Antimycobacterial Drugs

Question 1

treatment of active TB

Answer 1

4 drugs- 
isoniazid
rifampin
pyrazinamide
ethambutol

Question 2

treatment of MDR-TB

Answer 2

5-6 drugs

Question 3

latent TB treatment

Answer 3

isoniazid or rifampin alone for 9 months

Question 4

locations of TB drugs

Answer 4

intracellular
extracellular
cavities

Question 5

speed of intracellular replication

Answer 5

slow

Question 6

speed of extracellular replication

Answer 6

fast

Question 7

speed of cavitary replication

Answer 7

slow

Question 8

mycolic acid

Answer 8

long chain branched fatty acids in the wall

Question 9

mycelia acid benefits

Answer 9

resist dehdyration, disinfectants, antibiotics, hide from macrophages

Question 10

isoniazid works at

Answer 10

extra
intra
cavity

Question 11

isoniazid is cidal or static

Answer 11

either- depends on location

Question 12

isoniazid MOA

Answer 12

prodrug activated to nicotinoyl radical by Katg which inhibits mycolic acid synthesis by blocking InhA and KasA

Question 13

KatG

Answer 13

mycobacterium enzyme that activates isoniazid to nicotinoyl radical

Question 14

nicotinoyl radical

Answer 14

active form of isoniazid

Question 15

InhA

Answer 15

acyl carrier protein reductase

Question 16

KasA

Answer 16

acyl carrier protein synthetase

Question 17

isoniazid resistance mechanisms

Answer 17

spontaneous resistance
KatG mutation
InhA overexpression
resistance to oxidative stress

Question 18

isoniazid clearance

Answer 18

NAT2 aceylation in liver which is then either excreted by kidney oR converted to hydrazine by cops
acetylated and excreted

Question 19

what increases isoniazid toxicity

Answer 19

slow acetylators

cyp inducers

Question 20

isoniazid side effects

Answer 20

hepatotoxicity

neurotoxicity- PNS and CNS

Question 21

prevention of isoniazid side effects

Answer 21

B6 supplements

Question 22

isoniazid interactions

Answer 22

inhibits MAO- do not give with tyramine foods, excessive caffeine, MAOI

cyp inhibitors
alcohol

Question 23

extracellular acting first line tb drugs

Answer 23

isoniazid
rifampin
ethambutol
streptomycin

Question 24

intracellular acting first line tb drugs

Answer 24

isoniazid
rifampin
pyrazinamide

Question 25

cavity acting first line tb drugs

Answer 25

isoniazid rifampin ethambutol

Question 26

rifampin acts in

Answer 26

intracellular extracellular cavity

Question 27

rifampin cidal or static

Answer 27

cidal

Question 28

rifampin MOA

Answer 28

inhibits bacterial RNA polymerase

Question 29

rifampin resistance

Answer 29

RNA polymerase mutations

Question 30

rifampin clearance

Answer 30

deacetylation in liver

Question 31

specific isoniazid CNS effects

Answer 31

memory loss psychosis seizures

Question 32

specific isoniazid PNS effects

Answer 32

paresthesia of hands/feet

Question 33

rifampin ADR

Answer 33

elevated AFT- rare hepatotoxicity turns secretions red thrombocytopenia hypersensitivity rxn

Question 34

rifampin interactions

Answer 34

cyp inducer- MANY drug interactions oral contraceptives warfarin protease inhibitors

Question 35

rifapentine

Answer 35

same as rifampin but longer half life and fewer drug interactions

Question 36

pyrazinamide acts where

Answer 36

intracellular

Question 37

pyrazinamide cidal or static

Answer 37

cidal

Question 38

pyrazinamide MOA

Answer 38

prodrug- converted by pyrazinamidase (bacterial deaminase) to pyrazinoic acid disrupts membrane function and transport

