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Pharm 4 > TB > Flashcards

TB Flashcards

1
Q

Streptomycin - enters cells?

A

No

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2
Q

Streptomycin - static or cidal?

A

bactericidal

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3
Q

Streptomycin - toxicity?

A

Ototoxic and nephrotoxic

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4
Q

Streptomycin - when used?

A

Sever disease with other agents (a lot of resistance)

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5
Q

Streptomycin - in pregnancy?

A

No

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6
Q

Isoniazid - administration?

A

PO

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7
Q

Isoniazid - clearance?

A

Renal

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8
Q

Isoniazid - penetration?

A

Good. CNS/CSF and macrophages.

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9
Q

Isoniazid - static or cidal?

A

Bactericidal

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10
Q

Isoniazid - mechanism?

A

Inhibits mycolic acid synthesis (inhibits dihydrofolate reductase)

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11
Q

Isoniazid - drug or prodrug?

A

Prodrug

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12
Q

Isoniazid - what breaks down?

A

NAT2

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13
Q

Isoniazid - what activates in TB?

A

KatG

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14
Q

Isoniazid - resistance?

A

KatG del/mute, InhA over expression

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15
Q

Isoniazid - TOX?

A 
Hepatic tox (slow acetylators, +rifampin, >35)
Peripheral neuropathy (slow acetylators, give pyridoxine B6)
Rash, fever, lupus, seizure, coma
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16
Q

Isoniazid - in Preg?

A

NO

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17
Q

Which TB drug causes peripheral neuropathy?

A

Isoniazid

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18
Q

Isoniazid - interactions?

A

Acetaminophen (CYP2E1) - hepatotoxicity

Warfarin (CYP2C9) - bleeds

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19
Q

Pyrazinamide - administration?

A

PO

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20
Q

Pyrazinamide - clearance?

A

Renal

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21
Q

Pyrazinamide - distribution?

A

CNS, macrophage

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22
Q

Pyrazinamide - analog?

A

Nicotinamide

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23
Q

Which TB drug is an analog of nicotinamide?

A

Pyrazinamide

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24
Q

Pyrazinamide - drug or prodrug?

A

Prodrug (pyrazinoic acid by pncA) and acidic environment

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25
Q

Pyrazinamide - mechanism?

A

inhibits FAS1 (mycolic acid synthesis)

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26
Q

Pyrazinamide - static or cidal?

A

Bactericidal

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27
Q

Pyrazinamide - resistance?

A

pncA

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28
Q

Pyrazinamide - TOX?

A

Hepatic toxicity, Hyperuricemia, arthralgias

29
Q

Pyrazinamide - in pregnancy?

A

NO

30
Q

Which TB drug exacerbates gout?

A

Pyrazinamide

31
Q

Ethambutol - administration?

A

PO

32
Q

Ethambutol - clearance?

A

Renal

33
Q

Ethambutol - penetration?

A

CSF with meningeal inflammation

34
Q

Ethambutol - mechanism?

A

Inhibits mycobacterial arabinosyl transferase (embAB operon)

35
Q

Ethambutol - static or cidal?

A

Bacteriostatic (enhances cell wall permeability)

36
Q

Ethambutol - resistance?

A

embB mute

37
Q

Ethambutol - TOX?

A 
Optic neuritis (red green color blind)
Fever, rash
38
Q

Ethambutol - in pregnancy?

A

NO

39
Q

Which TB drug causes optic neuritis?

A

Ethambutol

40
Q

Rifampin - administration?

A

PO

41
Q

Rifampin - clearance?

A

Hepatic clearance - biliary excretion

42
Q

Rifampin - distribution?

A

CNS, macrophages

43
Q

Rifampin - static or cidal?

A

Bactericidal

44
Q

Rifampin - mechanism?

A

inhibits RNA synthesis (binds rpoB)

45
Q

Rifampin - resistance?

A

rpoB mute

46
Q

Rifampin - TOX?

A

N/V, fever, rash, fluids turn red/orange (stain lenses)

47
Q

Which TB drug turns fluids red/orange?

A

Rifampin

48
Q

Rifampin - in pregnancy?

A

NO

49
Q

Rifampin - caution in?

A

liver disease

50
Q

Rifampin - drug drug reactions?

A

Induces CYPs (increases clearance of HIV drugs - PI/reverse trancriptase inhibitors and OCPs)

51
Q

When do you use Rifabutin?

A

In TB to replace Rifampin when the patient is taking PIs

52
Q

Latent TB treatment?

A

INH - 9 months
OR
Rifampin - 4 months

53
Q

Active TB treatment?

A

RIPE - 2 months
THEN
RI - 4 months

54
Q

Which TB drugs has the most resistance?

A

INH

55
Q

MDR TB treatment?

A

4-6 drugs x 18 months

56
Q

Bedaquiline - administration?

A

PO

57
Q

Bedaquiline - Treatment?

A

24 weeks + > 3 drugs

58
Q

Bedaquiline - mechanism?

A

Inhibits mycobacterial ATP synthase

59
Q

Bedaquiline - resistance?

A

atpE (subunit c ATP synthase)

60
Q

Bedaquiline - metabolism?

A

CYP3A4 - hepatic clearance - biliary excretion (NOT with rifampin!)

61
Q

Bedaquiline - boxed warning?

A

Increased hepatic transaminases (monitor liver fx) and QT prolongation (death)

62
Q

Which TB drug has a boxed warning concerning hepatic transaminases and QT prolongation (death)?

A

Bedaquiline

63
Q

Bedaquiline - in pregnancy?

A

YES!

64
Q

Which TB drug is ok in pregnancy?

A

Bedaquiline

65
Q

MAC - treatment?

A

Macrolide + Ethambutol + Rifamycin (M or R for prox)

66
Q

M leprae (Hansen’s) - treatment?

A

Rifampin or Dapsone or Clofazimine

67
Q

Levofloxacin - mechanism?

A

Targets topoisomerase (inhibits DNA synthesis and supercoiling)

68
Q

FAS - I

A

C26

69
Q

FAS - II

A

C56

Pharm 4 (5 decks)

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