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10 Cards in this Set
- Front
- Back
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TB classification:
0, 1, 2, 3, 4, 5 |
0: no exposure, no infection
1: exposure , no infection 2: infection, no disease 3: infection with disease 4: previous disease 5: disease suspected |
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Isoniazid
-MOA -cidal vs. static -metabolism -drug interactions -SE |
-inhibits mycolase synthetase (makes cell wall components)
-only cidal in replicating organisms -hepatic metabolism (slow acetylators have slower metabolism) -inhibits CYP2C9, induces CYP2E1 (acetominophen metabolites) -SE: neuropathy (give pyridoxine, also for OD) -hepatotoxicity ~1% |
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Rifampin
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-inhibits DNA dependent RNA polymerase (binds beta subunit, inhibits transcription)
-SE: rash fever, hepatotoxicity -induces CYP3A and 2D6 (reduces effect of warfarin, OCs, verapamil, antifungals, antiretrovirals -uses: TB (w/INH), prophylaxis for H. inf and N. menin, against S. aureus (w/ B-lactams) -red/orange secretions (along with rifapentine and rifabutin) |
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Rifampin vs. Rifapentine vs. Rifabutin
-MOA -half lives -activity -cross resistance -drug interactions SE |
-all same MOA (inhibit DNA dependent RNAp)
-half life: Rifampin (5hrs) < Rifapentine (13hrs) < Rifabutin (45hrs) -Rifabutin is also active against Mycobacterium avium-intracellulare and used as substitute in TB in HIV infected person on antiHIV meds (instead of rifampin) -all have cross resistance with eachother -all induce CYP enzymes (rifampin is strongest) -SE: rash, orange secretions, neutropenia, leukopenia |
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Ethambutol
-MOA -SE |
-inhibition of arabinogalactan of cell wall
-SE: optic neuritis (visual acuit and colors), hyperuricemia, rash -combined with INH and rifampin in TB |
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Pyrazinamide
-MOA -SE |
-targets fatty acid synthase I gene (mycolic acid synthesis)
-teratogenic, hepatotoxic |
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Streptomycin
-1st or 2nd line agent? -what is it? -MOA -SE |
-second line agent
-aminoglycoside -inhibits protein synthesis (binds 30S ribosomal unit) -ototoxic, nephrotoxic, avoid in pregnancy, NMB |
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Second line agents
1. ototoxic and nephrotoxic 2. use if SM resistant 3. many CNS side effects 4. similar to INH 5. folate antagonist 6. resistant mycobacteria 7. HIV+ pts |
1. streptomycin (SM)
2. capreomycin, amikacin 3. cycloserine 4. ethionamide 5. PASA 6. FQs 7. rifabutin |
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TB regimens
1. PPD+, no disease 2. PPD+, with symptoms |
1. 9mo INH
2. 2mo (INH, rifampin, PZA, with ethambutol or SM) + 4mo (INH and rifampin) |
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When can a TB pt be declared non-infectious?
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-no resistant TB
-received 2-3wks multidrug tx -all close contacts identified -3 consecutive AFB smears |