Question 39

pyrazinamidase

Answer 39

enzyme that activates pyrazinamide

Question 40

pyrazinoic acid

Answer 40

active form of pyrazinamide

Question 41

resistance mechanism for pyrazinamide

Answer 41

pyrazinmidase mutation

Question 42

elimination of pyrazinamide

Answer 42

kidney

Question 43

pyrazinamide ADR

Answer 43

hepatotoxicity | hyperurecemia

Question 44

most hepatotoxic first line tb

Answer 44

pyraziamide

Question 45

pyramidamide interactions

Answer 45

none

Question 46

ethambutol acts

Answer 46

extracellular | cavities

Question 47

ethambutol MOA

Answer 47

inhibits arabinagalactan synthesis

Question 48

arabinagalactan synthesis

Answer 48

anchor for mycolic acid

Question 49

ethambutol resistance

Answer 49

mutation in target enzyme

Question 50

ethambutol clearance

Answer 50

renal

Question 51

ethambutol ADR

Answer 51

optic neuritis | hyperuricemia

Question 52

hepatotoxic first line tb drugs

Answer 52

isoniazid | pyrazinaide

Question 53

hyperurecemia is in what first line tb drugs

Answer 53

pyrazinamide | ethambutol

Question 54

optic neuritis is in what first line tb drug

Answer 54

ethambutol

Question 55

streptomycin acts wehre

Answer 55

extracellular

Question 56

streptomycin cidal or static

Answer 56

cidal

Question 57

streptomycin MOA

Answer 57

binds 30S subunit and causes mRNA misreading

Question 58

streptomycin resistance

Answer 58

rRNA and protein mutations

Question 59

streptomycin elimination

Answer 59

renal

Question 60

streptomycin ADR

Answer 60

ototoxicity- vestibular and auditory | nephrotoxicity

Question 61

ototoxic first line tb

Answer 61

streptomycin

Question 62

nephrotoxic first line tb

Answer 62

streptomycin

Question 63

weakest first line tb

Answer 63

ethambutol

Question 64

neurotoxic tb drugs

Answer 64

isoniazid cycloserine ethioamide

Question 65

what is given to prevent neurotoxicity

Answer 65

pyridoxine

Question 66

what drugs is pyridoxine given with

Answer 66

isoniazid | cycloserine

Question 67

cycloserine cidal or static

Answer 67

both

Question 68

cycloserine MOA

Answer 68

inhibits peptidoglycan synthesis

Question 69

cycloserine clearance

Answer 69

renal

Question 70

cycloserine side effects

Answer 70

neurotoxicity peripheral neuropathy CNS- anxiety, depression, psychosis, memory loss, seizures

Question 71

cycloserine contraindicated in

Answer 71

psychosis alcoholism epilepsy renal impairment

Question 72

ethionamide cidal or static

Answer 72

both

Question 73

ethionamide MOA

Answer 73

prodrug- inhibits InhA (mycolic acid synthesis)

Question 74

ethionamide ADR

Answer 74

GI upset CNS toxicity- depression, sensory disturbances hepatitis

Question 75

amino salicylic acid static or cidal

Answer 75

static

Question 76

amino salicylic acid MOA

Answer 76

inhibits thymine nucleotide synthesis

Question 77

aminosalicylic ADR

Answer 77

GI upset | hypersensitivity

Question 78

drugs causing GI upset

Answer 78

Ethambumide | aminosalicylic acid

Question 79

bedaquiline use

Answer 79

MDR only- with 3 other drugs known to work

Question 80

bedaquiline moa

Answer 80

inhibits ATP synthase

Question 81

bedaquiline elimi

Answer 81

cyp metabolism | plasma bound

Question 82

bedaquiline ADR

Answer 82

QT prolongation elevated AFT headache arthalgia

Question 83

QT prolongation

Answer 83

bedaquiline

Question 84

drugs that inhibit InhA

Answer 84

isoniazid | ethionamide

Question 85

leprosy drugs

Answer 85

rifampin | dapsone

Question 86

length leprosy treatment

Answer 86

6-12 months

Question 87

dapsone MOA

Answer 87

static, concentrated in infected skin inhibits folate synthesis inhibits neutrophil functioning antioxidant

Question 88

dapsone ADR

Answer 88

hemolysis- severe in G6PD deficiency | methemoglobinemia

Question 89

drug affected by G6PD decifiency

Answer 89

dapsone

Question 90

drugs for MAC

Answer 90

rifampin ethambutol aminoglycoside

Question 91

length of MAC treatment

Answer 91

12 months after first negative culture