Treatment of Leprosy Flashcards

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1
Q

What is the WHO recommended therapy for Tuberculoid Leprosy>

A

Dapsone and Rifampin for a year then the therapy is discontinued.

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2
Q

What is the WHO recommendation for Lepromatous Leprosy

A

Dapsone and Rifampcin, clofazimine 24 months and then therapy deiscontinuedq

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3
Q

WHat is the most notable product which Dapson is hydrolyzed to?

A

Hydroxylamine, this gives rise to hemolysis and methhemoglobinemia.

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4
Q

What the hell is methemoglobinemia

A

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

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5
Q

How does Dapsone work?

A

Its a folate antagonist that produces a bacteriostatic effect.
It also inhibits neutrophil chemotaxis

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6
Q

Dapsone syndrome

A

Hemolysis, Methemoglobinemia, Hepatitis, Cholestatic, peripheral nbeuropathy, severe hypoalbuminemia, psychosis, leukopenia, agranulocytosis

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7
Q

What is the other drug toxicity noted for Dapsone

A

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

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8
Q

Other uses of Dapsone?

A

acne, dermatitis, herpetiformis

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9
Q

How does Rifampin work?

A

It is a RNA synthesis inhibitor

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10
Q

Rifampin works extremely well against slow growing organisms

A

Truth

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11
Q

What are the 5 R’s

A
Rifampin:
DNA dependent RNA polymerase inhibitor (RNA synthesis)
Revs up CYP450
Red Secretions
Resistance if used alone
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12
Q

Multiple drug interactions with Rifampin why?

A

Because of its CYP induction capability

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13
Q

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

A

true

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14
Q

Rifampin adverse effects:

A

Increases in hepatic enzymes and severe, sometimes fatal liver toxicity.
Can discolor body fluids red.
Makes diabetes management difficult

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15
Q

Clofazimine works how?

A

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.

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16
Q

Why can Clofazimine persist in tissue for so long?

A

It is highly Lipophilic so it can persist in Adipose for months

17
Q

How is clofazimine metabolized and excreted?

A

No Metabolism. Excreted as is by the liver which can cause hepatitis and jaundice

18
Q

Body fluids may appear what color when taking clofazimine?

A

Brown…the suckling infant can turn brown

19
Q

Feces may appear black or tarry

A

true

20
Q

Skin discoloration can occur and trigger

A

depression

21
Q

Describe the two adverse reactions to TB drug therapy

A

Type 1: red rash, swollen hands and feet, joint pain. TREAT WITH CORTICOSTEROIDS
Type 2: Numerous painful nodes, Give corticosteroids, clofazimine and Thalidomide

22
Q

How does Thalidomide work?

A

Inhibits NFKappa B transcriptional upregulation and TNF-Alpha production

23
Q

Adverse effects of Thalidomide

A

Teratogen,
Causes increase in HIV viral load
Adverse effects like somnolence, rash, and headache