Antimycobacterials

Question 1

Isoniazid is less effective in

Answer 1

Atypical mycobacteria

Question 2

Isoniazid

If used as a single drug

Answer 2

10-20% prevalence

Question 3

Isoniazid

As a single agent in cases of

Answer 3

Recent converters
Immunocompromised individuals
Close contacts
Abnormal chest x ray but activity has been R/O

Question 4

Complex semisynthetic derivative of Rifampicin

Answer 4

Rifampin

Question 5

Rifampin

Active against

Answer 5

Gm - and + cocci
Some enteric bacteria
Chlamydia

Question 6

Rifampin

Cross resistance with

Answer 6

Rifabutin

Question 7

Rifampin

Clinical use

Answer 7

Mycobacterial infection - + INH, ethambutol x 6month
Atypical mycobacteria - 600 mgd or 2x weekly x 6 months
Leprosy- + sulfone

Question 8

Rifampin

Other indication

Answer 8

Meningococcal carriage
H. Influenza type B contact
Staph
Pneumococci (menigitis)

Question 9

Synthetic, water soluble, heat stable compound

Answer 9

Ethambutol

Question 10

Ethambutol

Most common adverse effect

Answer 10

Loss of visual acuity and red green color

Question 11

Ethambutol

CI

Answer 11

Very young because visual acuity assessment is difficult

Question 12

A relative of nicotinamide, stable, inexpensive

Answer 12

Pyrazinamide

Question 13

Pyrazinamide

Inhibits

Answer 13

Intracellular organism

Question 14

Resistant to some non tuberculous species

Answer 14

Streptomycin

Question 15

Streptomycin

Extracellular tubercle bacilli;

Answer 15

Inflamed meninges

Question 16

Streptomycin

Clinical use

Answer 16

Severe, life threatening forms of TB

Drug resistance

Question 17

Streptomycin

Adverse

Answer 17

Oto toxicity

Nephrotoxicity

Question 18

Treatment of TB: guidelines for national programmes 3rd edition. WHO Geneva June 2004

Answer 18

H- isoniazid
R- Rifampicin
S- streptomycin
Km- kanamycin
Q- quinolone (ciprofloxacin  or ofloxaxin)
Z- pyrazinamide
E- ethambutol
Cs- cycloserine
Et- etionamide

Question 19

DOTS stands for?

Answer 19

Directly Observed Treatment Short course

Question 20

Five elements of DOTS

Answer 20

Political commitment
Quality sputum microscopy for diagnosis
Regular supply of anti TB drugs
Standardized recording and reporting of TB data
Supervised treatment

Question 21

TB and pregnancy

Answer 21

INH, Rifampicn, ethambutol vit B6

Question 22

Risk of teratogenicity

Answer 22

PZA

Question 23

Infants should be given 3 mos.

Answer 23

INH prophylaxis

Question 24

Related to INH, poorly soluble in water

Answer 24

Ethionamide

Question 25

Ethionamide MOA

Answer 25

Blocks mycolic acid synthesis

Question 26

Ethionamide Adverse reaction

Answer 26

Hepatotoxic | Neurotoxicity

Question 27

Ethionamide Resistance

Answer 27

When used as single agent

Question 28

Capreomycin MOA

Answer 28

Peptide protein synthesis inhibitor from streptomyces capreolus

Question 29

Capreomycin Used for multi drug resistant cases

Answer 29

Streptomycin | Amikacin

Question 30

Capreomycin Resistance

Answer 30

rrs mutation

Question 31

Capreomycin Adverse effect

Answer 31

Nephrotoxic | Ototoxic

Question 32

Cycloserine MOA

Answer 32

Inhibitor of cell wall synthesis

Question 33

Cycloserine Adverse effect

Answer 33

``` Peripheral neurophaty CNS dysfunction (give pyridoxine) ```

Question 34

Aminosalycylic acid MOA

Answer 34

Folate synthesis antagonist

Question 35

Aminosalycylic acid Structure

Answer 35

Similar to PABA and sulfonamides

Question 36

Aminosalycylic acid Widely distributed in tissues and body fluids except in

Answer 36

CSF | Excreted in urine

Question 37

Aminosalycylic acid Adverse effects

Answer 37

``` Anorexia Nausea LBM Epigastric pain Peptic ulceration Hemorrhage Hypersensitivity reaction ```

