Treatment Regimens

Question 1

M. tuberculosis

Answer 1

Prophylaxis = Isoniazid

Treatment = Rifampin, Isoniazid, Pyrazinamide, Ethambutol

RIPE for treatment

Question 2

M. Intracellulare

Answer 2

Prophylaxis = Azithromycin, rifabutin

Treatment = Azithromycin or clarithromycin + ethambutol, can add rifabutin or ciprofloxacin

(more drug resistant that M. tuberculosis)

Question 3

M. Leprae

Answer 3

no prophylaxis

Treatment = long term

- Tuberculoid - dapsone and rifambin
- Lepromatous - dapsone, rifampine + clofazimine

Question 4

Antihelminthic therapy

Answer 4

Mebendazole, pyrantel pamoate, ivermectin, diethylcarbamazine, praziqauntel

= immobilize helminths

Question 5

Antiprotozoan therapy

Answer 5

Pyrimethamine (toxoplasmosis)
Suramin & melarsoprom (T. brucei)
nifurtimox (T. cruzi)
sodium stibogluconate (leishmaniasis)

Question 6

Hepatitis C treatment

Answer 6

Combination treatment ALWAYS used

Genotypes 1,4,5,6:
= ribavarin, pegylated IFN & sofobuvir

Genotypes 2,3:
= ribavirin & sofosbuvir

Question 7

HIV therapy

Answer 7

Highly active antiretroviral therapy (HAART)
- initiated when Pt present w/ AIDS-defining illness, low CD4 cell count (<500 cell/mm), or high viral load:

2 NRTIs + 1 NNRTI or Protease inhibitor or Integrase inhibitor

Question 8

Hodgkin’s Lymphoma

Answer 8

MOPP = Mechlorethamine, Vincristine, Procarbazine, Prednisone

Question 9

Bismuth

Sucralfate

Answer 9

Mucosal Protective Agents - bind to ulcer base, providing physical protection & allowing HCO3- secretion to reestablish pH gradient in the mucous layer

Tx - ↑ ulcer healing, travelers’ diarrhea (bismuth),
- prevent stress related bleeding in Pt where suppression of acid secretion is not desired (sucralfate)

Question 10

Misoprostol

Answer 10

Mucosal Protective Agent = PGE1 analog = ↑ production & secretion of gastric mucous barrier, ↓ acid production

Tx - Prevention of NSAID-induced peptic ulcers

• maintenance of a PDA
• used to induce labor (ripens cervix)

AE - Diarrhea
CI - women of childbearing potential (abortifacient)

Question 11

Octreotide

Answer 11

Long-acting somatostatin analog

Tx - Acute variceal bleed, acromegaly, VIPoma & carcinoid tumors

AE - Nausea, cramps, steatorrhea

(Tx - secretory diarrhea - ↓ gut motility)

Question 12

Magnesium Hydroxide
Magnesium Citrate
Polyethylene Glycol
Lactulose

Answer 12

Osmotic Laxatives = Provide osmotic load to craw water out

Tx - Constipation

AE - Diarrhea, Dehydration (may be abused in bulemics)

Lactulose also treats hepatic encephalopathy since gut flora degrade it into metabolites (lactic & acetic acid) that promote nitrogen excretion as NH4+

Question 13

Infliximab

Answer 13

Monoclonal Ab to TNF-α (mouse/human chimeric)

Tx - IBD (CD & UC), RA, ankylosing spondylitis, psoriasis

AE - Infection (including reactivation of latent TB), fever, HoTN

Question 14

Sulfasalazine

Answer 14

Sulfapyridine (antibacterial) + 5-ASA (anti-inflammatory) which is activated by colonic bacteria

Tx - UC & CD

AE - Malaise, nausea, sulfonamide toxicity, reversible oligospermia

Question 15

Ondansetron

Answer 15

5-HT3 antagonist; ↓ vagal stimulation; powerful central-acting antiemetic

Tx - anti-emetic in post-op & chemotherapy

AE - Headache, constipation
- Prolonged QT

Question 16

Metoclopramide

Answer 16

D2 antagonist; ↑ resting tone, contractility, LES tone, motility (doesn’t influence colon transport time)
= prokinetic & antiemetic

Tx - Diabetic & post-surgery gastroparesis, antiemetic

AE - ↑ parkinsonian effects. Restlessness, drowsiness, fatigue, depression, nausea, dirrhea
CI - small bowel obstruction, Parkinson disease

Drug interaction w/ digoxin & diabetic agents