L6: Drugs for Tb and Leprosy

Question 1

Which drug can be used to treat both Tb and Leprosy?
A. Pyrazinamide
B. Izoniazid
C. Rifampin

Answer 1

C. Rifampin

Question 2

True or False: Tb is caused by mycobacterium tuberculosis, a bacillus

Answer 2

True

Question 3

How is Tb acquired?
A. Oral
B. Excretory
C. Inhalation

Answer 3

C. Inhalation

Question 4

Immunosuppression that following infection with ___ is an important risk factor for developing mycobacterial disease

Answer 4

HIV

Question 5

Infection with tubercle bacillus results in acquired immunity and tuberculin hypersensitivity. What cell type mediates both reactions?

Answer 5

T-Lymphocytes

Question 6

What is the first organ involved in Tb?

Answer 6

Lung
- Infection usually resides in the lower respiratory tract

Question 7

Tubercle bacilli lodge in the ___ and may multiple in phagocytes

Answer 7

alveoli

Question 8

True or False: Bacilli can disseminate from original pulmonary site largely through lymphatic system, to blood stream, causing infection to other organs and tissues

Answer 8

True

Question 9

Where does Tb reactivation most commonly occur?

Answer 9

Upper lobes of lung

Question 10

Which mycobacterial species is most frequently isolated from AIDS patients?

Answer 10

Mycobacterium avium complex

Question 11

True or False: Therapy for treating Tb must consist of only one drug and must continue for two months

Answer 11

False
- drugs: should consist of two or more
- treatment: three to six months

Question 12

Which three locations are tubercle bacilli believed to be found within the host?

Answer 12

1) Cavitary lesions
-O2 tension is high
- active replication

2) Closed caseous lesions
- O2 tension is low
- slow replication

3) Within macrophages
- acidic
- slow replication

Question 13

Which two drugs function at neutral pH (extracellular)?
A. Isoniazid, Rifampin
B. Ethambutol and Pyrazinamide

Answer 13

A. Isoniazid, Rifampin

Question 14

True or False: Rifampin, Isoniazid, Pyrazinamide, and Ethambutol all have metabolic activity in the alveoli and at acidic pH

Answer 14

True

Question 15

What three drugs can be used to treat Tb prophylactically?

Answer 15

Rifampin, Isoniazid, and Pyrazinamide

Question 16

In absence of drug resistance, a region of ___ and ___ administered for 9 months is curative (for Tb)

Answer 16

Rifampin and Isoniazid

Question 17

True or False: 6 months regimens are most common for Tb treatment in the US

Answer 17

True

Question 18

Which four drugs are used daily, for 2 months, to treat initial phase of Tb?

Answer 18

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

Question 19

Which two drugs are administered for four months to treat continuation phase of Tb?

Answer 19

Rifampin and Isoniazid

Question 20

True or False: DOT (direct observation of therapy) has been shown to improve leprosy treatment

Answer 20

False - Tb tx

Question 21

Which drug is the primary drug of Tb (first line anti-Tb agent, with Rifampin) but should NEVER be used alone (resistance develops!)
A. Rifampin
B. Isoniazid
C. Pyrazinamide
D. Ethambutol

Answer 21

B. Isoniazid

Question 22

Which drug is associated with hepatitis, elevated hepatic enzymes, and peripheral neuropathy? Tx?
A. Isoniazid
B. Rifampin
C. Pyrazinomide

Answer 22

A. Isoniazid
- Tx: Vit B6 (pyroxidine)

Question 23

True or False: Chemo for Tb in HIV patients should be given for 6 mths. Further, Isoniazid, Rifampin, and Pyrazinamide should be given daily for 2 mths.

Answer 23

True

Question 24

Visual acuity should be measured in patients receiving:
A. Rifampin
B. Isoniazid
C. Pyrazinamide
D. Ethambutol

Answer 24

D. Ethambutol

Question 25

If Pyrazinamide is given, baseline levels of serum ____ should be determined

Answer 25

Uric acid

Question 26

True or False: Rash, fever, and tachy are the most common hypersensitivity reactions associated with Tb drugs

Answer 26

True

Question 27

Mycobacterium leprae can cause ___

Answer 27

leprosy

Question 28

Leprosy is spread by ___ from the upper respiratory tract of infection persons that enter through respiratory tract of susceptible persons

Answer 28

bacilli

Question 29

What are the three types of Leprosy?

