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14 Cards in this Set

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drugs for TB
isoniazid

rifampin

pyrazinamide

ethambutol

others: streptomycin, amikacin, fluoroquinolones
Isoniazid
Isonizaid

Class:

MOA: activated by catalase-peroxidase, inhibits long-chain fatty acid reductase involved in mycolic acid synthesis

Use: M. tuberculosis, M. kansasii, prophylaxis and rx

AE: hepatitis (age related, monitor hepatic enzymes).. peripheral neuritis (pyridoxine (B6 def), reversible.. seizures, hematologic toxicity, optic neuritis, hypersensitivity - rash/fever

Contra: avium-intracellulaire

Interaction: potentiate AE phenytoin - nystagmus/ataxia

Admin: oral - impaired with food
Ethambutol
Ethambutol

Class: static

MOA: inhibit cell wall synthesis enzyme

Use: M. tuberculosis, M. avium-intracellulaire - when resistant to other drugs

AE: optic neuritis (dose dependent), impaired color vision (reversible)

Contra:

Interaction:

Admin:
Pyrazinamide
Pyrazinamide

Class:

MOA: metab to pyrazinoic acid by susceptible mycobacteria - lowers pH to level that they can't grow

Use: shortens course of rx - used w/ rifampin, isoniazid (given 1st 2 months)

AE: hyperuricemia, gout, rash, joint ache, hepatitis, hematologic effects

Contra:

Interaction:

Admin:
Rifampin
Rifampin

Class: derivative rifamycin

MOA: inhibit RNA synthesis, initiation step

Use: most mycobacteria, staph, legionella, never use alone, prophylaxis of meningo and H. influenza, leprosy

AE: hepatitis, hypersensitivity reactions, discoloration tears, saliva, urine, GI upset

Contra: hepatic failure - jaundice

Interaction: induce P450 enzymes, decrease t1/2 so need higher doses.. decreases levels of HIV drugs, warfarin, and others

Admin: wide distribution, enterohepatic cycling, biliary excretion
drugs for M. avium intracellulaire
Rifabutin

Azithromycin

clarithromycin

ethambutol

ciprofloxacin
Dapsone
Dapsone

Class:

MOA: inhibit folic acid synthesis, bacteriostatic folate antagonists

Use: long term leprosy rx

AE: G6PD - hemolytic anemia, methemoglobinemia, peripheral neuropathy, erythema nodosa

Contra:

Interaction:

Admin:
Clofazimine
Clofazimine

Class: phenazine dye

MOA:

Use: leprosy - M. tuberculosis, M. leprae, M. avium-intracellulaire, enhances phagocytic activity of neutrophils/macrophages, rx erythema nodosum leprosum (type II hypersensitivity)

AE: accumulated by macrophages, concentrated in liver, lungs, lymph nodes, spleen, other tissues

Contra:

Interaction: highly lipophilic, 55% bioavailable, excreted unchanged in bile and kidneys

Admin:
Thalidomide
Thalidomide

Class:

MOA: stimulate human T cell - CD8+

Use: orphan drug for TB, leprosy, erythema nodosum leprosum

AE: phocomelia (absence of limbs in pregnancy)

Contra:

Interaction:

Admin:
drugs for leprosy
sulfone,

rifampin,

clofazimine,

thalidomide
what do you use to rx tuberculoid leprosy
dapsone + rifampin
what do you use to rx lepromatous leprosy
dapsone + rifampin + clofazimine

consider thalidomide
what do you give to prevent TB in neonates/children < 5 years old who are exposed?
isoniazid for 3 months
what do you give for latent TB?
isoniazid for 9 months

alt: rifampin for 4 months if isoniazid resistant