TB

Question 1

Streptomycin - enters cells?

Answer 1

No

Question 2

Streptomycin - static or cidal?

Answer 2

bactericidal

Question 3

Streptomycin - toxicity?

Answer 3

Ototoxic and nephrotoxic

Question 4

Streptomycin - when used?

Answer 4

Sever disease with other agents (a lot of resistance)

Question 5

Streptomycin - in pregnancy?

Answer 5

No

Question 6

Isoniazid - administration?

Answer 6

PO

Question 7

Isoniazid - clearance?

Answer 7

Renal

Question 8

Isoniazid - penetration?

Answer 8

Good. CNS/CSF and macrophages.

Question 9

Isoniazid - static or cidal?

Answer 9

Bactericidal

Question 10

Isoniazid - mechanism?

Answer 10

Inhibits mycolic acid synthesis (inhibits dihydrofolate reductase)

Question 11

Isoniazid - drug or prodrug?

Answer 11

Prodrug

Question 12

Isoniazid - what breaks down?

Answer 12

NAT2

Question 13

Isoniazid - what activates in TB?

Answer 13

KatG

Question 14

Isoniazid - resistance?

Answer 14

KatG del/mute, InhA over expression

Question 15

Isoniazid - TOX?

Answer 15

Hepatic tox (slow acetylators, +rifampin, >35)
Peripheral neuropathy (slow acetylators, give pyridoxine B6)
Rash, fever, lupus, seizure, coma

Question 16

Isoniazid - in Preg?

Answer 16

NO

Question 17

Which TB drug causes peripheral neuropathy?

Answer 17

Isoniazid

Question 18

Isoniazid - interactions?

Answer 18

Acetaminophen (CYP2E1) - hepatotoxicity

Warfarin (CYP2C9) - bleeds

Question 19

Pyrazinamide - administration?

Answer 19

PO

Question 20

Pyrazinamide - clearance?

Answer 20

Renal

Question 21

Pyrazinamide - distribution?

Answer 21

CNS, macrophage

Question 22

Pyrazinamide - analog?

Answer 22

Nicotinamide

Question 23

Which TB drug is an analog of nicotinamide?

Answer 23

Pyrazinamide

Question 24

Pyrazinamide - drug or prodrug?

Answer 24

Prodrug (pyrazinoic acid by pncA) and acidic environment

Question 25

Pyrazinamide - mechanism?

Answer 25

inhibits FAS1 (mycolic acid synthesis)

Question 26

Pyrazinamide - static or cidal?

Answer 26

Bactericidal

Question 27

Pyrazinamide - resistance?

Answer 27

pncA

Question 28

Pyrazinamide - TOX?

Answer 28

Hepatic toxicity, Hyperuricemia, arthralgias

Question 29

Pyrazinamide - in pregnancy?

Answer 29

NO

Question 30

Which TB drug exacerbates gout?

Answer 30

Pyrazinamide

Question 31

Ethambutol - administration?

Answer 31

PO

Question 32

Ethambutol - clearance?

Answer 32

Renal

Question 33

Ethambutol - penetration?

Answer 33

CSF with meningeal inflammation

Question 34

Ethambutol - mechanism?

Answer 34

Inhibits mycobacterial arabinosyl transferase (embAB operon)

Question 35

Ethambutol - static or cidal?

Answer 35

Bacteriostatic (enhances cell wall permeability)

Question 36

Ethambutol - resistance?

Answer 36

embB mute

Question 37

Ethambutol - TOX?

Answer 37

``` Optic neuritis (red green color blind) Fever, rash ```

Question 38

Ethambutol - in pregnancy?

Answer 38

NO

Question 39

Which TB drug causes optic neuritis?

Answer 39

Ethambutol

Question 40

Rifampin - administration?

Answer 40

PO

Question 41

Rifampin - clearance?

Answer 41

Hepatic clearance - biliary excretion

Question 42

Rifampin - distribution?

Answer 42

CNS, macrophages

Question 43

Rifampin - static or cidal?

Answer 43

Bactericidal

Question 44

Rifampin - mechanism?

Answer 44

inhibits RNA synthesis (binds rpoB)

Question 45

Rifampin - resistance?

Answer 45

rpoB mute

Question 46

Rifampin - TOX?

Answer 46

N/V, fever, rash, fluids turn red/orange (stain lenses)

Question 47

Which TB drug turns fluids red/orange?

Answer 47

Rifampin

Question 48

Rifampin - in pregnancy?

Answer 48

NO

Question 49

Rifampin - caution in?

Answer 49

liver disease

Question 50

Rifampin - drug drug reactions?

Answer 50

Induces CYPs (increases clearance of HIV drugs - PI/reverse trancriptase inhibitors and OCPs)

Question 51

When do you use Rifabutin?

Answer 51

In TB to replace Rifampin when the patient is taking PIs

Question 52

Latent TB treatment?

Answer 52

INH - 9 months OR Rifampin - 4 months

Question 53

Active TB treatment?

Answer 53

RIPE - 2 months THEN RI - 4 months

Question 54

Which TB drugs has the most resistance?

Answer 54

INH

Question 55

MDR TB treatment?

Answer 55

4-6 drugs x 18 months

Question 56

Bedaquiline - administration?

Answer 56

PO

Question 57

Bedaquiline - Treatment?

Answer 57

24 weeks + > 3 drugs

Question 58

Bedaquiline - mechanism?

Answer 58

Inhibits mycobacterial ATP synthase

Question 59

Bedaquiline - resistance?

Answer 59

atpE (subunit c ATP synthase)

Question 60

Bedaquiline - metabolism?

Answer 60

CYP3A4 - hepatic clearance - biliary excretion (NOT with rifampin!)

Question 61

Bedaquiline - boxed warning?

Answer 61

Increased hepatic transaminases (monitor liver fx) and QT prolongation (death)

Question 62

Which TB drug has a boxed warning concerning hepatic transaminases and QT prolongation (death)?

Answer 62

Bedaquiline

Question 63

Bedaquiline - in pregnancy?

Answer 63

YES!

Question 64

Which TB drug is ok in pregnancy?

Answer 64

Bedaquiline

Question 65

MAC - treatment?

Answer 65

Macrolide + Ethambutol + Rifamycin (M or R for prox)

Question 66

M leprae (Hansen's) - treatment?

Answer 66

Rifampin or Dapsone or Clofazimine

Question 67

Levofloxacin - mechanism?

Answer 67

Targets topoisomerase (inhibits DNA synthesis and supercoiling)

Question 68

FAS - I

Answer 68

C26

Question 69

FAS - II

Answer 69

C56