASA ALLERGY

22
Q

Drug resistance to TB

A

remained stable over the last 20 years
most common is isoniazid
Multidrug resistance: isoniazid and rifampin

23
Q

MDR-TB and XDR TB

A

MDR= resistant to isoniazid and rifampin
XDR= resistant to INH and RIF AND at least 3 of second line anti-TB drugs

24
Q

Non tb mycobacterial tx

A

Atypical mycobacterial infections:
* Mac= mycobacterium avium complex
* pt with AIDS, fever, weightloss
* usually in severely immunocomp- HIV

SXS:
* sweating
* fatigue
* diarrhea
* sob
* right upper quadrant abdominal pain

Pulmonary pathogen
associated w/: osteo myelitis, tenosynovitis, synovitis

25
Q

Mycobacterium avium infection

pulmonary and disseminated agents

A

Tx with 2 or more drugs
can sub Azithromycin or clarithromycin
atleast for 12 months
1. Rifabutin
2. Rifampin
3. Azithromycin
4. Clarithromycin
5. Ethambutol

26
Q

Mycobacterium Kansasii tx

like TB

A

SX: hemoptysis, chest pain, cavitary lung disease
Effectively tx: Isoniazid, Rifampin, Ethambutol
Alt meds: fluroquinolones, clarithromycin, aminoglycosides
tx for 1 yr post neg

resistant to pyrazinamide

easily cured

27
Q

Mycobacterium Kansasii tx

like TB

A

SX: hemoptysis, chest pain, cavitary lung disease
Effectively tx: Isoniazid, Rifampin, Ethambutol
Alt meds: fluroquinolones, clarithromycin, aminoglycosides
tx for 1 yr post neg

resistant to pyrazinamide

easily cured

28
Q

M. Leprae

Leprosy

armadillos naturally infected

A

Requires sustained exposure in childhood
Endemic= Africa, Asia, Brazil
TX: Dapsone and Rifampin -> paucibacillary form
TX: Clofazimine plus rifampin and dapsone-> multibacillary form

29
Q

Mycobacterium Marinum

swimming pool granuloma

A

Found: NON CHLORINATED WATER
RF: Aquaria and swimming pools
Superficial cutaneous infection: minocycline, clarithromycin, doxycycline, trimethoprim-sulfamethozazol (monotherapy)
Severe inf: combo of rifampicin and ethambutol
Spontateous remission- in untreated infection adn immunocompetent

opportunistic infection

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Pharm (9 decks)

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