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Flashcards in TB drugs- Allman Deck (52):
1

define multidrug-resistant (MDR) TB

- resistant to at lead INH AND RIF

2

what are MDR patients at high risk for

-treatment failure and further acquired drug resistance

3

what happens to patients with just strain resistant to RIFAMPIN alone

- better prognosis
- increase risk for treatment failure

4

What is extensive drug Resistant (XDR) TB

-MDR TB plus resistance to FQN
-AND resistant to at least one other of the 3 injectable drugs
- amikacin
- kanamycin
-capreomycin

5

what defines therapeutic failure

positive sputum coherent scattering after 4 months of compliant therapy

6

what is the dosing guideline for TB drugs

- daily dosing
- twice or thrice weekly dosing
-Directly observed therapy

7

MOA for Rifampin

inhibits DNA-dependent RNA polymerase
- suppression of initiation of chain formation in RNA synthesis

Bactericidal: kills slow-growing mycobacteria present within macrophages and in caseating granulomas

8

where is Rifampin distributed

CNS
tuberculosis abscesses
intracellular sites

9

How is Rifampin metabolized

deacetylation
-autoinductin of metabolism occurs
-Rifampin Revs up Liver

10

3 major adverse effects of Rifampin

- transient elevation in serum transaminases
- hepatotoxicity
- orange discoloration ( sweat, tears, urine)

- Rifampin revs up and red

11

Drug interaction of Rifampin

- increase in cytochrome P-459
- increases metabolism of
- warfarin
- narcotics
- steroids ( oral contraceptives)

12

place in therapy: Rifampin

-treats active TB
- 2nd line agent for preventative therapy

13

MOA for Isoniazid ( INH)

inhibits synthesis of mycolic acid

14

metabolism of Isoniazid

acetylation

15

Rate of acetylation of Isoniazid depend son what

genes: can be slow or rapid acetylator

16

Adverse effects of Isoniazid

-transient elevation in serum transaminases
- hepatotoxicity
- Neurotoxicity

17

who is neurotoxicity seen in with Isoniazid, treatment?

- alcoholics, homeless
- Pyridoxine ( B6)

18

MOA for Pyrazinamide

- not well known
- toward dormant organism

19

Adverse effects of Pyrazinamide

Hepatotoxicity
hyperuricemia : decreased renal excretion of uric acid, bad for gout patients

20

MOA for Ethambutol

not well known
bacteriostatic

21

how is Ethambutol excreted

urine

22

Adverse effects of Ethambutol

optic neuritis ( retrobulbar neuritis)
-decrease visual acuity and red-green color blindess

23

Ethambutol should be used with caution in what patient group

children

24

MOA for Streptomycin

Aminoglycoside antibiotic
- inhibit protein synthesis

25

how is streptomycin absorbed and administered

poorly absorbed in GI tract
- given IM or IV

26

Adverse effects of Streptomcin

nephrotoxicity
impairment of 8th cranial nerve function

27

which is better ethambutol or streptomycin

ethambutol

28

when can you not give rifabutin

- unacceptable interactions with Rifampin
- or intolerance to Rifampin

29

Adverse reactions for Rifabutin

rash
GI
NEUTROPENIA

30

who can receive Rifapentine

HIV negative
- non-cavitary, drug susceptible pulmonary tuberculosis

31

what is the most widely used antilieprosy agent

Clofazaime

32

MOA of Clofazaomine

binds preferentially to mycobacterial DNA causing inhibition of transcription

33

Adverse effects of Clofazamine

- GI
- severe and life threatening abdominal pain and organ damage caused by crystal deposition
- discoloration of skin and eyes

34

how long is general treatment for TB

6 months

35

how long is treatment for osteo/miliary/meningitis

12-24 months

36

if a TB patient has renal failure what should you avoid

Streptomycin
Kanamycin
Capreomycin

37

TB children should avoid what medicine

Ethambutol

38

when is suspected treatment failure seen

- lack of clinical progression 6-8 wks into therapy
- add 2 or more new TB agents

39

treatment for Mycobacterium leprae should include

Dapsone
Rifampin
Clofazimine
DR. C

40

MOA for Dapsone

competitive inhibitor of folic acid synthesis

41

what are 2 major categories for Leprosy

1. lepromatous - disseminated
2. Tuberculoid - localized

42

How is leprosy transmitted

prolonged contact

43

how long is drug course of leprosy

2-5 years

44

what are symptoms for MAC

fever
night sweats
weight loss
anemia

45

Who does MAC usually occur in

HIV less than 100 CD4

46

when is primary prophylaxis recommended for HIV MAC

CD4 less than 50

47

How do non-HIV patients present with MAC

in lungs
chronic productive cough

48

prophylaxis regimen for MAC

Clarithromycin
Azithromycin
Alternative Rifabutin if above2 not tolerated

49

Treatment regimen for MAC

at least 2 agents
- Clarithromycin or Azithromycin plus Ethambutol
- consider adding one of the following: Clofazamine, Rifampin, Rifabutin or Cipro

50

how long is RIPE regiment

6 months total
- 2 months RIPE
- 4 months RI

51

how long is RIP regiment

6 months total
- 2 months RIPS
- 4 months RI

52

which drug is more active against MAC

Clarithromycin