TB Drugs

Question 1

First line therapy for TB

Answer 1

RIPE: rifampin, isoniazid, pyrazinamide, ethambutolol or streptomycin

Question 2

Patients in which isoniazid is contraindicated

Answer 2

children <2, HIV patients, pregnant women

Question 3

MOA for isoniazid

Answer 3

Interferes with mycolic acid synthesis and cell wall synthesis; bacteriocidal or static

Question 4

Metabolism of isoniazid

Answer 4

acetylated by N-acetyl transferase (slow/fast affects therapy); chronic liver disease decreases metabolism

Question 5

Adverse effects of isoniazid

Answer 5

Peripheral neuropathy (give Vit B6), hepatotoxicity

Question 6

Interactions with isoniazid

Answer 6

Antacids decrease absorption; inhibits CYP

Question 7

MOA for rifampin

Answer 7

Inhibition of RNA synthesis; bactericidal

Question 8

Adverse effects of rifampin

Answer 8

Orange-red tears, urine, and saliva; hepatotoxicity

Question 9

Drug interactions of rifampin

Answer 9

Induce CYP enzymes; don’t take oral contraceptives

Question 10

MOA of ethambutol

Answer 10

Disruptionof cell wall synthesis by inhibiting arabinosyl transferase; static effect

Question 11

Adverse effects of ethambutol

Answer 11

Decreased visual acuity, loss of color discrimination

Question 12

MOA of pyrazinamide

Answer 12

Decreases pH below threshold? Static or cidal

Question 13

Adverse effects of pyrazinamide

Answer 13

Heptatoxicity, hyperuricemia/gout

Question 14

Definition of multidrug-resistant TB

Answer 14

TB that is resistant to isoniazid and rifampin

Question 15

Second line agents for TB

Answer 15

Cycloserine, Ethionamide, Capreomycin

Question 16

MOA of cycloserine

Answer 16

Blocking cell wall synthesis; structural analog of D-ala

Question 17

Adverse effects of cycloserine

Answer 17

Risk of seizures, suicidal ideation

Question 18

MOA of ethionamide

Answer 18

Structural analog of isoniazid

Question 19

Adverse effects of capreomycin

Answer 19

Nephrotoxicity and ototoxicity