Treatment of Leprosy Flashcards
What is the WHO recommended therapy for Tuberculoid Leprosy>
Dapsone and Rifampin for a year then the therapy is discontinued.
What is the WHO recommendation for Lepromatous Leprosy
Dapsone and Rifampcin, clofazimine 24 months and then therapy deiscontinuedq
WHat is the most notable product which Dapson is hydrolyzed to?
Hydroxylamine, this gives rise to hemolysis and methhemoglobinemia.
What the hell is methemoglobinemia
It is a condition where the iron in hemoglobin becomes OXIDIZED and rendered less capable of carrying O2 than normal. O2 sats can fall, you can get blue nailbeds…etc
How does Dapsone work?
Its a folate antagonist that produces a bacteriostatic effect.
It also inhibits neutrophil chemotaxis
Dapsone syndrome
Hemolysis, Methemoglobinemia, Hepatitis, Cholestatic, peripheral nbeuropathy, severe hypoalbuminemia, psychosis, leukopenia, agranulocytosis
What is the other drug toxicity noted for Dapsone
A rash: Maculopapular exfoliative rash confied to either the upper limbs or the forehead
Stevens Johnson Syndrome has also been reported. This is a reaction to medicine that begins as flu like symptoms and then turns into a rash that causes the top layer of skin to die and shed. Its a medical emergency
Other uses of Dapsone?
acne, dermatitis, herpetiformis
How does Rifampin work?
It is a RNA synthesis inhibitor
Rifampin works extremely well against slow growing organisms
Truth
What are the 5 R’s
Rifampin: DNA dependent RNA polymerase inhibitor (RNA synthesis) Revs up CYP450 Red Secretions Resistance if used alone
Multiple drug interactions with Rifampin why?
Because of its CYP induction capability
Rifampin activity is variable in different patients. Differences in the CYP activity, polymorphisms in the genomic targets, etc… can all effect Rifampin activity. Thus there may be drug interactins and there may not
true
Rifampin adverse effects:
Increases in hepatic enzymes and severe, sometimes fatal liver toxicity.
Can discolor body fluids red.
Makes diabetes management difficult
Clofazimine works how?
Binds to mycobacterial DNA, specifically Guanine and Cytosine. This is preferentially in the Mycobacterim becasue there are more Cytosine and Guanine bases in the Myco than humans.
Produces anti-inflammatory and immunosuppresive effects.
Why can Clofazimine persist in tissue for so long?
It is highly Lipophilic so it can persist in Adipose for months
How is clofazimine metabolized and excreted?
No Metabolism. Excreted as is by the liver which can cause hepatitis and jaundice
Body fluids may appear what color when taking clofazimine?
Brown…the suckling infant can turn brown
Feces may appear black or tarry
true
Skin discoloration can occur and trigger
depression
Describe the two adverse reactions to TB drug therapy
Type 1: red rash, swollen hands and feet, joint pain. TREAT WITH CORTICOSTEROIDS
Type 2: Numerous painful nodes, Give corticosteroids, clofazimine and Thalidomide
How does Thalidomide work?
Inhibits NFKappa B transcriptional upregulation and TNF-Alpha production
Adverse effects of Thalidomide
Teratogen,
Causes increase in HIV viral load
Adverse effects like somnolence, rash, and headache