Question 38

Kanamycin and Amikacin MOA

Answer 38

Inhibits 30s ribosomal subunit

Question 39

Kanamycin and Amikacin For streptomycin resistant cases,

Answer 39

Multi drug resistant TB | Atypical mycobacterium

Question 40

Ciprofloxacin and levofloxacin MOA

Answer 40

Inhibits gyrase mediated DNA- supercoiling

Question 41

Ciprofloxacin and levofloxacin M. TB

Answer 41

Levo> ciprofloxacin

Question 42

Ciprofloxacin and levofloxacin Atypical myco

Answer 42

Levo

Question 43

Ciprofloxacin and levofloxacin Prophylaxis

Answer 43

Fluoroquinolone + PZA

Question 44

Ciprofloxacin and levofloxacin Resistance

Answer 44

Mutations in gyrase A subunit

Question 45

Derived from rifamycin, related to rifampin

Answer 45

Rifabutin

Question 46

Rifabutin Uses

Answer 46

TB, Avium, foruitum | Aids with cd4 count of

Question 47

Rifabutin Resistance

Answer 47

rpo mutation

Question 48

Rifabutin Less potent inducer

Answer 48

For HIV infected patients receiving other meds

Question 49

Analog of rifampin; against M. TB , M Avium

Answer 49

Rifapentine

Question 50

Rifapentine MOA

Answer 50

Bacterial RNA polymerase inhibitor

Question 51

Rifapentine Potent inducer of

Answer 51

Cytochrome p450

Question 52

Rifapentine Dose

Answer 52

600 mg once or 2x weekly

Question 53

Last resort of multi drug resistant TB

Answer 53

Clofazimine

Question 54

Effective against leprosy

Answer 54

Clofazimine

Question 55

Clofazimine MOA

Answer 55

Unknown | Involved in DNA binding

Question 56

Clofazimine AE

Answer 56

Skin dis colorization | GIT intolerance

Question 57

Inhibits protein synthesis (50S)

Answer 57

Linezolid (oxazolidinones)

Question 58

Linezolid (oxazolidinones) AE

Answer 58

Hematologic (thrombocytopenia, neutropenia)

Question 59

TB diagnostic category

Answer 59

Table memorize

Question 60

Not communicable from person to person | Disease produced are less severe than TB

Answer 60

Atypical Mycobacteria

Question 61

Disseminated disease in late stages of AIDS

Answer 61

MAC

Question 62

MAC 1st line treatment

Answer 62

Azithromycin 500mg Clarithromycin 500 mg + ethambutol 15mg Clofazimine/ciprofloxacin 750mg Amikacin

Question 63

MAC 2nd line treatment

Answer 63

``` Rifabutin 300 Rifampicin Ethionamide Cycloserine Imipenem ```

Question 64

MAC Prophylaxis in aids PT

Answer 64

Rifabutin 300 mg OD

Question 65

Mycobacterium marinarum 1st line tx

Answer 65

Rifampicin + ethambutol

Question 66

Mycobacterium marinarum 2nd line treatment

Answer 66

``` Clarithromycin Amikacin Kanamycin Minocycline Doxycycline ```

Question 67

Similar to TB but milder

Answer 67

Mycobacterium kansasii

Question 68

Mycobacterium kansasii 1st line treatment

Answer 68

INH + Rifampicin + ethambutol

Question 69

Mycobacterium kansasii 2nd line

Answer 69

``` Ethionamide Cycloserine Clarithromycin Amikacin Streptomycin ```

Question 70

Cervical lymphadenitis

Answer 70

Mycobacterium fortuitum | Tx, surgical excision

Question 71

Chronic lung disease and skin soft tissue infection

Answer 71

Mycobacterium fortuitum

Question 72

Mycobacterium fortuitum 1st line

Answer 72

Amikacin+ doxycycline

Question 73

Mycobacterium fortuitum 2nd line

Answer 73

Cefoxitin, | Rifampicin

Question 74

Leprosy

Answer 74

Skin and nerve | Cell mediated immunity

Question 75

Leprosy mode of transmission

Answer 75

Nasal secretions

Question 76

Dx leprosy

Answer 76

Slit skin smears

Question 77

Skin macules with clear centers and well defined margins, anesthetic,

Answer 77

Tuberculoid leprosy

Question 78

Impaired cell immunity, Atrophy of skin Muscles amputations Spontaneous ulceration

Answer 78

Lepromatous

Question 79

Major chemotherapeutic agents against M. Leprae

Answer 79

``` Dapsone (DDS) Rifampicin Clofazimine Ofloxacin Minocycline ```

Question 80

Other chemotherapeutic agents for leprosy

Answer 80

Levofloxacin Sparfloxacin Clarithromycin

Question 81

Dapsone MOA

Answer 81

Inhibits folate synthesis

Question 82

Mycobacterium fortuitum Adverse effects

Answer 82

Hemolysis GIT intolerance Erythema nodosum leprosum

Question 83

Exacerbation of lepromatous leprosy

Answer 83

Jarisch-herxheimer reaction

Question 84

Clofazimine (lamprene) MOA

Answer 84

Inhibit the template function of DNA

Question 85

Clofazimine SE

Answer 85

Discoloration of the skin | Eosinophilic enteritis

Question 86

Miscellaneous agents for leprosy

Answer 86

Thalidomide - tx of erythema nodosum | Ethionamide - substitute for clofazimine

Question 87

The most active drug for the treatment of TB

Answer 87

Isoniazid