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Anti-TB and Anti-Malarial Drugs Flashcards

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1
Q

First line anti-TB agents:

A 
Isoniazid
Streptomycin
Rifampicin
Ethambutol
Pyrazinamide
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2
Q

Isoniazid prodrug is activated by:

A

KatG

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3
Q

Only parenteral first-line anti-TB drug:

A

Streptomycin

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4
Q

Bacteriostatic first line TB drugs:

A

Isoniazid (against slowly dividing TB)

Ethambutol

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5
Q

Tuberocidal first line anti-TB drugs:

A

Isoniazid (against rapidly dividing TB)
Rifampicin
Pyrazinamide
Streptomycin

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6
Q

Drugs used against TB actively multiplying inside cavitary walls:

A

Streptomycin (best)
Isoniazid
Rifampicin

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7
Q

Drugs used against slowly dividing TB inside macrophages:

A

Pyrazinamide
Rifampicin
Isoniazid

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8
Q

Drugs active against dorman TB in caseous foci:

A

Rifampicin

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9
Q

Isoniazid inhibits DNA synthesis by inhibiting:

A

mycolase synthetase

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10
Q

Adverse effects of Isoniazid:

A

Peripheral neuritis
Hepatoxicity (most common)
Heomlysis n G6PD deficiency

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11
Q

These drugs decrease INH absorption:

A

Antacids

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12
Q

MOA of rifampicin:

A

Inhibits initiation of RNA synthesis

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13
Q

Excretion of rifampicin:

A

Mainly in bile, also in feces

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14
Q

PAS is syngergistic with ___ but decreases absorption of ____.

A

Isoniazid; Rifampicin

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15
Q

This drug affects the electron transport system by interfering with:

A

Pyrazinamide; NAD

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16
Q

Active form of pyrazinamide:

A

Pyrazinoic acid

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17
Q

Adverse effects of pyrazinamide:

A

Hepatic injury (most serious)
Vertigo and hearing loss (most common)
Hyperuricemia (CI in gouty arthritis)

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18
Q

Mechanism of resistance ot pyrazinamide:

A

Alters ribosomal binding sites (16S)

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19
Q

This parenteral TB drug acts by inhibiting ribosomal protein synthesis at the ___ subunit:

A

Streptomycin; 30S

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20
Q

Therapeutic concentrations of streptomycin are attained in the:

A

Bile, pleural fluids, extracellular fluids, and inflamed meninges

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21
Q

Drugs stopped after 2 months in 4 drug therapy:

A

Pyrazinamide

Streptomycin

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22
Q

This drug inhibits the polymerization of the crucial TB cell wall component ____:

A

Ethambutol; arabinogalactan

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23
Q

Retrobulbar neuritis is ____ caused by:

A

Red-green color blindness; Ethambutol

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24
Q

Adverse affects of streptomycin:

