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Resp II > TB Tx > Flashcards

TB Tx Flashcards

1
Q

Mycobacteria general resistance

A

slow growth
lipid rich mycobacterial cell wall
abundance of efflux pumps
quickly develop single-agent resistance

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2
Q

latent TB (LTBI)

A

Isoniazid (INH) for 9 months
or
Rifapentine and INH for 3 months
or rifampin for 4 months

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3
Q

active disease

A

2-month initial phase

continuation phase of 4 or 7 months

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4
Q

initial therapy

A

INH
rifampin
pyrazinamide
ethambutol (once susceptibility of above confirmed drop this drug)

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5
Q

risk for Tx failure

A

cavitary disease at presentation

positive sputum culture at 2 months

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6
Q

drug susceptible infection with 1 or no risk factors

A

continuation phase should be INH and rifampin for 4 months

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7
Q

both risk factors

A

continuation phase 7 months

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8
Q

TB osteomyelitis

A

6-9months

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9
Q

TB menigitis

A

9-12 months

add corticosteroid

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10
Q

TB pericarditis

A

add corticosteroid

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11
Q

pyrazinamide added to INH-rifampin

A

only needed for 2 months
shortens Tx to 6 months
but pyrazinamide is most nephrotoxic

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12
Q

resistance to INH

A

Tx w/rifampin, pyrazinamide, ethambutol

can add FQ

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13
Q

resistance to rifamycns

A

at least 12months of Tx with INH, ehtambutol, and FQ

pyrazinamide for 2 months

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14
Q

MDR and XDR

A

daily DOT therapy

INH, rifampin, ethambutol, pyrazinamide, aminoglycoside, FQ, PAS

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15
Q

LTBI + HIV

A

daily INH for 9 months

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16
Q

active TB +HIV

A

INH
rifamycin
ethambutol
pyrazinamide

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17
Q

ART +TB

A

rifampin largest drug interaction, inhibits ART

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18
Q

CD4 <50

A

initiate ART asap

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19
Q

CD4>50

A

wait until after initial phase of TB Tx

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20
Q

LTBI + TNF alpha inhibitor

A

high risk for developing active TB

patients should always be screened for TB

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21
Q

LTBI and prego

A

delay Tx for LTBI for 2-3 months after delivery

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22
Q

active TB and prego

A

requires Tx b/c of risk of TB to fetus

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23
Q

agents to avoid while Tx TB in prego

A

streptomycin -> deafness

kanamycin, amikacin, capreomycin

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24
Q

1st line against TB

A 
INH
rifampin
pyrazinamide
ethambutol
streptomycin
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25
Q

INH

A

prodrug activated by KatG

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26
Q

INH MOA

A

complex w/KasA which inhibits synthesis of mycolic acids, a cell wall component, killing cell

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27
Q

INH resistance

A

overexpression of inhA
mutation or deletion in katG
overexpression of aphC
mutations in kasA

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28
Q

INH adverse rxns

A
  • hepatitis, age dependent, rare under 20, increased risk w/alcoholics and pregnancy
  • minor increases in liver aminotransferases (benign)
  • peripheral neurophathy and other CNS issues due to vit B deficiency, supplementation helps
  • drug fever
  • rashes
  • drug induced SLE
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29
Q

INH CI

A

hepatitis

serious rxns

30
Q

rifampin

A

readily penetrates into phagocytic cells and can kill organisms that are poorly accessible to other agents

31
Q

rifampin MOA

A

binds to beta-subunit of DNA dependent RNA polymerase inhibiting RNA synthesis
bactericidal

32
Q

rifampin resistance

A

several points of mutation in rpoB gene

33
Q

rifampin uses

A 
mycobacterial infections
menigococcal carriers
prophylaxis of children exposed to H. influenza B
staphylococcal carriers
serious staphylococcal infections
34
Q

adverse rxns to rifampin

A 
strong P450 inducer
extreme caution in HIV
harmless red/orange color to urine, feces, saliva, sweat, tears, CSF, contact lenses
rashes
GI
thrombocytopenia
nephritis
hepatotoxicity (not as common as INH)
less then 2x/wk flu like symptoms
35
Q

pyrazinamide

A

prodrug converted to pyrazinoic acid by pncA

36
Q

pyrazinamide resistance

A

imparied uptake of pyrazinamide

mutations in pncA

37
Q

adverse rxns to pyrazinamide

A

hepatotoxicity (most of all 1st line agents)
GI
hyperuricemia
drug rash (most of all 1st line agents)

