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SG - Pharm 4 > TB > Flashcards

TB Flashcards

1
Q

The most prevalent communicable infectious disease on earth and remains a leading infectious killer globally

A

Tuberculosis (TB)

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2
Q

Is mycobacteria fast or slow growing?

A

Slow growing

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3
Q
A
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4
Q
A
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5
Q

Once infected w/ M. tuberculosis, a person’s lifetime risk of active TB is approximately ___%

A

10

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6
Q
  • What are the 2 most important drugs in tx of TB?
  • Which age groups have a 2-5X greater risk for active disease compared w/ other age groups?
A
  • Isoniazid & Rifampin
  • <2y/o and >65y/o
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7
Q

____ should be used whenever possible to reduce tx failures and the selection of drug-resistant isolates

A

Directly Observed Treatment (DOT)

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8
Q

TB is more common in which 5 groups of people?

A
  • Prison inmates
  • IV drug abusers
  • Immigrants
  • HIV infected pts*
  • Young minority adults
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9
Q

Sxs of TB

A

General ROS:

  • Fatigue
  • Fever
  • Weight loss
  • Night sweats
  • Productive cough
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10
Q
  • 2 or more antimicrobials are used in the tx of _____.
  • Generally, __ drugs are given at the outset of tx
  • Which 2 drugs are the best for preventing drug resistance
A

Active tuberculosis

4

Rifampin & Isoniazid

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11
Q

What are the 4 drugs used in Tx of Active TB in order of preference?

A
  • Isoniazid
  • Rifampin
  • Pyrazinamide
  • Ethambutol

(IRPE)

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12
Q
  • Monotherapy can be used only for infected pts who _____.
  • Combination therapy is required for treating ____.
A
  • do not have active TB (latent infection)
  • Active TB (at least 2 drugs)
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13
Q

Regimens for treating TB:

  • Intensive phase is ___months
  • Continuation phase of either ___ or ___ months

(total of __ to ____ months of tx)

A
  • 2
  • 4 - 7
  • 6 - 9
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14
Q

Which 2 TB meds are weight based?

A
  • Pyrazinamide
  • Ethambutol
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15
Q

Drugs given in:

  • Initial Phase:
  • Continuation Phase:
A
  • Initial: all 4 - Isoniazid, Rifampin, pyrazinamide, ethambutol
  • Continuation: Isoniazid & Rifampin

(Have best results in HIV patients + or -)

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16
Q

Which 2 drugs need to be adjusted for renal function? Why?

A
  • Pyrazinamide
  • Ethambutol

(they are weight based)

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17
Q

What is the tx for Latent TB?

Is latent or active more common?

A
  • Isoniazid (6 or 9 months)
  • Isoniazid & Rifampin (3 months)
  • Rifampin (4 months)

Latent

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18
Q
  • Does a pt w/ latent TB have active disease and are able to trasmit it to others?
  • In what type of pt does latent TB become active?
A
  • no!
  • Immunocompromised
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19
Q

Which TB drug?

  • Inhibits cell wall synthesis
A
  • Isoniazid
  • Ethambutol
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20
Q

Which TB drug?

  • Inhibits RNA synthesis
A

Rifampin

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21
Q

Which TB drug?

  • Exact target is unclear
  • Disrupts Plasma Membrane
  • Disrupts Energy Metabolism
A

Pyrazinamide

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22
Q

What is the 1st line tx for Active AND Latent TB?

A

Isoniazid

23
Q

Which drug?

  • Inhibits synthesis of mycolic acids, an essential component of mycobacterial cell walls
  • First-line for active and latent TB
  • PK: Hepatic clearance
A

Isoniazid

(1st line for active/latent TB)

24
Q

What are the 2 ADEs of Isoniazid?

A
  • Hepatic toxicity
  • Peripheral neuropathy : VIt B6-pyridoxine
25
Q

Which drug?

  • Turns body fluids orange
  • Inhibits DNA-dependent RNA polymerase (Blocking production of RNA)
  • First-line for active and latent TB
A

Rifampin

26
Q

Rifampin can be used for what other 3 infections?

