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TB and Malaria Flashcards

1
Q

TB transmission

A

droplet nuclei, when a person with infectious TB sneezes, speaks, sings, or coughs

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2
Q

general facts about mycobacterium tuberculosis

A

acid fast bacteria, slow generation time which makes it difficult to treat, facultative intracellular parasite

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3
Q

property of cell wall that is unique to mycobacterium

A

mycolic acid

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4
Q

first line TB drugs

A

isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin, rifabutin, rifapentine

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5
Q

4 drugs to treat active TB

A

RIPE

isoniazid, rifampin, pyrazinamide, ethambutol

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6
Q

recommended dosing for a new positive TB case

A

2 months: isoniazid, rifampin, pyrazinamide, ethambutol

4 months: isoniazid, rifampin

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7
Q

drugs to treat latent TB infection

A

isoniazid, rifampin, or isoniazid + rifapentine

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8
Q

isoniazid MOA

A

static

inhibits biosynthesis of mycolic acid

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9
Q

prophylaxis for TB

A

isoniazid

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10
Q

isoniazid inactivation

A

acetylation in the liver

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11
Q

isoniazid toxicities

A

hepatitis in fast acetylators
peripheral neuritis in slow acetylators
hemolysis
lupus like syndrome

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12
Q

rifampin MOA

A

inhibits DNA dependent RNA polymerase inhibiting transcription

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13
Q

rifampin spectrum

A

BROAD, effective against leprosy and also G+ and G- microbes

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14
Q

rifampin toxicities

A

hepatic enzyme induction, of CYP450s
not recommended for HIV patients
body secretions are orange
decreases effectiveness of birth control

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15
Q

ethambutol MOA

A

inhibits arabinosyl transferases involved in the synthesis of arabinogalactan

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16
Q

CNS penetration for ethambutol?

A

YES

if TB meningitis, this is a good drug to give

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17
Q

ethambutol toxicities

A

decreased of visual acuity and loss of green-red perception

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18
Q

pyrazinamide MOA

A

prodrug, mechanism unknown

active at acidic pH

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19
Q

CNS penetration for pyrazinamide?

A

YES

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20
Q

toxicities of pyrazinamide

A

hepatic dysfunction

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21
Q

pyrazinamide resistance

A

high, so it must be used in combination with isoniazid and rifampin

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22
Q

streptomycin MOA

A

binds on 30s ribosome

bacteriocidal

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23
Q

toxicities of streptomycin

A

ototoxic and nephrotoxic

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24
Q

rifamycin family MOA

A

inhibits DNA dependent RNA polymerase

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25
2 drugs in rifamycin family
rifabutin and rifapentine
26
side effects of rifamycin drugs
body secretions are orange colored | inducer of P450, use rifabutin before rifapentine
27
DOC for latent TB
isoniazid + rifapentine
28
one of the DOC for active TB in HIV individuals
rifabutin (replaces rifampin)
29
reasons why second line TB drugs are second line
lower potency and/or greater toxicity
30
treatment for MAC
1. clarithromycin or azithromycin 2. ethambutol 3. rifabutin, rifampin, or ciprofloxacin
31
treatment for mycobacterium leprae
1-5 patches: dapsone and rifampin for 6 months | > 5 patches: dapsone and rifampin for 6-12 months
32
dapsone MOA
PABA antagonist as well as interference with the nutrition of M. leprae
33
dapsone route of administration
oral
34
dapsone toxicity
nasal obstruction is most common
35
DOC for erythema nodosum leprosum
Thalidomide
36
toxicity of thalidomide
teratogenic
37
what are the 4 causative organisms to infect humans with malaria
P. falciparum, P. vivax, P. ovale, P. malariae
38
what two organisms remain dormant in the liver stages of malaria
p. vivax and p. ovale
39
malaria is most commonly caused by what species
p. falciparum
40
what are you treating for a clinical cure
patients symptoms
41
what are you treating for a radical cure
patients symptoms + dormant tissue forms
42
what form does a blood schizonticide work on
erythrocytic forms of the parasite
43
what stages does a tissue schizonticide work on
hepatic stages, think vivax and ovale
44
top 2 DOC for cholorquine resistant malaria
1: artesunate + atovoquone/proguanil 2: artemether-lumefantrine
45
DOC for malaria
Chloroquine
46
mechanism of resistance for cholorquine
transport pump removes drug from parasite
47
MOA of cholorquine
interferes with lysosomal degradation of Hgb leading to parasite toxicity
48
areas of the body where chloroquine accumulates
melanin rich tissues: skin, retina
49
toxicity of chloroquine
retinal and corneal toxicity (high, chronic doses) | hemolysis, QT prolongation, contraindicated in patients with psoriasis and porphyria
50
artemisinins: name the two and what its used for
artesunate and artemether most rapid action of all current drugs against p. falciparum must give with another antimalarial due to short 1/2 life
51
MOA for proguanil and pyrimethamine + sulfadoxine
inhibition of folate metabolism sulfadoxine: inhibits incorporation PABA into folic acid pyrimethamine and proguanil: inhibit DHF to THF
52
relationship of malarone (atovaquone + proguanil)
synergistic
53
MOA of malarone
atovaquone: inhibits mitochondrial ETC and ATP synthesis | proguanil: DHF reductase inhibitor
54
what drug should be combined with malarone
artesunate
55
what drug is lumefantrine combined with
artemether
56
toxicity of lumefantrine
headache and QT prolongation
57
when would you use quinine or quinidine
complicated, chloroquine-resistant plasmodia | combine with doxy, tetra, clinda
58
quinine/quinidine toxicity
cinchonism, antiarrhythmic agent, QT elongation, diarrhea, hemolysis in G6PD deficient patients
59
what would you use to treat complicated, chloroquine-resistant plasmodia in children or pregnant women?
quinine + clindamycin
60
mefloquine toxicity
depression of myocardium, can cause seizures and may aggravate latent psychoses, vivid dreams SHOULD NOT BE USED IN PATIENTS WITH HX OF MENTAL ILLNESS OR EPILEPSY
61
what drug should be used for empirical treatment and preventative intermittent therapy for malaria in pregnant women
pyrimethamine + sulfadoxine+ artesunate
62
what two drugs are tissue schizonticides
primaquine and tafenoquine
63
toxicity of primaquine
contraindicated in patients with SLE or RA, hemolytic anemia (caution for those with G6PD deficiency, avoid in pregnant/breastfeeding women, children < 6 months)
64
tafenoquine, blood or tissue stage?
BOTH
65
contraindications of tafenoquine
patients with G6PD deficiency or unknown G6PD status

Pharmacology (7 decks)

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