TB Drugs

Question 1

Treatment for TB

Answer 1

Prophylaxis:
Isoniazid

Treatmt: RIPES

Question 2

Treatment for M. Avium-Intracellulare

Answer 2

Prophylaxis:
Azithromycin, Rifabutin

Treatment: More resistant than TB
Azithro or clarithro + Ethambutol
Can add Rifabutin or Cipro

Question 3

M. Leprae

Answer 3

Prophylaxis:
None

Treat:
Tuberculoid form: Dapsone, Rifampine
Lepromatous: Dapsone, Rifampin, Clofazimine

Question 4

Isoniazid? (INH)
MOA
Use
SE

Answer 4

sounds like “ionize” so needs catalase to become ionized

Decrease synthesis of mycolic acids. Needs bacterial catalase (encoded by KatG) to convert INH to active metabolite

Must give with B6

(if a strain of TB didn’t have this, then INH ineffective)

Use: TB, only one that can be used solo for prophylaxis

SE: Neurotox, Hepatotox. Give B6 to prevent neurotox, lupus

Note: Different half lives if fast v slow acetylators

INH Injures Neurons & Hepatocytes

Question 5

Rifamycins
MOA
Use

Answer 5

Rifampin, Rifabutol (Red)

Blocks DNA dependent RNA polymerase

Use:
TB
Leprosy, delays resistance to Dapsone
Prophylaxis for N. Meningitis, and H. Flu

SE: Increase P-450
Orange body fluids
Rifabutin preferred over Rifampin in HIV pts bc less P450 SEs

Question 6

What are the 4Rs of Rifampin?

Answer 6

RNA polymerase
Ramps up P450
Red/Orange body fluids
Rapid Resistance if used alone

RifAMPin ramps up P450, BUT RifuBUTin does not

Question 7

Pyrazinamide
MOA
Use
SE

Answer 7

Cut the Pie with acid phaggot (phagolysosome)

Acidify phagolysosome where TB is hiding at. Converted to pyrazinoic acid

Use: TB

SE: Hyperuricemia, Hepatotox

Question 8

Ethambutol
MOA
Use
SE

Answer 8

Ethambutol…No sugar on The HAMbutol…so no GRABBIN (sound like arabin)

Prevent carbohydrate assembly of mycobacterium cell wall by blocking ARABINOSYLTRANSFERASE

SE: Red/green color blind
central scotoma