38
Q

ethambutol MOA

A

inhibits mycobacterial arabinosyl transferases encoded by embCAB, essential part of cell wall

39
Q

ethambutol resistance

A

overexpression of emb gene

mutations w/embB gene

40
Q

adverse rxns ethambutol

A

retrobulbar neuritis-> loss of visual acuity, red-green color blindness
CI in children where acuity and color vision cannot be assessed

41
Q

streptomycin

A

aminoglycoside

well absorbed as IM, typically administered

42
Q

streptomycin MOA

A

irreversibly inhibitor of protein synthesis

30S

43
Q

streptomycin resistance

A

mutations in rpsL gene
mutations in rrs gene
TB, MAC, and M. kansasii only mycobacteria that are susceptible

44
Q

streptomycin adverse effects

A

ototoxicity
nephrotoxicity
relative CI in prego

45
Q

Second line use for TB

A

1st line resistance
failure w/traditional therapy
serious adverse effects of traditional therapy

46
Q

second line drugs

A 
ethionamide
capreomycin
cycloserine
aminosalicyli acid (PAS)
kanamycin and amikacin
FQs
linezolid
rifabutin
rifapentine
47
Q

ehtionamide

A 
blocks synthesis of mycolic acids
oral
hepatotoxicity
intense GI
thyroid and neuro adverse effects
single agent  -> rapid resistance
48
Q

capreomycin

A 
peptide protein synthesis inhibitor
IM injections
resistance due to rrs mutations
nephro and ototoxic
significant pain and abscesses at injection site
49
Q

cycloserine

A

inhibits cell wall synthesis

peripheral neuropathy and CNS dysfnx

50
Q

aminosalicylic acid

A

folate synthesis inhibitor
active exclusively against TB
GI adverse effects
severe hypersensativity rxns

51
Q

kanamycin and amikacin

A

protein synthesis inhibitors
amikan less toxic
used w/MDR and streptomycin resistant TB
adverse effects- nephro and ototoxicity

52
Q

FQs

A

block bacterial DNA synthesis via DNA gyrase and toposiomerase IV
also active against atypical myco
resistance due to point mutations in grase A
used when resistant to first line agents
GI and CNS disturbances can occur
impaired glucose control

53
Q

linezolid

A

significant and potentially life-threatening adverse effects
bone marrow suppresion, irreversible peripheral and optic neuropathy
rifabutin

54
Q

rifabutin

A 
TB
MAI
M. fortuitum
patients with HIV on ARV
expensive
55
Q

rifapentine

A

active against TB and MAI

56
Q

M. leprae

A

dapsone
rifampin
clofazimine

57
Q

dapsone

A

similar to sulfonamides, inhibits folate synthesis
hemolysis and methemoglobinemia common
P. jiroveci in AIDs Tx as well

58
Q

clofazimine

A

half life up to 2 months
sulfone resistant leprosy
skin discoloration, GI intolerance

59
Q

M. kansasii clinical

A

resembles TB

60
Q

M. kansasii Tx

A 
cipro
clarithromycin
ethambutol
INH
rifampin
trimethoprim-sulfamethoxazole
61
Q

M. marinum clinical

A

granulomatous cutaneous disease

62
Q

M. marium Tx

A 
Amikacin
clarithromycin
ethambutol
doxycycline
minocycline
rifampin
trimethoprim-sulfamethoxazole
63
Q

M. scrofulaceum clinical

A

cervical adenitis in kids

64
Q

M. scrofulaceum Tx

A

amikacin, erythromycin, rifampin, streptomycin

surgical excision Tx of choice

65
Q

M. avium complex clinical

A

pulmonary disease in patients w/chronic lung disease, disseminated in AIDs

66
Q

M. avium complex Tx

A 
amikacin
azithromycin
clarithromycin
cipro
ethambutol
rifabutin
67
Q

M. chelonae clinical

A

abscess
sinus ract
ulcer
bone, joint, or tendon infection

68
Q

M. chelonae Tx

A

amikacin, doxy, imipenem, macrolide, tobramycin

69
Q

M. fortuitum clinical

A

abscess
sinus ract
ulcer
bone, joint, or tendon infection

70
Q

M. fortuitum Tx

A 
amikacin 
cefoxitin
cipro
doxy
ofloxacin
trimethoprim-sulfamethoxazole
71
Q

M. ulcers clinical

A

skin ulcers

72
Q

M. ulcers Tx

A

INH, streptomycin, rifampin, minocycline,

surgical excision

Resp II (15 decks)

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