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26 Cards in this Set

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