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Pharmacology > TB and Malaria > Flashcards

TB and Malaria Flashcards

1
Q

TB transmission

A

droplet nuclei, when a person with infectious TB sneezes, speaks, sings, or coughs

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2
Q

general facts about mycobacterium tuberculosis

A

acid fast bacteria, slow generation time which makes it difficult to treat, facultative intracellular parasite

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3
Q

property of cell wall that is unique to mycobacterium

A

mycolic acid

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4
Q

first line TB drugs

A

isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin, rifabutin, rifapentine

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5
Q

4 drugs to treat active TB

A

RIPE

isoniazid, rifampin, pyrazinamide, ethambutol

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6
Q

recommended dosing for a new positive TB case

A

2 months: isoniazid, rifampin, pyrazinamide, ethambutol

4 months: isoniazid, rifampin

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7
Q

drugs to treat latent TB infection

A

isoniazid, rifampin, or isoniazid + rifapentine

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8
Q

isoniazid MOA

A

static

inhibits biosynthesis of mycolic acid

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9
Q

prophylaxis for TB

A

isoniazid

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10
Q

isoniazid inactivation

A

acetylation in the liver

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11
Q

isoniazid toxicities

A

hepatitis in fast acetylators
peripheral neuritis in slow acetylators
hemolysis
lupus like syndrome

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12
Q

rifampin MOA

A

inhibits DNA dependent RNA polymerase inhibiting transcription

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13
Q

rifampin spectrum

A

BROAD, effective against leprosy and also G+ and G- microbes

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14
Q

rifampin toxicities

A

hepatic enzyme induction, of CYP450s
not recommended for HIV patients
body secretions are orange
decreases effectiveness of birth control

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15
Q

ethambutol MOA

A

inhibits arabinosyl transferases involved in the synthesis of arabinogalactan

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16
Q

CNS penetration for ethambutol?

A

YES

if TB meningitis, this is a good drug to give

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17
Q

ethambutol toxicities

A

decreased of visual acuity and loss of green-red perception

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18
Q

pyrazinamide MOA

A

prodrug, mechanism unknown

active at acidic pH

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19
Q

CNS penetration for pyrazinamide?

A

YES

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20
Q

toxicities of pyrazinamide

A

hepatic dysfunction

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21
Q

pyrazinamide resistance

A

high, so it must be used in combination with isoniazid and rifampin

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22
Q

streptomycin MOA

A

binds on 30s ribosome

bacteriocidal

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23
Q

toxicities of streptomycin

A

ototoxic and nephrotoxic

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24
Q

rifamycin family MOA

A

inhibits DNA dependent RNA polymerase

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25
Q

2 drugs in rifamycin family

A

rifabutin and rifapentine

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26
Q

side effects of rifamycin drugs

A

body secretions are orange colored

inducer of P450, use rifabutin before rifapentine

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27
Q

DOC for latent TB

A

isoniazid + rifapentine

28
Q

one of the DOC for active TB in HIV individuals

A

rifabutin (replaces rifampin)

29
Q

reasons why second line TB drugs are second line

A

lower potency and/or greater toxicity

30
Q

treatment for MAC

A
  1. clarithromycin or azithromycin
  2. ethambutol
  3. rifabutin, rifampin, or ciprofloxacin
31
Q

treatment for mycobacterium leprae

A

1-5 patches: dapsone and rifampin for 6 months

> 5 patches: dapsone and rifampin for 6-12 months

32
Q

dapsone MOA

A

PABA antagonist as well as interference with the nutrition of M. leprae

33
Q

dapsone route of administration

A

oral

34
Q

dapsone toxicity

A

nasal obstruction is most common

35
Q

DOC for erythema nodosum leprosum

A

Thalidomide

36
Q

toxicity of thalidomide

A

teratogenic

37
Q

what are the 4 causative organisms to infect humans with malaria

A

P. falciparum, P. vivax, P. ovale, P. malariae

38
Q

what two organisms remain dormant in the liver stages of malaria

A

p. vivax and p. ovale

39
Q

malaria is most commonly caused by what species

A

p. falciparum

40
Q

what are you treating for a clinical cure

A

patients symptoms

41
Q

what are you treating for a radical cure

A

patients symptoms + dormant tissue forms

42
Q

what form does a blood schizonticide work on

A

erythrocytic forms of the parasite

43
Q

what stages does a tissue schizonticide work on

A

hepatic stages, think vivax and ovale

44
Q

top 2 DOC for cholorquine resistant malaria

A

1: artesunate + atovoquone/proguanil
2: artemether-lumefantrine

45
Q

DOC for malaria

A

Chloroquine

46
Q

mechanism of resistance for cholorquine

A

transport pump removes drug from parasite

47
Q

MOA of cholorquine

A

interferes with lysosomal degradation of Hgb leading to parasite toxicity

48
Q

areas of the body where chloroquine accumulates

A

melanin rich tissues: skin, retina

49
Q

toxicity of chloroquine

A

retinal and corneal toxicity (high, chronic doses)

hemolysis, QT prolongation, contraindicated in patients with psoriasis and porphyria

50
Q

artemisinins: name the two and what its used for

A

artesunate and artemether
most rapid action of all current drugs against p. falciparum
must give with another antimalarial due to short 1/2 life

51
Q

MOA for proguanil and pyrimethamine + sulfadoxine

A

inhibition of folate metabolism
sulfadoxine: inhibits incorporation PABA into folic acid
pyrimethamine and proguanil: inhibit DHF to THF

52
Q

relationship of malarone (atovaquone + proguanil)

A

synergistic

53
Q

MOA of malarone

A

atovaquone: inhibits mitochondrial ETC and ATP synthesis

proguanil: DHF reductase inhibitor

54
Q

what drug should be combined with malarone

A

artesunate

55
Q

what drug is lumefantrine combined with

A

artemether

56
Q

toxicity of lumefantrine

A

headache and QT prolongation

57
Q

when would you use quinine or quinidine

A

complicated, chloroquine-resistant plasmodia

combine with doxy, tetra, clinda

58
Q

quinine/quinidine toxicity

A

cinchonism, antiarrhythmic agent, QT elongation, diarrhea, hemolysis in G6PD deficient patients

59
Q

what would you use to treat complicated, chloroquine-resistant plasmodia in children or pregnant women?

A

quinine + clindamycin

60
Q

mefloquine toxicity

A

depression of myocardium, can cause seizures and may aggravate latent psychoses, vivid dreams
SHOULD NOT BE USED IN PATIENTS WITH HX OF MENTAL ILLNESS OR EPILEPSY

61
Q

what drug should be used for empirical treatment and preventative intermittent therapy for malaria in pregnant women

A

pyrimethamine + sulfadoxine+ artesunate

62
Q

what two drugs are tissue schizonticides

A

primaquine and tafenoquine

63
Q

toxicity of primaquine

A

contraindicated in patients with SLE or RA, hemolytic anemia (caution for those with G6PD deficiency, avoid in pregnant/breastfeeding women, children < 6 months)

64
Q

tafenoquine, blood or tissue stage?

A

BOTH

65
Q

contraindications of tafenoquine

A

patients with G6PD deficiency or unknown G6PD status

Pharmacology (7 decks)

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