A
  • Atypical mycobacterial infections
  • eradication of meningococcal colonization
  • Staphylococcal infections
27
Q

Which drug?

  • PK: hepatic clearance & CYP inducer
  • ADEs:
    • turns body fluids orange color**
    • Cholestasis (hepatitis**)
    • Rash
    • Flu like syndrome w/ intermittent dosing
    • Thrombocytopenia (bruising/bleeding)
    • Nephritis**
A

Rifampin

28
Q

Which drug?

  • Used for disseminated M. avium infection in AIDS pts and is quite active against M. tuberculosis
  • Most rifampin resistant organisms are resistant to this drug
  • Less potent enzyme inducer than rifampin, it may be used for pts who are receiving protease inhibitors
  • For HIV-positive pts, the ATS/CDC recommends regimens with 3 or more doses of the TB drugs / week
A

Rifabutin

29
Q

Which drug?

  • A long-acting rifamycin that can be used once weekly in the continuation phase of treatment (after the first 2 months) in carefully selected HIV-negative patients
  • Approximately as potent an enzyme inducer as rifampin

similar drug interactions are likely

A

Rifapentine

30
Q

Which drug?

  • a sterilizing agent prescribed during the first 2 months of therapy
  • Mechanism not fully understood
    • Possibly disrupts plasma membrane
    • Possibly energy metabolism
  • Because it is a “sterilizing” agent the total duration of therapy for TB to be shortened to 6 months**
A

Pyrazinamide

31
Q

Which drug?

  • Hepatic clearance, metabolites renally cleared-reduced dose if <30mlmin clearance
  • ADE:
    • hepatotoxicity
    • hyperuricemia***
    • rash
    • GI disturbance
    • arthralgias (don’t give acetaminophen bc/ hepatotoxic.)
A

Pyrazinamide

32
Q

_____ is given until drug sensitivities are known

  • Inhibits mycobacterial arabinosyl transferases, which are involved in the polymerization rxn of arabinoglycan, an essential component of the mycobacterial cell wall
A

Ethambutol

33
Q

Which drug?

  • Given in four drug initial combination therapy for tuberculosis until drug sensitivities are known
  • Hepatic & Renal clearance, dose reduction in renal failure
A

Ethambutol

34
Q

What are the ADEs of Ethambutol?**

A
  • Retrobulbar neuritis (reversible if drug stopped)
35
Q

Multiple Drug Resistant - TB

  • Caused by organisms that are resistant to at least ___ of the best anti-TB drugs: Isoniazid & Rifampin
A

2

36
Q

Which drug?

  • The first drug in a new class of anti-TB meds to be approved in more than 40 yrs
  • Inhibits the proton transfer chain of mycobacterial ATP synthase required for energy generation of M. tuberculosis
  • Box warning:
    • increased mortality
    • QT prolongation >500ms (get EKG before giving this drug)
A

Bedaquiniline

37
Q

MDR TB (multiple drug resistant) can take up to __ months to cure.

A

24

38
Q

Bedaquiline monitoring:

  • How often should you monitor for sxs: N, HA, hemoptysis, CP, joint pain, rash
  • ECG before start of tx and repeat when?
  • Monitor for ___ related adverse drug rxns w/ serum transaminases
  • ____ drug monitoring should be considered in pts w/ severe renal impairment & when given w/ other drugs that induce/suppress the cytochrome P450 system
A
  • once a week
  • 2, 12, and 24 weeks after tx started
  • liver-related
  • Therapeutic drug monitoring
39
Q

5 second line TB meds

A
  • Streptomycin
  • Capreomycin
  • Amikacin/kanamycin
  • Moxifloxacin
  • p-Aminosalicylic acid

(SCAMP)

40
Q

Which “other” med?