A

Facial paresthesias
Vestibular ototoxicity
Teratogen
Minimally nephrotoxic

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25
2nd line anti-TB drugs:
``` Levofloxacin Rifepentine Para-aminosalicylic acid Ethionamide Amikacin Cycloserine Capreomycin Rifabutine ```
26
2nd line TB drugs related to rifampicin:
Rifapentine | Rifabutine
27
Used in TB treatment of HIV:
Rifabutine
28
2nd line TB drug used to inhibit onset of resistance to these 1st line drugs:
PAS; Streptomycin and Isoniazid
29
2nd line drug not able to penetrate the BBB:
PAS
30
PAS is a ____ which acts almost exclusively against M. tb:
folate synthesis antagonist
31
This drug is related to isonizaid:
Ethionamide
32
Ethionamide hepatoxicity increases when used with:
Rifampicin
33
Coadministration of Amikacin with these drugs may increase nephrotoxicity:
Aminoglycosides Penicllin Cephalosporin Amphotericin B
34
Amikacin increases the effects of ____ which may cause ____.
Neuromuscular blocking agents; respiratory depression
35
Administration of amikacin with loop diuretics may cause:
Irreversible hearing loss
36
Cycloserine is a structural analogue of ___ which inhibits:
D-alanine; bacterial cell wall synthesis
37
Cycloserine in combination with ___ may increase it's:
Isoniazid; CNS effects
38
Capreomycin is administered ___ and is useful for M.tb that is resistant to:
parenterally; streptomycin or amikacin
39
Two phases of short course chemotherapy:
``` First phase (Intensive/Bactericidal phase) Second phase (Maintenance phase) ```
40
TB drugs contraindicated in pregnant women:
Pyrazinamide | Streptomycin
41
If not possible to defer treatment in patients with acute hepatitis, the treatment regimen is:
3SE/6HR (hepatotoxic H, R, P)
42
Treatment regimen in those with renal failure:
2HRZ/4HR (nephrotoxic S and E)
43
Corticosteroids are used in the following conditions:
``` TB meningitis with high ICP Acute pericardia effusion Pleural effusion Miliary TB Enlarged mediastinal lymph nodes TB pericarditis ```
44
Recommended TB treatment regimen in elderly patients:
9HR + other drugs
45
Malaria drug resistance is most notable in:
P. falciparum
46
Malaria parasites responible for clinical illness:
erythrocytic parasites
47
These malaria species go through only one cycle of liver cell invasion, and no parasite remains in the liver:
P. falciparum | p. malariae
48
These malaria species have liver parasites that are not eradicated and may produce relapse:
p. vivax | p. ovale
49
The only true causal prophylactic drugs:
The antifols: Pyrimethamine Chloroguanide
50
Factors in choosing an anti-malarial drug:
Plasmodium species Patient's clinical status Parasite's drug susceptibility
51
MOA of quinine:
Interfere with the parasite ability to break down and digest hemoglobin
52
Side effects of quinine:
Cinchonism (tinnitus) Blackwater fever Cardiotoxicity
53
Guinidine-like (antiarrhythmic) malaria drugs:
Quinine Chloroquine Mefloquine
54
Blood schizonticides:
Quinine Mefloquine (against. p. falciparum and vivax) Halofantrine Atovaquone
55
Used in chloroquine resistant malaria:
Atovaquone Antifols Mefloquine Quinine
56
Drugs increasing quinine blood concentrations:
Cimetidine (also chloroquine) Sodium bicarbonate Digoxin
57
Drugs decreasing quinine blood levels or bioavailability:
Antacids | Rifamycins
58
MOA of chloroquinine:
Prevents hemoglobin breakdown, leading to toxic heme buildup
59
Malarial drugs with metabolite activity:
Chloroquine (modesethylchloroquine) Halofantrine (n-desbutyl halofantrine) Antifols (cycloguanil)
60
Malarial drugs not recommended as prophylaxis:
Quinine Halofantrine Atovaquine
61
Malarial drugs useful in pregnancy:
Chloroguanide | Mefloquine (2nd and 3rd trimesters only)
62
Drugs interfering with chloroquine absorption:
Magnesium trisilicate | Kaopectate
63
These two anti-malarial drugs in combination may fatally increase the QT interval:
Halofantrine | Mefloquine
64
These two anti malarial drugs in combination increase the risk of convulsion
Mefloquine | Chloroquine
65
This drug combined with quinine or other beta blockers may cause:
Mefloquine; ECG abnormalities and cardiac arrest
66
Anti malarials excreted through feces:
Mefloquine (also bile) | Halofantrine
67
MOA of mefloquine:
Raising intravesicular pH within parasite vesicles
68
Most frequent adverse effects of Mefloquine:
GI effects Dizziness Loss of balance Neurological and psychiatric effects
69
Most well tolerated anti-malarials:
Antifols (Chloroguanide and Pyrimethamine) | Halofantrine
70
Co-administration of this drug with warfarin may potentiate warfarin:
Chloroguanide
71
Antimalarials CI in pregnancy:
``` Primaquine Fansidar Tetracycline Quinhaosu Halofantrine ```
72
Antimalarials CI in infants and children:
Primaquine Fansidar Mefloquine
73
Drug used in congenital and neonatal malaria:
Chloroquine
74
2 drugs that should be avoided during malaria infection:
Corticosteroids (esp. cerebral malaria) | Paracetamol (prolongs parasitic clearance)
75
p. vivax and p. ovale should be treated with:
Primaquine
76
1st line therapy for p. falciparum:
Quinine and Quinidine
77
Most serious toxic effects of cycloserine:
Peripheral neuropathy CNS dysfunction Depression Psychosis
78
Co-administration of capreomycin and aminoglycosides may increase the risk of:
Respiratory paralysis | Renal dysfunction
79
TB grouping in patient management:
A - Failure to convert (despite 4-6 mos.) B - Previous Relapse (after 2 standard, 1 MDR) C - Multi Drug Resistant (4 or more) D - High relapse risk (destroyed lung)

Pharmacology (14 decks)

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