Antibiotics (Antimycobacterial Drugs) Flashcards Preview

P Pha T > Antibiotics (Antimycobacterial Drugs) > Flashcards

Flashcards in Antibiotics (Antimycobacterial Drugs) Deck (17):
1

Chemotherapy for mycobacterial infections always involves the use of drug ________________ to delay the emergence of resistance and enhance efficacy.

combinations

2

Isoniazid
- inhibits mycolic acid synthesis
- for tuberculosis (active, latent, prophylaxis)
- SE: hepatitis, neurotoxicity (seizures, neuritis, insomnia), acute hemolysis in G6PD deficiency, drug-induced lupus (___________ increased), drug interactions
- most important drug used in TB
- Prevent neurotoxicity by co-administering ______________

_________________
- inhibits mycolic acid synthesis
- for tuberculosis (active, latent, prophylaxis)
- SE: hepatitis, neurotoxicity (seizures, neuritis, insomnia), acute hemolysis in G6PD deficiency, drug-induced lupus (anti-histones increased), drug interactions
- most important drug used in TB
- Prevent neurotoxicity by co-administering Vitamin B6

MNEMONIC: INH injures Neurons and Hepatocytes

3

_______________
- inhibits DNA-dependent RNA polymerase
- for TB (active, latent), leprosy, prophylaxis for meningococcal and staphycoccal carrier states, drug-resistant infections
- SE: red-orange urine, light chain proteinuria, skin rash, thrombocytopenia, hepatotoxicity, flu-like syndrome
- rapid development of resistance if used alone
- delays the emergence of resistance to ____________

Rifampicin
- inhibits DNA-dependent RNA polymerase
- for TB (active, latent), leprosy, prophylaxis for meningococcal and staphycoccal carrier states, drug-resistant infections
- SE: red-orange urine, light chain proteinuria, skin rash, thrombocytopenia, hepatotoxicity, flu-like syndrome
- rapid development of resistance if used alone
- delays the emergence of resistance to dapsone

MNEMONIC:
Rifampicin = R
RNA polymerase inhibitor
Red-orange body fluids
Rapid development of resistance
Revs up cytochrome P450

4

______________
- Rifampicin derivative that is not absorbed in the GIT, thus used for prevention of hepatic encephalopathy, for treatment of traveler's diarrhea
- Off-label use: IBS, pseudomembranous colitis

Rifaximin
- Rifampicin derivative that is not absorbed in the GIT, thus used for prevention of hepatic encephalopathy, for treatment of traveler's diarrhea
- Off-label use: IBS, pseudomembranous colitis

5

________________
- inhibits arabinosyl transferase involved in the synthesis of _________________ in mycobacterial cell wall
- visual disturbances (decreased visual acuity, red-green colorblindness, retrobulbar neuritis, retinal damage), headache, confusion, hyperuricemia, peripheral neuritis
- perform ophthalmologist examination before starting antimycobacterial therapy

Ethambutol
- inhibits arabinosyl transferase involved in the synthesis of arabinogalactan in mycobacterial cell wall
- visual disturbances (decreased visual acuity, red-green colorblindness, retrobulbar neuritis, retinal damage), headache, confusion, hyperuricemia, peripheral neuritis
- perform ophthalmologist examination before starting antimycobacterial therapy

MNEMONIC
Ethambutol = E = Eye-related side effects

6

_________________
- unknown MOA; bacteriostatic but can be bactericidal on actively dividing mycobacteria

Pyrazinamide

7

anti-TB drug known as sterilizing agent

Pyrazinamide

8

Most hepatotoxic anti-TB drug

Pyrazinamide

9

Anti-TB drug with the following SE:
Non-gouty polyarthralgia, hyperuricemia, myalgia, hepatotoxicity, GIT irritation, rash, porphyria, photosensitivity

Pyrazinamide

10

First-line anti-TB drugs in order of increasing hepatotoxicity

Isoniazid, rifampicin, pyrazinamide
(ISO a Red Pyr; I saw a red fire)

11

________________
- inhibit protein synthesis by binding to 30s subunit
- for TB, tularemia, bubonic plague, brucellosis
- SE: reversible _________toxicity, irreversible _________toxicity, congenital deafness (teratogen)
- aminoglycoside (administered IM, synergistic effect with beta-lactam antibiotics)

