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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
What is the MOA of Streptomycin?
Bactericidal- inhibition of protein synthesis
26
What are the downsides of using Streptomycin?
It is only effective against extracellular organisms; must be given IV or IM due to poor absorption
27
What are the side effects of Streptomycin?
1. 8th CRANIAL NERVE IMPAIRMENT (mainly vestibular) | 2. Nephrotoxicity
28
What is Rifamate?
Rifampin + Isoniazid
29
What is Rifater?
Rifampin + Isoniazid + Pyrazinamide
30
What is the MOA of Bedaquiline? What is the side effect?
Inhibits Mycobacterial ATP Synthase; QT Prolongation and Death
31
What is Rifabutin?
An alternative for pts who cannot tolerate Rifampin -- is better for MAC and is primarily used to treat/prevent MAC
32
What are the side effects of Rifabutin?
1. Discoloration 2. Neutropenia 3. Hepatotoxicity
33
What is the advantage of using Rifapentine? What are the conditions?
Once Weekly Dosing; patient must be HIV negative and non-cavitary, dry susceptible pulmonary TB w/ negative sputum smears
34
What is the MOA of Clofazamine? What is its use?
Mainly an anti-leprosy drug | Binds to mycobacterial DNA --> inhibition of transcription
35
What are the side effects of Clofazamine?
1. SEVERE ABDOMINAL PAIN due to Crystal Deposition | 2. Discoloration of skin and eyes
36
What other drugs are less efficacious but may be useful in TB treatment?
Macrolides and Quinolones
37
What drugs make up RIPE (S)
Rifampin Isoniazid Pyrazinamide Ethambutol (Streptomycin)
38
How long should RIPE be given?
6 months for TB 12-24months for Osteo/Meningitis/Miliary
39
When should RIPS be given?
For children who cannot have Ethambutol (optic SE)
40
What drug should be avoided in renal failure?
Streptomycin
41
Which type of leprosy is widespread and has a loss of specific cell mediated immunity?
Lepromatous
42
Which type of leprosy is localized and has strong cell-mediated immunity?
Tuberculoid
43
What is leprosy?
A disease of the coin, peripheral nerves and mucous membranes --> lesions, hypo pigmentation and anesthesia
44
How is leprosy diagnosed?
Acid-Fast Stain | **Cannot be cultured
45
What is the drug regimen for Leprosy?
Dapsone Rifampin Clofazimine
46
What is the MOA of Dapsone?
Competitive inhibition of folic acid synthesis (dihydropteroate synthase --> prevents use of para-aminobenzoic acid) Bacteriostatic
47
What are the side effects of Dapsone?
1. Sulfone Syndrome- Hypersensitivity --> fever, malaise, dermatitis and jaundice Tx- steroids
48
What are the recommended treatments for the types of Leprosy?
Tuberculoid- Dapsone + Rifampin for 6 months Lepromatous- Dapsone + Clofazimine + Rifampin for 24 months
49
What condition is associated with Mycobacterium Avium Complex?
HIV
50
What are the symptoms of MAC?
Fever, night sweats, weight loss and anemia
51
When is prophylaxis for MAC given?
When the CD4
52
What is the treatment for MAC?
Clarithromycin + Ethambutol (can add Rifampin or Clofazamine)
53
How is leprosy transmitted?
Prolonged skin contact

D&T3 Pulm (5 decks)

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