Ipapburke Pharm2 Test 1- Antimycobacterial

Front 1

Why are mycobacteria infections difficult to treat with antibiotics?

Back 1

slow growing, ability to go dormant, lipid rich cell wall (impermeable), are protected by human macrophages, develop resistance quickly

Front 2

Causative organism in Tuberculosis

Back 2

Mycobacterium tuberculosis

Front 3

Most new US cases of TB

Back 3

AIDS patients or homeless

Front 4

Why is multiple drug therapy standard for TB?

Back 4

due to resistance

Front 5

First line agents for TB

Back 5

Isoniazid, Pyrazinimide, Rifampin, and either Ethambutol or Streptomycin

Front 6

4 drug regime- active or dormant TB?

Back 6

active infection

Front 7

Why is primary TB usually silent?

Back 7

because T cells and macrophages contain organisms

Front 8

What percentage of people with latent infections will develop active TB if not treated?

Back 8

10%

Front 9

Can people with latent infection of TB transmit the disease?

Back 9

no

Front 10

What are the symptoms in Progressive Primary TB?

Back 10

classic symptoms of TB

Front 11

Primary organ involved in TB

Back 11

lungs

Front 12

S/S of TB

Back 12

malaise, anorexia, weight loss, fever, night sweats, chronic cough, blood streaked sputum

Front 13

Complications of active TB

Back 13

lung collapse, pus in lungs, emphysema, pulmonary fibrosis

Front 14

Elements needed for TB diagnosis

Back 14

chest X ray, lab sputum tests, PE, and TB skin test

Front 15

What is considered a positive reaction to the TB PPD?

Back 15

raised area > or equal to 5-15 mm in diameter depending on risk

Front 16

Does a positive PPD indicate active disease or exposure?

Back 16

only indicates exposure

Front 17

What vaccine will give a positive TB test?

Back 17

Bacillus Calmette-Guerin (BCG)

Front 18

What is the goal of TB therapy?

Back 18

eliminate all bacilli from infected individuals without incurring drug resistance

Front 19

What is the major cause of treatment failure and resistance in TB?

Back 19

lack of compliance

Front 20

What is the treatment for latent infection of TB?

Back 20

INH for 9 months; possibly B6 (Pyroxidine)

Front 21

For INH resistance, what medication is used for latent TB infection?

Back 21

Rifampin for four months

Front 22

If there is INH and Rifampin resistance in latent TB, what two drugs are used?

Back 22

PZA and ETH x 6-12 mths

Front 23

When is ETH discontinued in treatment of active TB infection?

Back 23

at 3 months if isolate is INH sensitive

Front 24

For how many months do patients with active infection receive all four drugs in the regimen?

Back 24

for the first 2 months, then ETH is discontinued if INH sensitive

Front 25

What are the considerations in treatment of HIV positive TB patient?

Back 25

same treatment but for a longer period, there will be more drug to drug interactions (antiretrovirals and rifamycin derivatives)

Front 26

In cases of low resistance or INH/RIF susceptible patients, what duration of treatment is usually adequate?

Back 26

6 months is usually adequate but if no conversion at 6 months, tx is continued for 9 months

Front 27

Isoniazid is a synthetic analog of ____________.

Back 27

pyroxidine

Front 28

Use for Isoniazid

Back 28

active TB

Front 29

Shin splints are caused by the irritation of ________________.
This is more common in what muscle?

Back 29

Shapley's fibers
Tibialis anterior muscle

Front 30

MOA of Isoniazid

Back 30

interferes with enzymes responsible for assembly of mycotic acids into the o outer layer of the bacteria

Front 31

Adverse effects of INH

Back 31

peripheral neuritis and hepatitis and idiosyncratic hepatotoxicity

Front 32

Use for Rifampin (Rifadin or Rimactane)

Back 32

TB, leprosy, meningitis, and other bacterial infections

Front 33

MOA for Rifampin

Back 33

inhibits RNA synthesis by suppressing the initiation site

Front 34

What body fluids will you find Rifampin in?

Back 34

all including CNS

Front 35

Adverse Reactions to Rifampin

Back 35

nausea, vomiting, rash, and fever

Front 36

What drug interaction is common with Rifampin?

Back 36

increased phenytoin levels

Front 37

What patients are at risk for peripheral neuritis?

Back 37

diabetic, uremic, malnourished, alcoholics, HIV, pregnancy, and seizure disorder

Front 38

Why do you monitor INH by checking LFTs monthly?

Back 38

hepatitis and idiosyncratic hepatotoxicity are

Front 39

What should you tell patients about the color of their body fluids with the use of Rifampin?

Back 39

their body fluids will be red organ

Front 40

What is the advantage of Rifabutin over Rifampin?

Back 40

same activity and cross resistance, but less induction of the cytochrome P450 enzyme system

Front 41

What caution do you need to take when using Rifampin in the elderly and alcoholics?

Back 41

It may cause tic failure esp. in these populations, so watch for jaundice

Front 42

What is the adverse reaction to Pyrazinimide?

Back 42

hepatotoxicity and may cause gout

Front 43

Use for Pyrazinimide

Back 43

used in active Tb or in latent with Rifampin when there is resistance to INH

Front 44

Adverse effects of Ethambutol (Myambutol)

Back 44

optic neuritis-

Front 45

Standard route for Streptomycin

Back 45

oral not available---it is IM

Front 46

When is the only time that Pyrazinimide can be used in pregnant patients?

Back 46

not used unless documented resistance to other drugs and susceptibility