Answer 29

1) Tuberculoid: few skin lesions 2) Borderline: intermediate 3) Lepromatous: wide-spread, symmetrical distribution of skin lesions; macrophages

Question 30

Which of following types of Leprosy is associated with a high CMI? low CMI?

Answer 30

High CMI = Tuberculoid Low CMI = Lepromatous

Question 31

Three cardinal signs of infection with M. leprae?

Answer 31

Skin lesions Skin anesthesia Enlarged nerves

Question 32

Which of the following drugs primarily used Tb (but also can be used for Leprosy) suppresses RNA synthesis by inhibition bacterial DNA-dependent RNA Polymerase? A. Rifampin B. Isoniazid C. Ethambutol D. Pyrazinamide

Answer 32

A. Rifampin

Question 33

A patient begins having GI disturbances and excretions that are red following treatment of leprosy. Which drug did she likely take? A. Rifampin B. Isoniazid C. Ethambutol D. Pyrazinamide

Answer 33

A. Rifampin

Question 34

Which of the following drugs inhibits mycolic acid biosynthesis? A. Rifampin B. Isoniazid C. Ethambutol D. Pyrazinamide

Answer 34

B. Isoniazid - Therefore: affects lipids, nucleic acids, and glycolysis

Question 35

___ and ____ are first line anti-Tb agents used with Isoniazid

Answer 35

Pyrazimide and Ethambutol

Question 36

A patient with Tb begins taking medication for treatment. However, she notices that she begins having difficulty with her vision and develops a rash. Which drug did she likely take?

Answer 36

Ethambutol

Question 37

Which of the following is NOT a primary drug for Tb? A. Rifampin B. Isoniazid C. Ethambutol D. Pyrazinamide

Answer 37

D. Pyrazinamide

Question 38

Which drug inhibits incorporation of mycolic acid to mycobacterial cell wall?

Answer 38

Ethambutol and Isoniazid

Question 39

___ is only effective against Mycobacteria, while ___ is specific for Mycobacterium tuberculosis

Answer 39

Ethambutol; Pyrazinamide

Question 40

Hyperuricemia and hepatotoxicity may be seen with use of ____

Answer 40

Pyrazinamide

Question 41

Pyrazinamide is converted to pyrazinoic acid by mycobacteria. POA lowers __, preventing growth

Answer 41

pH

Question 42

Human populations show genetic heterogeneity with regard to rate of acetylation of ____ A. Rifampin B. Isoniazid C. Ethambutol D. Pyrazinamide

Answer 42

B. Isoniazid

Question 43

True or False: Hepatitis is more likely to occur in a slow acetylator taking Isoniazid

Answer 43

True

Question 44

When is Rifampin most active?

Answer 44

During cell replication

Question 45

Which drug is used orally with isoniazid and rifampin in Tb chemotherapy?

Answer 45

Ethambutol

Question 46

Pyrazinamide exhibits bacterial action only at a slightly __ pH

Answer 46

acidic

Question 47

Pyrazinamide is not iteslf active, but it is hydrolyzed to the active compound _____, which has anti-Tb activity

Answer 47

pyrazinoic acid

Question 48

Hepatotoxicity is the main serious side effect when using ___

Answer 48

pyrazinamide

Question 49

Non-gouty polyarthralgia and hyperuricemia are AE seen with the use of which drug?

Answer 49

Pyrazinamide

Question 50

Hepatitis (less likely than with INH) and GI disturbances are common AE associated with ____use

Answer 50

Rifampin

Question 51

Which drug induces P450 enzymes (and therefore, may be prone to DDI)?

Answer 51

Rifampin

Question 52

Which red color compounds treats LEPROMATOUS LEPROSY by binding to mycobacterial DNA and interfering with bacterial growth? Hint: drug can cause skin discoloration

Answer 52

Clofazimine

Question 53

____ is a drug that is principally bacteriostatic (not bactericidal to M. leprae) and is used for all patients infected with sulfone-sensitive Mycobacterium leprae. Hint: it inhibits synthesis of folic acid

Answer 53

Dapsone

Question 54

True or False: You should never use Clofazimine alone, because resistance may develop

Answer 54

False - does not

Question 55

What are the three primary toxicities associated with Dapsone use?

Answer 55

1) Hemolytic Anemia 2) Methemogloinemia 3) Sulfone Syndrome