  • Injectable agent given intramuscularly in doses of 15–30 mg/kg/day (maximal dose 1 g)
  • Major toxicities include ototoxicity (both vestibular and cochlear) and nephrotoxicity
  • If the medication must be used in older patients, the dose should not exceed 750 mg
A

•Capreomycin

41
Q

Which “other” med?

  • A phenazine dye used in the treatment of leprosy
  • Active in vitro against M avium complex and Mycobacterium tuberculosis
  • Given orally as a single daily dose of 100 mg for treatment of M avium complex disease
  • Clinical efficacy for the therapy of tuberculosis has not been established.
  • Adverse effects include nausea, vomiting, abdominal pain, and skin discoloration
A

•Clofazimine

42
Q

Which “other” med?

  • A bacteriostatic agent, is given in doses of 15–20 mg/kg (not to exceed 1 g) orally
  • Used in re-treatment regimens and for primary therapy of highly resistant M tuberculosis
  • Can induce a variety of central nervous system dysfunctions and psychotic reactions.
A

•Cycloserine

43
Q

Which “other” med?

  • Like cycloserine, bacteriostatic, given orally in a dose of 15–20 mg/kg (maximal dose 1 g)
  • Used in combination therapy but is poorly tolerated with marked gastric irritation
A

•Ethionamide

44
Q

Which “other” med?

  • Particularly moxifloxacin
  • Active in vitro against M tuberculosis, with MICs of 0.25–2 mcg/mL
  • These medications demonstrated to be efficacious in treating tuberculosis in patients unable to take isoniazid, rifampin, and pyrazinamide
  • Rapid emergence of resistance has been described in some series
  • Combination of 6 months of the long-acting rifamycin, rifapentine, in combination with moxifloxacin, is as effective as standard therapy in the treatment of tuberculosis
A

•Fluoroquinolones

45
Q

Which “other” med?

  • effective in achieving culture conversion in patients with treatment-refractory, highly resistant pulmonary tuberculosis
  • Long-term use of this agent for tuberculosis is associated with significant side effects, particularly the 600 mg daily dose
A

•Linezolid

46
Q

ADE of which drug?

  • Asymptomatic elevation of aminotransferases
  • Clinical hepatitis / Fatal hepatitis
  • Peripheral neurotoxicity / CNS effects
  • Lupus-like syndrome
  • Hypersensitivity
  • Monoamine poisoning
  • Diarrhea
A

Isoniazid

47
Q

ADE of which drug?

  • Cutaneous rxns
  • GI rxns (N, anorexia, abd pain)
  • Flu-like syndrome
  • Hepatotoxicity
  • Severe immunologic rxns
  • Orange discoloration of bodily fluids (sputum, urine, sweat, tears)
  • Drug interactions due to induction of hepatic microsomal enzymes
A

Rifampin

48
Q

ADE of which drug?

  • Hepatotoxicity
  • GI sxs (N/V)
  • Non-gouty polyarthralgia
  • Asymptomatic hyperuricemia
  • Acute gouty arthritis
  • Transient morbilliform rash
  • Dermatitis
A

Pyrazinamide

49
Q

ADE of which drug?

  • Retrobulbar neuritis
  • Peripheral neuritis
  • Cutaneous rxns
A

Ethambutol

50
Q

Monitoring of which drug?

  • LFT monthly in patients who have preexisting liver disease or who develop abnormal liver function that does not require discontinuation of drug; dosage adjustments may be necessary in patients receiving anticonvulsants or warfarin
A

Isoniazid

51
Q

Monitoring of which drug?

  • Liver enzymes and interacting drugs as needed (eg, warfarin)
A

Rifampin

52
Q

Monitoring of which drug?

  • Serum uric acid can serve as a surrogate marker for adherence; LFTs in patients with underlying liver disease
A

Pyrazinamide

53
Q

Monitoring of which drug?

  • Baseline visual acuity testing and testing of color discrimination; monthly testing of visual acuity and color discrimination in patients taking >15–20 mg/kg, having renal insufficiency, or receiving the drug for >2 months
A

Ethambutol

SG - Pharm 4 (16 decks)

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