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42 Cards in this Set
- Front
- Back
what type of therapy do you use for active TB?
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combination therapy
one agent isnt going to work |
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when do you use 2nd line drugs for TB?
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Used for TB strains resistant to 1st line
Generally more toxic and less efficacious |
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What are the first line anti-TB drugs?
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StRIPE drugs
Streptomycin Rifampin Isoniazid Pyrazinamide Ethambutol |
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what are the main drug combination used for therapyof TB?
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RIPE
Rifampin Isoniazid Pyrazinamide Ethambutol |
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What 2 drug combination gives a >95% cure rate in 9 months for TB
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Rifampin
Isoniazid |
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What TB drug helps reduce the treatment duration to 6 months?
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Pyrazinamide
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What TB drug provides coverage for RIF and INH resistance?
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Ethambutol
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What is the MOA for Pyrazinamide?
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it is unknown
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how long does it take for TB to grow?
importance? |
Slow growing
Doubling time >20 hrs hard to treat |
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what happens when you treat TB with one drug?
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you only kill one strain, and then the others emerge and are more resistant
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what is the mainstay drug of therapy for TB?
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Isoniazid
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if you can't use Isoniazid what do you switch to?
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rifampin
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what is the MOA of Isoniazid?
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it is a prodrug...
the active metabolite is catalase-peroxidase INHIBITS THE SYNTHESIS OF CELL WALL OF TB*** |
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What clears Isoniazid?
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the liver-->acetylation
don't have to worry about renal failure or problems |
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What important drug-drug interaction must you consider with use of Isoniazid?
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inhibits CYP 3A4
which can inhibit the metabolism of many drugs need to have therapuetic dose monitoring |
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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 |
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what drug is can claim most frequent major toxic effect?
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Isoniazid
TB Cell wall synthesis inhibitor |
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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?
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drug-induced hepatitis (DEATH)
from isoniazid (TB wall synthesis inhibitor) |
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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 |
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if a pt is having Peripheral neuropathy and CNS toxicity from isoniazid, what should you give them
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Vitamin B6
Causes decrease synaptic neurotransmitter synthesis |
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when do you use Rifampin
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when you can't use Isoniazid
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MOA for Rifampin?
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RNA polymerase inhibitor
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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) |
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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?
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Rifampin causes this
nothing, it is harmless |
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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 |
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what TB drug is most hepatotoxic of the 1st line agents?
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Pyrazinamide
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Hyperuricemia can be seen with what TB drug?
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Pyrazinamide
don't use with gout! |
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what 3 TB drugs are dangerous to the liver?
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RIP
Rifampin Isoniazid Pyrazinamide all standard first line drugs ... all three are hepatotoxic and ‘RIP’ the liver |
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What is the only bacteriostatic 1st line TB drug? What are the others?
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Ethambutol
all the other RIPE drugs are Bacteriosidal |
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what is the mechanism of Ethambutol
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inhibits CELL WALL BIOSYNTHESIS
just know that it does it in a different way than isoniazid, |
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Optic Neuritis is a side effect of what TB drug?
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Ethambutol
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What are the 2 drugs that decrease Uric Acid Excretion?
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Pyrazinamide
Ethambutol |
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when do you use Streptomycin
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Serious/ severe life threatening TB
or drug-resistant |
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how do you administer Streptomycin
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parenterally (IM)
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vertigo and hearing loss (ototoxicity) are side effects of what?
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Streptomycin
can be permanent! |
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nephrotoxicity can be a side effect of what?
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Streptomycin
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toxicity to Streptomycin increases with what?
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age
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MOA for Streptomycin
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protein synthesis inhibitor
Belongs to aminoglycoside class of antibiotic drugs |
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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. |
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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 |
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What do you do if there is INH resistance ?
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stay with 6 months of therapy, but use RIF + PZA + ETB
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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
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