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22 Cards in this Set

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Regarding treatment of tuberculosis, list the first line of drugs in order of their frequency.
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
Streptomycin
Regarding tbc, what are the 2 types of populations one may see?
1. Those with active tbc
2. Those with reactive PPD skin test, representing a latent infection
a patient with active pulmonary or extra pulmonary tbc should receive a 6 month or 9 month treatment. TRUE/FALSE
TRUE.
What is treatment of PPD reactors?
These persons may have latent M. tbc in their bodies and might develop a reactivation tbc. treatment of PPD reactors is preventitive. Isoniazid is used alone for 6-12 months as prophylactic therapy.
These drugs do carry risks. Decision to treat should be weighed regarding severity.
Advancing age and alcohol consumption increase the risk of developing hepatitis from isonizid. TRUE/FALSE
TRUE. Under the age of 35, there is virtually no risk of developing hepatitis with isoniazid.
Which group represents the greatest risk of reactivation?
Persons with HIV
Those with fibrotic changes on chest X ray
Close contact with persons with newly diagnosed active tbc.
Who represents moderate risk?
Treat these persons at any age if PPD is = or > 10mm.
Do all tbc drugs cause hepatotoxicity?
Isoniazid/ Rifampin/Pyrazinamide are of concern. Mild elevations of liver enzymes can be expected to occur in 15-20% of patients on isoniazid.
All are orally absorbed.
All penetrate into most tissues.
isoniazid interferes with the biosynthesis of the mycolic acid component of the cell wall of Mycobacteria. TRUE/FALSE
TRUE.
can Isoniazid cause peripheral neuropathy?
Yes. It increases the urinary excretion and depletion of pyridoxine(Vit B6) which is needed for proiper nerve function.
Are there any visible effects of Rifampin?
Yes. Body fluids such as urine, feces, saliva, sweat and tears are colored a bright red orange.
How does Rifampin work/
It inhibits the DNA dependent RNA polymerase of the Mycobacterium tbc.
Can Rifampin effect the function of other drugs?
Yes. It induces the cytochrome P450 enzyme system(microsomal oxidase system), so many other drugs are gobbled up by the spruced up MOS. Certain drugs will have reduced half lives.(anticonvulsants and Coumadin and oral contraceptives are in this group)
What is Rifabutin?
It is similar to Rifampin in structure and antibacterial structure. It is used in the treatment of M. avium intracellulare.
What are the adverse effects of Ethambutol?
It is dose dependent reversible ocular toxicity(scotomata-loss of central vision)
What is Streptomycin?
It is an Aminoglycoside which inhibits protein synthesis at the 30S ribosomal subunit and is given IM or IV. It is ototoxic and nephrotoxic.
What is Rifamate?
It is a fixed dose combination of isoniazid and rifampin.
Rifater-(isoniazid/ rifampin and pyrazinamide).
What are second line drugs/
These can be used when multiple antibiotics are needed for the treatment of multidrug resistant M. tbc.
Para-aminosalicylic acid
capreomycin
Cycloserine
Ethionamide
Kanamycin
Amikacin
Quinolones.
Severe cases of leprosy should be treated with Rifampin, dapsone and Clofazimine for a minimum of 2 years and until patients are acid fast bacilli negative. TRUE/FALSE
TRUE.
What is Clofazimine?
It works by binding to the DNA of M. leprae. It also has anti-inflammatory actions as well. It may cause red skin blotches.
What is a Type 1 leprosy reaction?
Occurs in borderline patients, and occur during the first year of treatment. It is adelayed hypersensitivity reaction to the dead bacilli. It is important that anti leprosy drugs not be withdrawn even if a reaction occurs.
What is Type 2 reaction of leprosy?
Erythema Nodosum leprosum, is associated with borderline leprosy and Lepromatous leprosy.
This involves the deposition of immune complexes in tissues followed by complement activation.
treatment of choice is Thalidomide. This is the only condoned use, considering it is a potent teratogen.