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26 Cards in this Set
- Front
- Back
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What are the goals of therapy?
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kill tuberculi bacilli fast, minimize resistance, sterilize host tissues
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what are the first line TB drugs?
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rifampin, isoniazid, pyrasinamide, ethambutol, streptomycin, two more rifs
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what to know about initial phase?
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mandates 4 drugs regimen upfront!!!!!!!
slows resistance DOT is directly observed therapy... and is used in TB treatment |
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initial phase TB drugs?
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RIPE:
rifampin, iso, pyrasinamide, ethambutol |
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contiuation phase: 4-7 months
when to use 7 months? |
cavitary pulmonary TB whose sputum culture at 2 months of Tx is positive
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rifampin.... whats the MOA? adverse effects?
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inhibits RNA synthesis
HEPATOTOXICITY (potent CYP450 inducer), discoloration of secretions |
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CYP induction order?
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rifampin > rifapentene > rifabutin
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isoniazid... how does it work?
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prodrug; activated by mycobacterium cells; inhibits component of bacterial cell wall.
metabolized by N-acetyltransferase (slow acetylators will have decreased metabolism... fast acetylators will need more drug) |
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INH toxicity?
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hepato!!!! 10-20% will have rises in aminotransferases (becomes addative with other meds, and on INH for a long time)
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INH toxicity besides hepato?
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peripheral neuropathy (dose related... supplement pyridoxine [B6])
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pyrazinamide (PZA) MOA
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MOA unknown, but turned into acid form (active)
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PZA SEs?
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nausea, vomiting
hepatotoxicity, dose-dep elevations in serum uric acid, teratogenicity, non-gouty polyarthralgias |
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ethambutol (EMB) MOA.... SE!! most imp.
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inhibits arabinosyl transferase (decreases cell wall components) SE: retrobullar optic neuritis (bilateral blurry vision, red-green color, dose-dep)
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streptomycin; why has it fallen out of favor?
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high resistance rates, only used if comfirmed suscesptibility
Adverse drug RXN: nephro, oto, vestibular toxicity |
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fluoroquinolones: moxifloxacin, levofloxacin: MOA, ADE
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inhibition of DNA gyrase
not first line because not a lot of data (but maybe someday) CNS, QT prolongation |
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drug interactions with FQs?
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chelation... bind in the gut... etc.
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linezolid, MOA, Adverse RXNS
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50S ribosomal subunit, thrombocytopenia (not able to tolerate for whole course of therapy)
WEAK MONOAMINE OXIDASE INHIBITOR (serotonergic agents) |
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other aminoglycosides... kanamycina and amikacin.. when used?
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only if streptomycin resistant and susceptibility
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capreomycin... what does it do?
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inhibits peptide protein synth.... just like aminoglycosides
adverse events also mimics |
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ethionamide, related to what and adverse effects are what?
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INH and mimics hepatotoxicity and neuropathies, GI (high and leads to non-adherence)
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cycloserine: MOA
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structural analog of d-alanine
second lines: big time SE: CNS BIG TIME---> TREMORS, peripheral neuropathy, supplement B6 |
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Aminosalicylic Acid
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works on folate synthesis like aminoglycosides
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How do you manage GI upset?
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check liver function tests!!! MOst important thing.
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manage rash?
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if minor: antihistamines
if major: stop all meds and reintroduce one by one |
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how to manage hepatitis?
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in absence of symptoms, increase LFT monitoring
if >5x ULN, or >3x ULN with symptoms--> preform workup for alternate causes, when AST decreases... reintoduce meds on by one |
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which drug is avoided in pts with HIV protease inhibitors?
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rifampin
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