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27 Cards in this Set
- Front
- Back
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Latent TB infection DOC
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Isoniazid (INH) for 6-9 months
9 months if HIV+ note: twice weekly dosing requires direct observational therapy |
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Latent TB infection alternative tx if resistant to INH
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Rifampin for 4 months
*be careful with HIV+ pts, can interfere with protease inhibitors or non-nucleoside reverse transcriptase inhibitors |
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1st line Anti-tuberculosis drugs for active infection
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(acronym RRRIPE)
Isoniazid Rifampin Pyrazinamide Ethambutol Rifabutin (not approved by FDA for TB use) Rifapentine |
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2nd line Anti-TB drugs for active infection
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Streptomycin
Cycloserine p-Aminosalicylic acid Ethionamide Amikacin or kanamycin* Capreomycin* Levofloxacin Moxifloxacin* (*=not approved by FDA for TB use) |
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Ethambutol (EMB, Myambutol): Indication, MOA, ADE, Interactions
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PO
I: combination tx for 1st 2 months of active TB tx MOA: suppresses mycobacteria multiplication by interfering with RNA synthesis ADE: generally well tolerated; optic neuritis (monthly testing of visual acuity and color discrimination), hematologic, GI, CNS, and cutaneous rxns *avoid in children |
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Isoniazid (INH, Isonicotinic acid hydrazide, Laniazid): route, indication, MOA, ADE, contra, drug interactions
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route: tablets, syrup, or IV/IM
I: for tx of latent TB, or incombination with other drugs for tx of active TB MOA: inhibits mycolic acid synthesis, bactericidal ADE: neurologic (peripheral neuropathy, ataxia, and paresthesia) and hepatic (toxicity); alsourticaria, rash, abdominal pain, n/v, hemolytic anemia, and drug induced lupus syndrome supplement with vit-B6 to prevent neurotoxicity Contra: active liver dz Interactions: inhibits cytochrome hepatic enzyme system (phenytoin, theophylline, warfarin, etc); increased hepatotoxicity with alcohol or rifampin |
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Pyrazinamide (PZA): Indication, MOA, ADE
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PO
I: in combo with other drugs for first 2 months of active TB tx MOA: unknown, may accelerate sterilizing effect of INH and rifampin ADE: GI intolerance, hepatotoxicity, nongouty polyarthralgias, precipitate gouty attacks |
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Rifampin (RIF, Rifadin, Rimactane): route, indication, MOA, ADE, Interactions
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Route: PO or parenteral
I: 1st line for active TB in combination; alternative for latent TB MOA: inhibits bacterial DNA-dependent-RNA-polymerase ADE: (preg cat C) n/v, diarrhea, headache, fever, rash, itching, flushing, flu-like sx, thrombocytopenia, acute hemolytic anemia, red-orange secretions and body fluids; infrequently associated with hepatitis Interactions: Induces cytochrome p450 isoenzyme cyp3a4 (decreases- oral contraceptives, corticosteroids, digoxin, theophylline, warfarin, etc *Should not be given with non-nucleoside reverse transcriptase inhibitors or protease inhibitors, can substitute with rifabutin |
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Rifapentine (RPT, Priftin):
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PO
similar to rifampin but half life is 4x longer Potent enzyme inducer Used once-weekly with INH for HIV (-) adults with drug susceptible noncavitary TB and negative AFB smears at completion of initial tx phase |
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Rifabutin (Mycobutin): Route, Indication, MOA, ADE, Interactions
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PO
I: for TB patients recieving medications that interact with rifampin (ie PIs, or NNRTIs) MOA: inhibits bacterial DNA-dependent-RNA-polymerase ADE: signs of toxicity= arthralgia, uveitis, and leukopenia Interactions: less-potent inducer of CYP3A4, thus doses of PIs or NNRTIs will need to be adjusted; increase rifabutin dose if used with Efavirenz; do not use with delavirdine |
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Empiric tx in non-HIV patients: option 1
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INH, RIF, PZA, and EMB for 2 months (daily, 2, 3, or 5x/week)
followed by INH and RIF for 4 months (daily, 2, 3, or 5x/week) |
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Empiric tx in non-HIV patients: option 2
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INH, RIF, and EMB for 2 months (daily or 5x/wk)
followed by INH and RIF for 7 months (daily, 2, or 5x/week) |
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Empiric tx in HIV patients: Option 1
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INH, RIF, PZA, and EMB for 2 months (daily, 3 or 5x/week)
followed by INH and RIF for 4 months (daily, 3, or 5x/week) |
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Empiric tx in HIV patients: Option 2
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INH, RIF, and EMB for 2 months (daily or 5x/wk)
followed by INH and RIF for 7 months (daily or 5x/week) |
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Fixed dose combinations for non-resistant TB
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Rifamate: INH and RIF
Rifater: INH, RIF, and PZA |
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Agents for drug resistant TB
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Thioamides
Cycloserine PAS Fluoroquinolones Cyclic Peptides Aminoglycosides |
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Cycloserine: Indication, MOA, ADE
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I: 2nd-line drug for resistant TB, can be used in patients with acute hepatitis
MOA: inhibits cell wall synthesis ADE: peripheral neuropathy, CNS dysfunction (depression, psychotic rxns, seizures) |
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Ethionamide: indication, MOA, ADE
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I: 2nd-line for drug resistant TB
MOA: similar structure to INH, inhibits cell wall synthesis ADE: GI (metallic taste, n/v), hepatotoxicity, neurotoxicity, endocrine effects (gynecomastia, alopecia, hypothyroidism, makes diabetes more difficult to manage |
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Streptomycin (SM): Indication, MOA, ADE
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IV/IM
I: 2nd line for resistant TB MOA: inhibits protein synthesis ADE: ototoxicity, neurotoxicity, nephrotoxicity |
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Capreomycin: Indication, MOA, ADE
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IV/IM
I: 2nd line for drug resistant TB MOA: inhibits protein synthesis ADE: nephrotoxicity, ototoxicity |
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p-Aminosalicylic Acid (PAS): indication, MOA, ADE
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I: 2nd line for drug resistant TB
MOA: folate synthesis antagonist ADE: hapatotoxicity, GI distress, malabsorption syndrome, hypothyroidism, coagulopathy |
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Fluoroquinolones (levofloxacin or moxifloxacin): indications, MOA
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I: for use in TB when 1st line not tolerated, or with strains resistant to RIF, INH, or EMB
MOA: inhibits DNA gyrase |
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Protocol if TB resistant to INH
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Rifampin, pyrazinamide and ethambutol for 6-9 months
*may sub rifabutin for rifampin in HIV patients *quinolones added if extensive dz *Streptomycin is an alternative to EMB *patients unable to tolerate PZA can take RIF and EMB for 12 months |
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Protocol if TB resistant to RIF
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INH, PZA, EMB for 9-12 months
*may add SM for 1st 2 months to shorten total tx to 9 months |
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Multidrug resistant TB protocol
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Limited data
*should use at least 4 drugs *tx for 18-24 months |
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Children and Adolescent TB tx
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*use DOT
*if < 15yo tx with 3 drugs in initial phase (INH, RIF, PZA) *EMB not unless INH resistant or "adult-like" TB infection * 3x weekly therapy NOT recomended *duration of 6 months |
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TB tx with Pregnancy
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Initial phase = INH, RIF, and EMB
*Do NOT substitute SM for EMB as SM is a teratogen *PZA not recomended *Continue tx for 9 months |
