David's Antimycobacterials

Front 1

Mycobacteria motility? Encapsulation? Spores?

Back 1

non-motile. Non-encapsulated. No spores for you.

Front 2

What about the cell wall of mycobacteria makes it hardy?

Back 2

lipid rich

Front 3

Most common toxicity associated with anti-TB agents?

Back 3

hepatitis (for primary, GI for secondary)

Front 4

Prophylaxis?

Back 4

exposure to TB with positive skin test if patient < 35 yo -> isoniazid therapy

Front 5

Who requires therapy with first line agents?

Back 5

positive x-ray and/or positive smear from mycobacterium

Front 6

First line agents?

Back 6

Isoniazid, Rifampin, Pyrazinamide, Ethambutol

Front 7

Second line agents?

Back 7

Ethanionamide, Ciprofloxacin, PAS (para amino salicyclic acid), Capreomycin, Moxifloxicin, Levofloxicin, Streptomycin

Front 8

Pregnancy should avoid what agents?

Back 8

Quinolones (Ciprofloxacin, Ofloxacin), Aminoglycosides (Streptomycin), Pyrazinamide, Ethionamide

Front 9

Agents safe for pregnancy?

Back 9

INH, Rifampin, Ethanbutol

Front 10

Agents for TB meningitis? What agent is not recommended in children with TB?

Back 10

Pyrazinamide, Isoniazid, Ethionamide. Ethanbutol is not recommended for children with TB

Front 11

Isoniazid distribution? Bacteri-? Exceretion?

Back 11

all body fluids including CSF. 2) Bactericidal to TB. 3)acetylated in liver, excreted in urine (slow acetylators risk hepatitis)

Front 12

Isoniazid MOA?

Back 12

Inhibits parahydroxylation of phenytoin (careful if both drugs are being used)

Front 13

Special additional Rx for Isoniazid?

Back 13

Pyridoxine should be given too for malnourished, elderly, pregnant, diabetics, or alcoholics.

Front 14

Rifampin/Rifabutin Bacteri-? 2) MOA? 3) excretion

Back 14

Bactericidal to both intra/extracellular TB. 2) Binds to the beta-subunit of DNA-dependent RNA polymerase -> blocks RNA synthesis -> effective against other bacteria. 3) liver -> bile

Front 15

Which rifamycin is effective against MOTTS?

Back 15

Rifabutin

Front 16

Rifampin/Rifabutin adverse effects (4)

Back 16

1) Orange color to secretions. 2) Hepatitis. 3) Thrombocytopenia. 4) rash

Front 17

Rifampin/Rifabutin decrease t1/2 for what 4 drugs? Decrease effectiveness of what else?

Back 17

1) prednisone. 2) digitoxin. 3) ketoconazole. 4) propranolol. Also decreases effectiveness of oral contraceptives

Front 18

Rifamate?

Back 18

Rifampin + Isoniazid

Front 19

What disease is one of the rifamycin contraindicated? What should be done?

Back 19

Rifampin is contraindicated in HIV patients taking protease and NNRT inhibitors -> use rifabutin instead since it's less potent inducer of P450s

Front 20

Ethambutol MOA? What side effect does this cause? Bacteri-?

Back 20

1) Blocks arabinosyl transferase (cell wall synthesis). 2) Destabilizes drugs allowling lipophilic drugs in (Rifampin). 3) Bacteriostatic against TB

Front 21

Ethambutol distribution? Excretion? Adverse effect?

Back 21

1) synthetic, water soluble, penetrates CSF poorly unless inflamed. 2) 50% in the urine and accumulates in renal failure. 3) Visual disturbances -> red-green color blindness -> contraindicated in children

Front 22

Streptomycin MOA? Bacteri- against what/why? Excretion?

Back 22

1) Aminoglycoside and irreversible inhibitor of protein synthesis (30S). 2) Bactericidal for extracellular TB since weakly taken up by cells. 3) Glomerular filtration so can be nephrotoxic

Front 23

Streptomycin adverse effects (2)? MAC?

