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42 Cards in this Set

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what type of therapy do you use for active TB?

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combination therapy

one agent isnt going to work
when do you use 2nd line drugs for TB?
Used for TB strains resistant to 1st line

Generally more toxic and less efficacious
What are the first line anti-TB drugs?
StRIPE drugs

Streptomycin
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
what are the main drug combination used for therapyof TB?
RIPE

Rifampin
Isoniazid
Pyrazinamide
Ethambutol
What 2 drug combination gives a >95% cure rate in 9 months for TB
Rifampin
Isoniazid
What TB drug helps reduce the treatment duration to 6 months?
Pyrazinamide
What TB drug provides coverage for RIF and INH resistance?
Ethambutol
What is the MOA for Pyrazinamide?
it is unknown
how long does it take for TB to grow?

importance?
Slow growing
Doubling time >20 hrs

hard to treat
what happens when you treat TB with one drug?
you only kill one strain, and then the others emerge and are more resistant
what is the mainstay drug of therapy for TB?
Isoniazid
if you can't use Isoniazid what do you switch to?
rifampin
what is the MOA of Isoniazid?
it is a prodrug...

the active metabolite is catalase-peroxidase

INHIBITS THE SYNTHESIS OF CELL WALL OF TB***
What clears Isoniazid?
the liver-->acetylation

don't have to worry about renal failure or problems
What important drug-drug interaction must you consider with use of Isoniazid?
inhibits CYP 3A4

which can inhibit the metabolism of many drugs

need to have therapuetic dose monitoring
what is the most frequent side effect of Isoniazid?

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Drug-Induced Hepatitis

Most frequent major toxic effect (~1%)
Clinical hepatitis – potentially fatal
what drug is can claim most frequent major toxic effect?
Isoniazid

TB Cell wall synthesis inhibitor
you see a pt who is being treated for TB. He has loss of appetitie, nausea, vomiting, and jaundice. What are you worried about? What drug is causing this?
drug-induced hepatitis (DEATH)

from isoniazid
(TB wall synthesis inhibitor)
What makes you more at risk for getting drug induced hepatitis?

what drug causes this?
AGE (older increases risk)

Isoniazid

note: alcohol increases risk too
if a pt is having Peripheral neuropathy and CNS toxicity from isoniazid, what should you give them
Vitamin B6

Causes decrease synaptic neurotransmitter synthesis
when do you use Rifampin
when you can't use Isoniazid
MOA for Rifampin?

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RNA polymerase inhibitor
What is the important drug-drug interaction for Rifampin

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POTENT CYP450 INDUCER

increases the elimination of numerous drugs

(example: contraceptives effectiveness is reduced while using this)
a TB patient comes in and reports that they are currently having a red-orange tint to their urine, sweat, and feces... What caused this? What should you do?

****
Rifampin causes this

nothing, it is harmless
MOA of Rifabutin ?
why do we use Rifabutin? what pts do we use this on? why isn't it the standard?
same as Rifampin: RNA polymerase inhibitor

less impact on P450s

HIV Patients

SUPER EXPENSIVE
what TB drug is most hepatotoxic of the 1st line agents?
Pyrazinamide
Hyperuricemia can be seen with what TB drug?
Pyrazinamide

don't use with gout!
what 3 TB drugs are dangerous to the liver?
RIP
Rifampin Isoniazid Pyrazinamide

all standard first line drugs ...
all three are hepatotoxic and ‘RIP’ the liver
What is the only bacteriostatic 1st line TB drug? What are the others?
Ethambutol

all the other RIPE drugs are Bacteriosidal
what is the mechanism of Ethambutol
inhibits CELL WALL BIOSYNTHESIS

just know that it does it in a different way than isoniazid,
Optic Neuritis is a side effect of what TB drug?
Ethambutol
What are the 2 drugs that decrease Uric Acid Excretion?
Pyrazinamide

Ethambutol
when do you use Streptomycin
Serious/ severe life threatening TB

or drug-resistant
how do you administer Streptomycin
parenterally (IM)
vertigo and hearing loss (ototoxicity) are side effects of what?
Streptomycin


can be permanent!
nephrotoxicity can be a side effect of what?
Streptomycin
toxicity to Streptomycin increases with what?
age
MOA for Streptomycin
protein synthesis inhibitor

Belongs to aminoglycoside class of antibiotic drugs
what is the initial therapy for TB and how long?

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use RIPE

2 months

note * ETB may be discontinued in <2 mo if drug susceptibility testing indicate no drug resistance.
After you have undergone initial therapy for TB what do you use for continuation therapy and how long?

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INH + RIF

4 months
What do you do if there is INH resistance ?

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stay with 6 months of therapy, but use RIF + PZA + ETB
What is Directly Observed Therapy?

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You must physically observe the pts taking their TB medication or you are responsible for the pt and the spread of TB to others