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D&T3 Pulm > TB Drugs > Flashcards

TB Drugs Flashcards

1
Q

Cough, night sweating, cavitary lesions of upper lung lobes and hemoptosis are symptoms of what condition?

A

TB

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2
Q

How is TB spread?

A

Respiratory Droplets

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3
Q

Why is latent TB treated?

A

To prevent reactivation

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4
Q

What are the conditions to be classified as MDR TB? What are the consequences?

A

Resistance to Rifampin and Isoniazid

Increased risk of treatment failure- refer to ID or CDC

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5
Q

Which has the better prognosis- MDR TB or Rifampin-resistant TB?

A

Rifampin Resistant TB

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6
Q

What are the conditions to be classified as XDR TB?

A

Resistance to Rifampin and Isoniazid + Resistance to Fluoroquinolones + Resistance to 1 of the following: Amikacin, Kanamycin or Capreomycin

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7
Q

What cells are infected by TB?

A

Macrophages

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8
Q

Describe the outer membrane of TB?

A

Composed of arabinogalactan + Mycolic Acid and Extractable Phospholipids

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9
Q

What is therapeutic failure described as?

A

Positive sputum CXS after 4 months of compliant therapy

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10
Q

Describe the general MOA of the RIPE drugs

A

Rifampin- inhibits RNA synthesis
Isoniazid- inhibits cell wall synthesis
Pyrazinamide- disrupts plasma membrane and metabolism
Ethambutol- inhibits cell wall synthesis

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11
Q

Describe the MOA of rifampin

A

Inhibits DNA-dependent RNA polymerase –> suppression of initiation of chain formation in RNA synthesis

Bactericidal- kills growing bacteria

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12
Q

What are the main side effects of Rifampin?

A
  1. Hepatotoxicity
  2. Discoloration of bodily fluids –> ORANGE
  3. Hypersensitivity and Thrombocytopenia
  4. GI upset
  5. Drug interactions
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13
Q

What drug increases the metabolism of Warfarin, Theophylline, Narcotics, Oral Hypoglycemics and Steroids?

A

Rifampin- by increasing CP450 activity

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14
Q

What is the MOA of Isoniazid?

A

Inhibits synthesis of Mycolic Acid –> disruption in cell wall synthesis

Kills growing organisms and inhibits dormant organisms

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15
Q

How are Rifampin and Isoniazid metabolized?

A

Acetylation in the liver

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16
Q

The hydroxylation of which drug –> electrophilic intermediates that cause hepatotoxicity?

A

Isoniazid

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17
Q

What are the side effects of Isoniazid?

A
  1. Hepatotoxicity

2. NEUROTOXICITY

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18
Q

What can be used to mitigate the neurotoxicity associated with Isoniazid?

A

Pyridoxine (B6)

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19
Q

Which groups are more likely to get neurotoxicity with Isoniazid?

A
  1. Alcoholics
  2. Children
  3. Malnourished
  4. Slow Acetylators
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20
Q

What is the MOA of Pyrazinamide?

A

Bactericidal toward dormant organisms residing within the macrophage

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21
Q

What are the side effects of Pyrazinamide?

A
  1. Hepatotoxicity
  2. HYPERURICEMIA (bad for Gout)
  3. Photosensitivity and Rash
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22
Q

What is the MOA of Ethambutol?

A

Bacteriostatic

23
Q

What are the side effects of Ethambutol?

A
  1. OPTIC NEURITIS

2. Red-Green Color Blindness

24
Q

Which drug must you use caution with in children? Why?

A

Ethambutol- adverse optic effects

25
Q

What is the MOA of Streptomycin?

A

Bactericidal- inhibition of protein synthesis

26
Q

What are the downsides of using Streptomycin?

A

It is only effective against extracellular organisms; must be given IV or IM due to poor absorption

27
Q

What are the side effects of Streptomycin?

A
  1. 8th CRANIAL NERVE IMPAIRMENT (mainly vestibular)

2. Nephrotoxicity

28
Q

What is Rifamate?

A

Rifampin + Isoniazid

29
Q

What is Rifater?

A

Rifampin + Isoniazid + Pyrazinamide

30
Q

What is the MOA of Bedaquiline? What is the side effect?

A

Inhibits Mycobacterial ATP Synthase; QT Prolongation and Death

31
Q

What is Rifabutin?

A

An alternative for pts who cannot tolerate Rifampin – is better for MAC and is primarily used to treat/prevent MAC

32
Q

What are the side effects of Rifabutin?

A
  1. Discoloration
  2. Neutropenia
  3. Hepatotoxicity
33
Q

What is the advantage of using Rifapentine? What are the conditions?

A

Once Weekly Dosing; patient must be HIV negative and non-cavitary, dry susceptible pulmonary TB w/ negative sputum smears

34
Q

What is the MOA of Clofazamine? What is its use?

A

Mainly an anti-leprosy drug

Binds to mycobacterial DNA –> inhibition of transcription

35
Q

What are the side effects of Clofazamine?

A
  1. SEVERE ABDOMINAL PAIN due to Crystal Deposition

2. Discoloration of skin and eyes

36
Q

What other drugs are less efficacious but may be useful in TB treatment?

A

Macrolides and Quinolones

37
Q

What drugs make up RIPE (S)

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol (Streptomycin)

38
Q

How long should RIPE be given?

A

6 months for TB

12-24months for Osteo/Meningitis/Miliary

39
Q

When should RIPS be given?

A

For children who cannot have Ethambutol (optic SE)

40
Q

What drug should be avoided in renal failure?

A

Streptomycin

41
Q

Which type of leprosy is widespread and has a loss of specific cell mediated immunity?

A

Lepromatous

42
Q

Which type of leprosy is localized and has strong cell-mediated immunity?

A

Tuberculoid

43
Q

What is leprosy?

A

A disease of the coin, peripheral nerves and mucous membranes –> lesions, hypo pigmentation and anesthesia

44
Q

How is leprosy diagnosed?

A

Acid-Fast Stain

**Cannot be cultured

45
Q

What is the drug regimen for Leprosy?

A

Dapsone
Rifampin
Clofazimine

46
Q

What is the MOA of Dapsone?

A

Competitive inhibition of folic acid synthesis (dihydropteroate synthase –> prevents use of para-aminobenzoic acid)

Bacteriostatic

47
Q

What are the side effects of Dapsone?

A
  1. Sulfone Syndrome- Hypersensitivity –> fever, malaise, dermatitis and jaundice

Tx- steroids

48
Q

What are the recommended treatments for the types of Leprosy?

A

Tuberculoid- Dapsone + Rifampin for 6 months

Lepromatous- Dapsone + Clofazimine + Rifampin for 24 months

49
Q

What condition is associated with Mycobacterium Avium Complex?

A

HIV

50
Q

What are the symptoms of MAC?

A

Fever, night sweats, weight loss and anemia

51
Q

When is prophylaxis for MAC given?

A

When the CD4

52
Q

What is the treatment for MAC?

A

Clarithromycin + Ethambutol (can add Rifampin or Clofazamine)

53
Q

How is leprosy transmitted?

A

Prolonged skin contact

D&T3 Pulm (5 decks)

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