Treatment of Mycobacterial infections

Question 1

Isoniazid, Rifampin, Pyrazinamide and Ethambutol are first line drugs for this condition

Answer 1

Tuberculosis

Question 2

First line drug for tuberculosis that inhibits lipid (mycolic acid) synthesis required for cell wall integrity

Answer 2

Isoniazid

Question 3

MOA of Isoniazid

Answer 3

Inhibits mycolic acid synthesis required for cell wall integrity

Question 4

Isoniazid is inactivated by genetically determined ______

Answer 4

Acetylation
(Acetyl isoniazid may be converted to acetyl hydrazide, then to a hepatotoxic metabolite)

Question 5

Tuberculosis drug that is inactivated by genetically determined acetylation

Answer 5

Isoniazid

Question 6

Neurotoxicity from Isoniazid may be minimized by administration of this

Answer 6

Pyridoxine (vit b6)

Question 7

Pyridoxine (B6) may minimize this adverse effect of Isoniazid

Answer 7

Neurotoxicity

Question 8

Pyridoxine (B6) may minimize nephrotoxicity of this tuberculosis drug

Answer 8

Isoniazid

Question 9

High acetylators have higher risk of this adverse effect of Isoniazid

Answer 9

Hepatotoxicity

Question 10

Isoniazid use should be avoided if there is a five fold increase in this in normal individuals or three fold increase in patients with symptoms of hepatitis

Answer 10

Serum aspartate aminotransferase

Question 11

Neurotoxicity, hepatotoxicity, and hemolysis in patients with G6PD deficiency are adverse effects of this tuberculosis drug

Answer 11

Isoniazid

Question 12

Primary toxicity of Ethionamide

Answer 12

Neurological disruption

Question 13

Tuberculosis drug with neurological disruption as a primary toxicity

Answer 13

Ethionamide

Question 14

Tuberculosis drug that inhibits arabinogalactan polymerization by inhibition of arabinosyl transferase, thereby disrupting cell wall synthesis

Answer 14

Ethambutol

Question 15

Ethambutol inhibits this enzyme

Answer 15

Arabinosyl transferase
thus inhibits arabinogalactan polymerization

Question 16

Retrobulbar neuritis (visual defects that are usually reversible, including loss of central vision, impaired red/green discrimination, and constriction of peripheral vision) is a characteristic adverse effect of this tuberculosis drug

Answer 16

Ethambutol

Question 17

Primary adverse effect of Ethambutol

Answer 17

Retrobulbar neuritis (visual defects)

Question 18

MOA of rifamycins

Answer 18

Inhibit DNA-dep RNA pol

Question 19

Tuberculosis drug that inhibits DNA-dep RNA pol

Answer 19

Rifamycin

Question 20

Tuberculosis drug that can induce microsomal enzymes systems (high risk of drug interactions)

Answer 20

Rifamycin

Question 21

Tuberculosis drug where half life will fall during early stages of therapy due to autoinduction

Answer 21

Rifamycin

Question 22

Tuberculosis drug that has increased risk of hepatotoxicity when given with isoniazid

Answer 22

Rifamycin

Question 23

Tuberculosis drug with immunosuppressive effects, most common with intermittent therapy, early flu-like symptom

Answer 23

Rifamycin

Question 24

Is Pyrazinamide safe in pregnancy?

Answer 24

Not recommended; effect on fetus unknown

Question 25

Hepatotoxicity related to dose and duration of treatment, and Hyperuricemia are adverse effects of this tuberculosis drug

Answer 25

Pyrazinamide

Question 26

Hyperuricemia is an adverse effect of this tuberculosis drug

Answer 26

Pyrazinamide

Question 27

2 main adverse effects of Pyrazinamide

Answer 27

Hepatotoxicity
Hyperuricemia

Question 28

2 Tuberculosis drugs that inhibit dihydropteroate synthase to block folate synthesis

Answer 28

Para-Aminosalicylic acid and Dapsone

Question 29

MOA of Para-Aminosalicylic acid

Answer 29

Inhibits dihydropteroate synthase to block folate synthesis

Question 30

Sodium overload is a concern for this tuberculosis drug as oral preps are very high in sodium

Answer 30

Para-Aminosalicylic acid

Question 31

This is a concern with Para-Aminosalicylic acid oral preps

Answer 31

Sodium overload

Question 32

Tuberculosis drug with similar structure to Alanine, acts as a competitive inhibitor of Alanine racemase, blocks incorporation of D-ala into cell wall components

Answer 32

Cycloserine

Question 33

MOA of cycloserine

Answer 33

Similar structure to alanine
Competitive inhibitor of alanine racemase
Blocks incorporation of D-alanine into cell wall components

Question 34

2 main adverse effects of cycloserine

Answer 34

Neurological effects
Hemolysis in patients with G6PD deficiency

Question 35

MOA of Dapsone

Answer 35

Inhibits folic acid synthesis by inhibiting dihydropteroate synthase

Question 36

Characteristic hypersensitivity reaction of Dapsone involving fever, malaise, exfoliative dermatitis, jaundice and hepatic necrosis

Answer 36

Sulfone syndrome

Question 37

Characteristic hypersensitivity reaction involving fever, malaise, exfoliative dermatitis, and juandice and hepatic necrosis is an adverse effect of this tuberculosis drug

Answer 37

Dapsone

Question 38

6 month TB treatment regimen involves these 4 drugs during the intensive phase

Answer 38

“RIPE”
Rifamycin
Isoniazid
Pyrazinamide
Ethambutol