Tuberclulosis Medications Flashcards Preview

Pharmacotherapeutics I > Tuberclulosis Medications > Flashcards

Flashcards in Tuberclulosis Medications Deck (12):
1

Mycobacterium

Slow growing, rod shaped, unique lipid-ric cell wall aerobe.
Relatively impermeable to many ABX
Mycobacteria can reside inside non-activated macrophages.
Multiple drug tx required

2

Tuberculosis

Transmitted via airborne particles
Leading cause of death world wide
Pulmonary disease that can disseminate

3

Isoniazid (INH)- MOA

Inhibition of cell wall synthesis by inhibiting acid synthesis
Bacteriostatic for stationary phase and bactericidal for rapid dividing phase
Penetrates host cell and drug retained within hose cell longer
Metabolized by N-acetylation and hydrolysis

4

Isoniazid (INH)- Resistance and Adverse effects

No cross resistance to other TB drugs
AE- peripheral neuritis- pyroxidine deficiency
Inhibits phenytoin metabolism and may produce convulsions in seizure prone patients
Hepatitis/hepatotoxicity- most severe and increased with rifampin and daily ETOH

5

Isoniazid (INH)- Black box Warning

Sever and sometimes fatal hepatitis associated with isoniazid therapy may occur & may develop even after many months of tx

6

Rifamycins- Mechanism

Blocks transcription by interacting w. the beta subunit of bacterial DNA-dependent RNA polymerase.
Antimicrobial spectrum- Broader spectrum vs INH

7

Rifamycins- Spectrum of activity

Bactericidal against gram (+) and (-) organisms: used prophylactically in individuals exposed to meningitis.
Rifabutin, analog of rigampin, active against mycobacterium gyium complex, but less active for TB

8

Rifamycin- pharmacokinetics

Oral admin, distribution all body fluids and organs
Induces hepatic mixed-function oxidases increasing its own metabolism and other drugs
Eliminated via feces and urine which may have an orange-red color.
Adverse effects- nausea and vomiting.

9

Pyrazinamide- MOA

Bactericidal
Enters M. tuberculosis by passive diffusion, concerted to pyrazinoic acid by PZase
Inhibits fatty acid synthase I
Accumulates within acidic environment of macrophages monocytes and kills tubercle bacill.

10

Pyrazinamide- Adverse Effects

Liver injury (15%) with jaundice (2-3%), rarely fatal
Get liver function test, do not use if problems

11

Ethambutol

Bacteriostatic
Inhibits cell wall synthesis by inhibiting synthesis of polysaccharides and transfer of mycolic acids to the cell wall.
Helps prevent emergence of RIF resistant organisms

12

Ethambutol- Adverse reactions

Optic neuritis
Results in diminished visual acuity and loss of red/green discrimination
Decreases urate excretion= gout if predisposed.