TB drugs

Question 1

RIPE (names)

Answer 1

Rifamycins (rifampin, rifapentine)
Isoniazid (INH)
Pyrazinamide
Ethambutol

Question 2

Isoniazid (INH) MOA

Answer 2

inhib cell wall synthesis

bacteriocidal

Question 3

Isoniazid (INH) indication

Answer 3

first step for TB
used in kids and adults
for tx and prevention

Question 4

Isoniazid (INH) ADRs

Answer 4

I: intestinal upset (N/V)
N: neuropathy (worse in DM, ETOH, malnourished)
H: hepatotoxicity (usually decrease after stop drug)

vit B6 deficiency (pyridoxine)
agranulocytosis, lupus like, fever (all rare)

hard to dose –> can OD (N/V, dizzy, respir depression, CNS probs, high BGL, sz, etc)

Question 5

Isoniazid (INH) CI

Answer 5

acute liver dz

preg cat C

Question 6

Isoniazid (INH) drug interactions

Answer 6

P450 at 2C9 inhib
warfarin
sz meds
antacids
carbamazepime
benzodiazapines

Question 7

Rifamycin (names)

Answer 7

rifampin (RPT)

rifapentine

Question 8

rifamycin MOA

Answer 8

inhib DNA-dependent RNA polymerase

bacteriocidal

Question 9

Rifampin (RPT) indications

Answer 9

TB (latent with just INH, active with RIPE)
meningococcal carriers (but not active meningitis)

others: leprosy, MRSA (not first line)

Question 10

rifampin (RPT) ADRs

Answer 10

turns all excreted water orange
N/V/D
heart burn
anorexia
jaundice
flatulence
cramps
c. diff
thrombocytopenia
HA
fever
drowsy/dizzy
vision probs
dysmenorrhea
hyperuricemia
pruritis, urticaria, rash
SJS/TEN

Question 11

rifampin (RPT) drug interactions

Answer 11

P450 3A4 inducer (one of the most powerful --> lots of drug interactions)
oral contraceptives
warfarin
ketoconazole
SMX-TMP
INH (but still used together)

Question 12

rifapentine indications

Answer 12

similar to RPT, but not used as much

Question 13

rifapentine ADRs

Answer 13

hepatotoxicity
hyperbilirubinemia
color body fluids
c. diff
hyperuricemia
hematuria
UTI
proteinuria
neutropenia
anemia
hypoBGL

Question 14

rifapentine CI

Answer 14

HIV

preg

Question 15

rifapentine drug interactions

Answer 15

inducer at 3A4 and 2C9

Question 16

pyrazinamide (PZA) MOA

Answer 16

nicotinamide vit B3) analog

Question 17

pyrazinamide (PZA) indications

Answer 17

active TB in kids and adults

Question 18

pyrazinamide (PZA) ADRs

Answer 18

hyperuriciemia
increase LFTs
rash
arthralgia
myalgia

Question 19

pyrazinamide (PZA) CI

Answer 19

gout

severe liver dz

Question 20

ethambutol (EMB) MOA

Answer 20

inhib metabolite synthesis –> stop reproduction

Question 21

ethambutol (EMB) indication

Answer 21

only good with mycobacteria

only used with RIPE (not as monotherapy)

Question 22

ethambutol (EMB) ADRs

Answer 22

vision: decrease acuity, optic neuritis, optic neuropathy
hyperuricemia
arthralgia
GI
confusion/disorientation

Question 23

ethambutol (EMB) CI

Answer 23

optic neuritis

Question 24

streptomycin MOA

Answer 24

30S subunit inhib

Question 25

streptomycin indication

Answer 25

not used much anymore b/c resistance

good for TB and non-TB infect (UTI, plague, K pneumo, granuloma inguinale, tularemia, chancroid)

Question 26

streptomycin ADRs

Answer 26

ototoxicity

nephrotoxicity

Question 27

bedaquiline MOA

Answer 27

inhib mycobacterial ATP synthase

Question 28

bedaquiline indication

Answer 28

MDR TB

not on guidelines yet b/c too new

Question 29

bedaquiline ADRs

Answer 29

QT prolongation (worry about macrolides, antifungals, some fluoroquinalones)
hepatotoxicity
nausea
arthralgia
HA
increased risk of death

Question 30

bedaquiline drug interactions

Answer 30

3A4 substrate