Anti-Mycobacterial Agents (week 10)

Question 1

What are the four Antimycobacterial Agents?

Answer 1

Isoniazid (INH)
Rifampin (RIF)
Pyrazinamide (PZA)
Ethambutol (EMB)

Question 2

Reaction of TB after immunosuppression, HIV infection, or smoking

Answer 2

Secondary TB

Question 3

Positive Skin Test 
Negative Chest Xray
Does not feel sick
Not infectious
Requires treatment to prevent

Answer 3

Latent TB

Question 4

Positive skin test 
Abnormal chest Xray
Positive sputum 
Feels sick
Contagious 
Requires treatment for the disease

Answer 4

Active TB

Question 5

Why does TB treatment happen in multiple waves?

Answer 5

Because slow-growing microbes that show up after the first dose

Question 6

How many drugs do you start with for Active TB?

Answer 6

Four drugs

Question 7

Why are multiple drugs used over the course of TB Treatment?

Answer 7

Because of Resistance

Question 8

What does Multi-drug Resistance mean?

Answer 8

Resistant to both isoniazid and Rifampin

Question 9

What is Extensively drug-resistant TB?

Answer 9

Resistant to Isoniazid and Rifampin

All fluoroquinolone

Question 10

First 8 weeks of treatment
Most bacilli killed during this phase
4 drugs used

Answer 10

Intensive Phase of TB Treatment

Question 11

After first 8 weeks of treatment
Bacilli remaining after intensive phase
At least 2 drugs

Answer 11

Continuation Phase of TB treatment

Question 12

Surviving TB might cause TB later

Answer 12

Relapse of TB treatment

Question 13

What is Directly observed therapy (DOT) used for?

Answer 13

Patient non-adherence

Question 14

What do you assess to see if TB treatment is working?

Answer 14

Bacteriologic evaluation of sputum
Clinical Evaluation
Chest Radiographs

Question 15

What combination of drugs should not be offered for those who have Latent TB?

Answer 15

Rifampin and Pyrazinamide

Question 16

What is Isoniazid (INH) used for?

Answer 16

Must use in combination for active TB infection

Question 17

What is the MOA of Isoniazid (INH)?

Answer 17

Selective for mycobacteria, kills cells wall

Question 18

How is Isoniazid metabolized?

Answer 18

Acetylation

Question 19

What are common adverse effects of Isoniazid (INH)?

Answer 19

Peripheral neuropathy

Question 20

What are some serious side effects of Isoniazid (INH)?

Answer 20

Black Box Warning - Hepatotoxicity

Question 21

What do you want to know in the PMH before administering Isoniazid (INH)?

Answer 21

Acute liver disease or hx of INH hepatotoxicity

Rate of Acetylation

Question 22

How is Isoniazid administered?

Answer 22

PO

IM

Question 23

How do you take Isoniazid?

Answer 23

Empty stomach, either 1 hour before meals or 2 hours after

Question 24

What is the antidote to Isoniazid (INH)?

Answer 24

Pyridoxine (Vitamin B6)

Question 25

What is Rifampin used for?

Answer 25

Active TB | Prevention of disease caused by influenza B

Question 26

What is the MOA of Rifampin?

Answer 26

Inhibits synthesis of RNA and therapy causing defective proteins

Question 27

What are some common side effects of Rifampin?

Answer 27

Red/Orange discoloration of tears and urine

Question 28

What are some serious side effects of Rifampin?

Answer 28

Hepatotoxicity | CNS symptoms

Question 29

What are some drugs that interact with Rifampin?

Answer 29

Protease inhibitors and delavirdine | CYP3A4 inducers

Question 30

How is Rifampin administered?

Answer 30

Oral | IV

Question 31

How do you take Rifampin?

Answer 31

Oral - 1 hour before a meal or 2 hours after IV - slow infusion

Question 32

What is Pyrazinamide used for and what is the MOA?

Answer 32

TB | Unknown

Question 33

What are common side effects of Pyrazinamide?

Answer 33

Hyperuricemia | Arthralgia, Myalgia (body aches)

Question 34

What are serious side effects of Pyrazinamide?

Answer 34

Hepatotoxicity | Articular gout

Question 35

What do you want to know about PMH before administering Pyrazinamide?

Answer 35

Severe liver disease or acute gout

Question 36

How is Pyrazinamide administered?

Answer 36

Oral | Once a day, on a empty stomach

Question 37

What should you take for arthralgia?

Answer 37

NSAID

Question 38

What is Ethambutol (Myambutol) used for?

Answer 38

Initial treatment of TB

Question 39

What is the MOA Ethambutol (Myambutol)?

Answer 39

Unknown

Question 40

What are the common side effects of Ethambutol (Myambutol)?

Answer 40

Hyperuricemia

Question 41

What are the serious side effects of Ethambutol (Myambutol)?

Answer 41

Optic neuritis

Question 42

What kind of baseline info should you have before administering Ethambutol (Myambutol)?

Answer 42

Baseline eye test

Question 43

What should you know in the PMH before administering Ethambutol (Myambutol)?

Answer 43

Optic neuritis

Question 44

How is Ethambutol administered?

Answer 44

Oral | Take once a day