TB

Question 1

Rifampin

Answer 1

MOA:Inhibits DNA-dependent RNA-polymerase; bactericidal drug that kills TB in caseating granulomas and within macros

Metabolism: CYP-450 inducer by up regulating the ER of hepatocytes; increases it’s own metabolism as well as Warfarin, Theophylline, steroids, narcotics)

ADRs: Hepatotoxicity (elevated transaminases) and DISCOLORED bodily fluids (Who loves orange soda?)

-Do not give as monotherapy; will develop resistance

Question 2

Isoniazid

Answer 2

MOA: Inhibition of mycolic acid synthesis; kills actively growing TB and inhibits growth of dormant orgs; DOC for preventative therapy in (+) PPD

Metabolism: Depends on if the pt. is a slow/fast acetylator

ADRs: Hepatotoxicity; lupus-like syndrome Neurotoxicity***
=»Pyridoxine administration will decrease the risk of this; alcoholics, children, and egyptians at higher risk for this

Question 3

Pyrazinamide

Answer 3

MOA: Bactericidal towards dormant organisms in macros

ADRs: Hepatotoxicity; hyperuricemia*** (competes w/ uric acid for elimination)
=»Bad for gout pts.

Question 4

Ethambutol

Answer 4

MOA: Bacteriostatic

ADRs: OPTIC NEURITIS =» reversible decrease in visual acuity and red-green color sight
*Do not give to children because this is difficult to assess; instead give streptomycin (RIPS)

Question 5

Streptomycin (tx for TB)

Answer 5

MOA: AGC that binds to the 30s ribosomal subunit
-Must be given IV due to poor gastric absorption

ADRs: CN VIII toxicity (vertigo); some nephrotoxicity (all AGCs)

Question 6

Rifamate

Answer 6

RIF + INH

Question 7

Rifater

Answer 7

RIF + INH + PYR

-still need to give pyridoxine for this and Rifamate

Question 8

Rifabutin

Answer 8

Active against MAC; can also be given to TB pts. who have a CI for Rifampin but is less effective

ADRs: Discoloration of bodily fluids; NEUTROPENIA

Question 9

Rifapentine

Answer 9

Used on non-cavitary, drug susceptible TB

• Must be HIV negative
• Use once sputum cultures have converted to negative

Question 10

Clofazime

Answer 10

MOA: Binds preferably to Mycobacterium DNA; used for M. leprae (Dr.C)

ADRs: Life-threatening abdominal pain; discoloration of skin and eyes

Question 11

Dapsone

Answer 11

MOA: Bacteriostatic for M. leprae; DOC is bacteria is sensitive

ADRs: Sulfone Syndrome
-fever, dermatitis, jaundice; tx w/ steroids

Question 12

MAC tx

Answer 12

Clarithyromycin + Ethambutol

If necessary, could add clofazamine, rifampin

Prophylaxis recommended if CD4

Question 13

Extensive Drug Resistant TB

Answer 13

Resistance to RIF, INH, FQN, and at least 3 injectable drugs

Question 14

Ghon Complex

Answer 14

Nodule found in TB consisting of Langhan’s cells

Question 15

Orthomyxoviridae number of segments

Answer 15

8 RNA segments, negative sense ssRNA

Question 16

Pertussis

Answer 16

Infection cycle:

Incubation: 7-10 days

Catarrhal: 1-2 weeks (seems like common cold)

Paroxysmal: 2-4 weeks; will see petechiae and conjunctival hemorrhages assoc. To the severity of the coughing

Convalescent: 3-4 weeks; dissemination of cough and possible rise of secondary complications

ID: GNR that can be grown on potato agar; lymphocytosis on CBC, may be CXR findings

Tx: Macrolides to decrease the infectivity; supportive fluids; DTAP

⭐️A-B ribosylating toxin inactived GI proteins
➡️ impaired phagocytosis