Back 23

1) Ototoxicity (hearing loss, vertigo). 2) Other aminoglycosides like Amikacin are more active against MAC and other rapidly growing mycobacteria

Front 24

Pyrazinamide analog of? Effective for? Bacteri-what/when? Excretion?

Back 24

1) Analog of nicotinamide. 2) Intracellular organisms -> sterilizing agent. 3) Bactericidal for TB at acidic pH (inside macrophage). 4) glomerular filtration but the adverse effect is hepatitis (first line)

Front 25

Ethionamide related to what? Bacteri-? Adverse effects (2)?

Back 25

INH, blocks mycolic acid synthesis. 2) Bacteriostatic. 3) GI and neurologic symptoms

Front 26

Para-Aminosalicylic Acid similar to what? 2) Implication? 3) Bacteri-? 4) Distribution?

Back 26

1) PABA. 2) Inhibits folate synthesis. 3) Bacteriostatic. 4) most body fluids

Front 27

Quinolones (Ciprofloxacin, Ofloxacin) MOA? Activity (3)? Most common side effect?

Back 27

1) Blocks DNA gyrase. 2) TB, MAC, M. fortuitum. 3) GI

Front 28

Clarithromycin/Azithromycin are bacteri-? 2) Activity? 3) Absorption?

Back 28

1) Bacteriostatic. 2) MAC and rapid growers. 3) GI absorption with oral delivery

Front 29

Dapsone related to? 2) Excretion? 3) Side effects (4)? 4) Often used in combo with what for what? 5) note about safety?

Back 29

1) Sulfonamides. 2) urine. 3) hemolysis, anemia, nausea, vomiting. 4) With Rifampin for M. leprae. 5) safe to administer for a period of years

Front 30

Clofazimine MOA (2)? Bacteri-what against what, and activity against two other things? 3) side effect

Back 30

1) Phenazine dye that may alter DNA function. Also acts as anti-inf so prevents erythema nodosum leprosum. 2) Weakly bactericidal against M. leprae. Also has activity against MAC and M. ulcerans. 3) Red-black discoloration of skin may develop - eosinophilic enteritis

Front 31

R207910 is a what? 2) MOA. 3) Bacteri-? 4) Use? 5) administration? 6) clearance?

Back 31

1) Diaryl quinalone. 2) Blocks proton-pump of ATP synthase. 3) Bactericidal, extremely so. 4) resistant organisms. 5) oral with long dosing interval (173h). 6) cleared by kidneys but metabolized to glucuronide and sulfate conjugages (excreted unchanged in urine and feces)

Front 32

PA-824 is effective against what? Not against? Describe action?

Back 32

latent form of TB. 2) M. leprae. 3) Under anaerobic conditions, aromatic nitro group on FAD is interacted with causing buildup of NO = "bomb blast from within"

Front 33

MOTT infectious? Vector? Resistance?

Back 33

Not very infectious, primarily opportunisitic by environmental organisms. Usually resistant to drugs used to Tx TB

Front 34

Name 2 rapidly growing mycobacteria. Usually the cause of? Active agents (3)

Back 34

1) M. fortuitum, M. chelonae. 2) Chronic wound infectious. 3) Amidacin, Cephalosporin, Imipenem

Front 35

To Tx M. leprae, Dapsone is often administed with one of what two drugs? Excretion? Toxicity?

Back 35

1) Rifampin or Clofazimine. 2) bile. 3) hemolysis with methemoglobinemia

Front 36

MOA by 1) inhibition of cell wall synthesis. 2) Inhibition of RNA polymerase. 3) inhibition of protein synthesis.

Back 36

1) Isoniazid and Ethambutal. 2) Rifampin, Rifabutin. 3) Aminoglycosides, Clarithromycin, Azithromycin