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PHARMACOLOGY > TB II > Flashcards

TB II Flashcards

1
Q

What are the side effects of Rifampicin?

A

Nausea, GI disturbances
Discolouration of body fluids
(tears, saliva, urine, faeces) orange/red
Enzyme induction

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2
Q

What pt education will you give the pt regarding taking rifampicin?

A

Must be taken with food

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3
Q

What is a contraindication of Rifampicin?

A

Oral contraceptives

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4
Q

What are the side effects of isoniazid?

A

Peripheral neuropathy (burning / pins & needles in feet & legs)

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5
Q

How can you prevent SE of Isoniazid?

A

Supplement with pyridoxine

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6
Q

What are the side effects of Ethambutol?

A

Optic neuritis
Vision check-ups are NB

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7
Q

What are the side effects of Pyrazinamide?

A

Hepatotoxicity and joint pain

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8
Q

Where is rifampicin metabolised?

A

In the liver
cause autoinduction and potent enzyme inducer

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9
Q

Where is rifampicin eliminated?

A

Primarily biliary-fecal route

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10
Q

Drug interaction with Rifampicin

A

Drug-interactions with drugs
metabolised in the liver
* Oral contraceptives & progestin implants (replace with injectable contraceptives)

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11
Q

Describe distribuution of isoniazid

A

Distribution: wide including the CSF

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12
Q

Explain metabolism of isoniazid

A

Metabolism in the liver via
acetylation (slow acetylators at
greater risk of neurotoxicity)

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13
Q

Excretion of isoniazid

A

Inactive metabolites excreted in the urine

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14
Q

Adverse effects of isoniazid

A

Hepatotoxic
* Neurotoxic (peripheral
neuropathy, seizures, psychosis,
ataxia & optic neuritis)

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15
Q

How to reverse neurotoxic effects of isoniazid

A

Pyridoxime (vit B6)

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16
Q

Drug interactions with isoniazid

A

Drug-interactions with drugs
metabolised in the liver (weak
enzyme inhibitor)

17
Q

When prescribing isoniazid, caution is given in patient with ________________

A

Epilepsy

18
Q

Ethambutol distribution

A

Wide but not in CSF

19
Q

Metabolism of ethambutol

A

Metabolism in the liver up to 15%

20
Q

Ethambutol elimination

A

Mainly unchanged in the urine. Dose adjustment is key, depending on creatinine clearance

21
Q

CI of ethambutol

A

Optic neuritis

22
Q

3 Cautions when prescribing ethambutol

A

-renal failure, in
-children under 8 years (visual
symptoms cannot always be monitored),
-hyperuricaemia

23
Q

Adverse effect of ethambutol

A

Ocular toxicity – patient self
monitoring (reading fine print),
monitor: colour discrimination
and visual field

24
Q

Distribution of pyrazinamide

A

Wide including the CSF

25
Q

Adverse effect of pyrazinamide

A

Dose-related hepatotoxicity
Hyperurecaemia (caused by
decreased uric acid clearance)
associated with arthralgia (may precipitate gout)

26
Q

State 3 wanted outcomes of TB treatment

A

-Prevent TB transmission
* Cure with minimal problems
* Cure with chronic lung disease

27
Q

state 3 unwanted outcomes of TB treatment

A

Transmission of TB
* MDR / XDR
* Death

28
Q

List types of Drug resistant TB

A

Mono-resistant TB
* Poly-resistant TB
* MDR-TB
* Rifampicin resistant-TB (RR-TB)
* Resistance to at least rifampicin
* Extensively drug-resistant TB (XDR-TB)
* Pre-XDR-TB

29
Q

What is MDR TB?

A

In vitro resistance to:
* Rifampicin
* Isoniazid
With or without resistance to other anti-TB drugs

30
Q

XDR TB definition

A

MDR TB
+
* In vitro resistance to:
* Any fluoroquinolone
AND
* Any injectable drug

Extremely difficult and expensive to
treat with a high mortality (90%) in
HIV co-infected patients

31
Q

How to test for isoniazid resistance?

A

Resistance tests:
* inhA mutation and
* katG mutation

32
Q

What to use when there is inhA mutation only?

A

use high dose INH: 10mg/kg/day

33
Q

What to use when there is katG mutation?

A

Use ethionamide

34
Q

T/F: When there is complete resistance (both), use both INH and ethionamide

A

F
Do not use INH or ethionamide

PHARMACOLOGY (30 decks)

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