TB drugs Flashcards
RIPE (names)
Rifamycins (rifampin, rifapentine)
Isoniazid (INH)
Pyrazinamide
Ethambutol
Isoniazid (INH) MOA
inhib cell wall synthesis
bacteriocidal
Isoniazid (INH) indication
first step for TB
used in kids and adults
for tx and prevention
Isoniazid (INH) ADRs
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)
Isoniazid (INH) CI
acute liver dz
preg cat C
Isoniazid (INH) drug interactions
P450 at 2C9 inhib warfarin sz meds antacids carbamazepime benzodiazapines
Rifamycin (names)
rifampin (RPT)
rifapentine
rifamycin MOA
inhib DNA-dependent RNA polymerase
bacteriocidal
Rifampin (RPT) indications
TB (latent with just INH, active with RIPE) meningococcal carriers (but not active meningitis)
others: leprosy, MRSA (not first line)
rifampin (RPT) ADRs
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
rifampin (RPT) drug interactions
P450 3A4 inducer (one of the most powerful --> lots of drug interactions) oral contraceptives warfarin ketoconazole SMX-TMP INH (but still used together)
rifapentine indications
similar to RPT, but not used as much
rifapentine ADRs
hepatotoxicity hyperbilirubinemia color body fluids c. diff hyperuricemia hematuria UTI proteinuria neutropenia anemia hypoBGL
rifapentine CI
HIV
preg
rifapentine drug interactions
inducer at 3A4 and 2C9
pyrazinamide (PZA) MOA
nicotinamide vit B3) analog
pyrazinamide (PZA) indications
active TB in kids and adults
pyrazinamide (PZA) ADRs
hyperuriciemia increase LFTs rash arthralgia myalgia
pyrazinamide (PZA) CI
gout
severe liver dz
ethambutol (EMB) MOA
inhib metabolite synthesis –> stop reproduction
ethambutol (EMB) indication
only good with mycobacteria
only used with RIPE (not as monotherapy)
ethambutol (EMB) ADRs
vision: decrease acuity, optic neuritis, optic neuropathy hyperuricemia arthralgia GI confusion/disorientation
ethambutol (EMB) CI
optic neuritis
streptomycin MOA
30S subunit inhib
streptomycin indication
not used much anymore b/c resistance
good for TB and non-TB infect (UTI, plague, K pneumo, granuloma inguinale, tularemia, chancroid)
streptomycin ADRs
ototoxicity
nephrotoxicity
bedaquiline MOA
inhib mycobacterial ATP synthase
bedaquiline indication
MDR TB
not on guidelines yet b/c too new
bedaquiline ADRs
QT prolongation (worry about macrolides, antifungals, some fluoroquinalones) hepatotoxicity nausea arthralgia HA increased risk of death
bedaquiline drug interactions
3A4 substrate