Streptomycin
- inhibit protein synthesis by binding to 30s subunit
- for TB, tularemia, bubonic plague, brucellosis
- SE: reversible nephrotoxicity, irreversible vestibulotoxicity, congenital deafness (teratogen)
- aminoglycoside (administered IM, synergistic effect with beta-lactam antibiotics)

12

TUBERCULOSIS
WHO Cat I
- new smear positive, new smear negative with extensive disease, new extrapulmonary TB (except CNS, bones, or joints)
- treatment regimen: ___________
WHO Cat Ia
- new extrapulmonary TB (CNS, bones, joints)
- treatment regimen: ___________
WHO Cat II
- previously treated drug-susceptible TB
- treatment regimen: ____________
WHO Cat IIa
- same as Cat II but involving CNS/bones/joints
- treatment regimen: _____________
Drug-resistant TB
-- MDR TB
-- XDR TB

TUBERCULOSIS
WHO Cat I
- new smear positive, new smear negative with extensive disease, new extrapulmonary TB (except CNS, bones, or joints)
- treatment regimen: 2HRZE, 4HR
WHO Cat Ia
- new extrapulmonary TB (CNS, bones, joints)
- treatment regimen: 2HRZE, 10HR
WHO Cat II
- previously treated drug-susceptible TB
- treatment regimen: 2HRZES 1HRZE, 5HRE
WHO Cat IIa
- same as Cat II but involving CNS/bones/joints
- treatment regimen: 2HRZES 1HRZE, 9HRE
Drug-resistant TB
-- MDR TB
-- XDR TB

13

ALTERNATIVE ANTIMYCOBACTERIAL DRUGS
Amikacin
- streptomycin-resistant or multi-drug resistant mycobacterial strains
Ciprofloxacin, Ofloxacin
- active against strains of M tuberculosis resistant to first-line agents
______________
- no cross-resistance with INH
- SE: severe gastrointestinal irritation and neurotoxicity
p-aminosalicylic acid (PAS)
- rarely used because primary resistance is common
- SE: gastrointestinal irritation, peptic ulcers, hypersensitivity reactions, effects on kidney, liver, and thyroid function
Capreomycin
- SE: ototoxicity, renal dysfunction
Cycloserine
- SE: peripheral neuropathy, CNS dysfunction

ALTERNATIVE ANTIMYCOBACTERIAL DRUGS
Amikacin
- streptomycin-resistant or multi-drug resistant mycobacterial strains
Ciprofloxacin, Ofloxacin
- active against strains of M tuberculosis resistant to first-line agents
Ethionamide
- no cross-resistance with INH
- SE: severe gastrointestinal irritation and neurotoxicity
p-aminosalicylic acid (PAS)
- rarely used because primary resistance is common
- SE: gastrointestinal irritation, peptic ulcers, hypersensitivity reactions, effects on kidney, liver, and thyroid function
Capreomycin
- SE: ototoxicity, renal dysfunction
Cycloserine
- SE: peripheral neuropathy, CNS dysfunction

14

______________
- most active drug against M. leprae
- MOA: inhibition of ___________ synthesis
- SE: methemoglobinemia
- usually used in combination with clofazimine and _______________

Dapsone
- most active drug against M. leprae
- MOA: inhibition of folic acid synthesis
- SE: methemoglobinemia
- usually used in combination with clofazimine and rifampicin

15

____________
- anti-leprosy drug
- binds to _________ bases in bacterial DNA
- SE: red-orange skin discoloration, GI irritation

Clofazimine
- anti-leprosy drug
- binds to guanine bases in bacterial DNA
- SE: red-orange skin discoloration, GI irritation

16

DRUGS USED for ATYPICAL MYCOBACTERIA
Prophylaxis
- _______________ or azithromycin with or without ___________ in patients with CD4 counts less than 50/L
Treatment
- ______________ or clarithromycin with ___________ and ___________

DRUGS USED for ATYPICAL MYCOBACTERIA
Prophylaxis
- clarithromycin or azithromycin with or without rifabutin in patients with CD4 counts less than 50/L
Treatment
- azithromycin or clarithromycin with rifabutin and ethambutol

17

WHO Treatment Guidelines for Leprosy:
Tuberculoid: __________ + ___________
Lepromatous: __________ + __________ + ____________

WHO Treatment Guidelines for Leprosy:
Tuberculoid: dapsone + rifampicin
Lepromatous: dapsone + rifampicin + clofazimine

Decks in P Pha T Class (62):