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34 Cards in this Set
- Front
- Back
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What are the 5 major drugs used to treat tuberculosis?
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isoniazid (INH)
rifampin ethambutol pyrazinamide streptomycin |
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What drug is INH?
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isoniazid
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What is INH related structurally to?
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pyridoxine
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What is the MOA of isoniazid?
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inhibition of mycolic acids which are components of the cell wall
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What is the main mechanism of resistance to INH? What is the other mechanism?
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1) katG gene mutation that encodes for a catalase-peroxidase which activates INH
2) low level resistance via inhA gene deletions that encodes the target enzyme of INH |
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Is INH bactericidal or static?
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cidal for growing organisms and less for dormant organisms
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Which ethnic groups are fast acetylators?
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asian origin and native americans
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What is the most important drug used in the treatment of TB?
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INH
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What are the side effects of isoniazid?
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1) peripheral neuritis, restlessness, muscle twitching, insomnia
2) hepatoxicity, jaundice, hepatitis 3) hemolysis in people with G6DP |
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What is given to alleviate the toxic effects of INH?
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pyrodoxine
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What is the MOA of rifampin?
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inhibits DNA dependent RNA polymerase
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What anti-tuberculosis drug can be used to treat MRSA and PRSP?
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rifampin with vancomycin
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What drug causes light chain proteinuria and may impair antibody responses?
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rifampin
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What are the toxic effects of rifampin?
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1) skin rashes
2) thrombocytopenia 3) nephritis 4) liver dysfunction 5) anemia and flu like symptoms if taken less often |
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What is rifabutin?
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it is related to rifampin but does not have the toxic effects and is preferred in aids
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What drug inhibits arabinosyl transferases which synthesize arabinogalactan in the TB cell wall?
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ethambutol
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Which drug causes dose dependent visual changes? What are the changes observed? What are other toxic effects?
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1) ethambutol
2) decreased visual acuity, red-green color blindness, optic neuritis and retinal damage 3) peripheral neuritis, headache, confusion, hyperuricemia |
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Is pyrazinamide bacteriostatic or cidal?
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bacteriostatic
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What is the mechanism for resistance to pyrazinamide?
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efflux pumps and gene mutations
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What are side effects associated with pyrazinamide?
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1) nongouty polyarthralgia
2) hyperuricemia 3) myalgia 4) maculopapular rash 5) hepatic dysfunction 6) porphyria 7) photosensitivity |
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Can pyrazinamide be given during pregnancy?
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no
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What aminoglycosides can be given to treat TB?
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1) streptomycin but resistance is growing
2) amikacin when resistance to streptomycin is present |
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What 2nd generation fluoroquinolones can be used to treat TB? when are they used?
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1) ciprofloxacin and ofloxacin
2) when resistance to 1st line agents is present |
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What is the standard regime for TB in areas where <4% resistance to INH is seen?
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3 drug regimen: INH, rifampin, and pyrazinamide
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If >4% resistance to INH is seen in an area what is the drug regimen?
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initial regimen should contain ethambutol or streptomycin and rifampin, and pyrazinamide
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What are sulfones used to treat? What are drugs in this class?
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1) leprosy
2) dapsone and acedapsone |
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What is the primary drug to treat leprosy?
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dapsone
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What is the MOA of dapsone?
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inhibits folic acid synthesis
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Dapsone is generally not taken alone. What should be taken with it?
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rifampin or clofazimine
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Someone develops fever, skin rashes and methemoglobinemia. What mycobacterial drug might they be on?
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dapsone. it also causes hemolysis in G6PD people
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Which antimycobacterial drug can be used to treat pneumocystis jiroveci?
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dapsone
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What are side effects of clofazimine?
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skin discoloration ranging from red-brown to nearly black
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What is the recommended prophylaxis regimen against M avium in someone with a CD4 count <50
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clarithromycin or azithromycin with or without rifabutin
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To treat M avium what is used?
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azithromycin or clarithromycin with ethambutol and rifabutin
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