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33 Cards in this Set

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major drugs used in TB
isoniazid, rifampin, ethambutol, pyrazinamide, streptomycin
neurotoxic effects of this drug (peripheral neuritis, restlessness, twitching, insomnia) can be alleviated by pyridoxine
inhibits mycolic acid (inhibits acyl carrier protein reductase), bactericidal for actively growing bacilli
toxic effects of INH?
neurotoxic, hepatotoxic (abnml LFTs, jaundice, hepatitis), P450 inhibitor, induces hemolysis in G6PD def pts, lupus-like syndrome.
metabolism of INH?
hepatic acetylation

("fast" and "slow" acetylators)
what confers resistance to INH?
deletion of katG (catalase-peroxidase that activates INH)

deletions in inhA that encodes target acyl carrier protein reductase
inhibits bacterial DNA-dependent RNA polymerase
DOC for latent TB in INH-intolerant pts?
DOC for meningococcal or staphylococcal carrier states?
side effect if rifampin is given less than twice/week
flulike syndrome and anemia
toxic effects of rifampin?
light chain proteinuria, impaired antibody responses, rash, thrombocytopenia, nephritis, liver dysfxn, induces P450, red/orange body fluids
tx for TB or other mycobacterial infxn in AIDS pts d/t less drug interactions?
MOA of ethambutol
inhibits arabinosyl transferases involved in arabinogalactan synthesis for mycobacterial cell wall
d/t large unmetabolized fraction excreted in urine, this drug requires dose reduction in renal flr
toxic effects of ethambutol?
vision: dec acuity, red-green blindness, optic neuritis, retinal damage
HA, confusion, hyperuricemia, peripheral neuritis
what confers resistance to EMB?
mutation in emb gene when used alone
resistance to PZA?
mutations in bioactivating enzyme and expression of drug efflux systems
toxic effects of PZA?
nongouty polyarthralgia, myalgia, GI upset, rash, liver dysfxn, porphyria, photosensitivity, teratogenic
used primarily for life-treatening tuberculous disease, i.e. memingitis, miliary dissemination, severe organ TB
drug used in streptomycin-resistant or MDR TB, but must be used in combo to avoid resistance
fluoroquinolones that can be jused in conjunction with other drugs for tx of M. tuberculosis
ciprofloxacin, ofloxacin
similar to INH but causes severe GI irritation and neurologic effects
not often used d/t resistance, GI upset, peptic ulceration, hypersensitivity, and effects on kidney, liver and thyroid fxn
P-aminosalicylic acid
not often used d/t ototoxicity and renal dysfxn
not often used d/t peripheral neuropathy and CNS dysfxn
standard regimens for pulmonary Tb in areas w/o resistance?
3-drug (INH + RIF + PZA)

if fully susceptible, continue 4 mo w/ INH + RIF
alternative regimen for fully susceptible pulmonary TB?
INH + RIF for 9 mo
or INH + EMB for 18 mo
what changes must be made to standard regimens if organism is resistant?
INH resistant: initial regimen should include EMB or streptomycin

MDR: 3+ drugs that it is susceptible to for >18 mo, including 12 mo after negative culture
DOC for leprosy?

what else is it used for?

alternative tx for P. jiroveci pneumonia in AIDS pts
toxic effects of dapsone?
GI upset, fever, rash, methemoglobinemia, hemolysis (G6PD def)
drug used for M. leprae that causes red-brown to black skin discoloration
Rx for M. avium infxn?
Azithromycin/clarithromycin + EMB + RIF
Px against M. avium for AIDS pts w/ CD4+ < 50/uL?
clarithromycin/azithromycin +/- RIF