TB treatment

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Author:
jcu1
ID:
204723
Filename:
TB treatment
Updated:
2013-03-03 23:23:38
Tags:
Gillis
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Description:
ID exam 2
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  1. drugs to treat TB
    • rifampin
    • isoniazid
    • pyrazinamide
    • ethambutol
  2. rifampin MOA
    • interacts with beta-subunit of DNA dependent RNA
    • inhibits mRNA transcription and therefore protein translation
  3. rifampin type of bacteria killed
    • slowly kills non-replicating persistent bacteria
    • "Semi-dormant" population
  4. rifampin dose adjustements
    none
  5. rifampin hepatotoxicity
    • yes
    • transient asymptomatic hyperbilirubinemia
  6. rifampin other AEs
    • CYP inducer
    • orange discoloration of bodily fluids
    • pruritis w or w/o rash - self limiting
    • Flu-like syndrome (intermittent dosing)
    • thrombocytopenia, thrombocytopenia purpura, hemolytic anemia
    • acute renal failure
  7. Isoniazid MOA
    • prodrug - activated by KatG
    • inhibits mycolic acid synthesis
  8. isoniazid type of bacteria killed
    • bacterial in log-phase growth
    • bactericidal
  9. isoniazid dose adjustements
    none
  10. isoniazid hepatotoxicity
    • yes
    • aminotransferase elevation
  11. isoniazid AEs
    • CYP inhibitor
    • peripheral neuropathy - dose related (pyroxidine to prevent)
    • dysphoria, seizures, irritability
    • hypersensitivity (rash, fever, SJS)
    • monoamine (histamine/tyramine) poisoning
    • Lupus like syndrome
  12. pyrazinamide MOA
    • prodrug - activated by pyrazinamidase
    • inhibits fatty acid synthase I (FAS I)
    • binds to ribosomal protein S1 (RpsA) --> inhibits protein translation
  13. pyrazinamide bacterial killed
    • kills slowly replicating bacteria
    • dormant or semi-dormant populations in macrophages
    • bacteriostatic
  14. pyrazinamide dosing
    fixed dose and frequency by IBW
  15. pyrazinamide dose adjustments
    • yes
    • CrCl <30 ml/min
  16. pyrazinamide hepatotoxicity
    yes
  17. pyrazinamide AEs
    • GI upset
    • nongouty polyarthralgia (use NSAIDs)
    • asymptomatic hyperuricemia
    • acute gouty arthritis (rare)
    • rashes
  18. ethambutol MOA
    inhibits arabinosyl transferase --> disrupts arabinogalactan synthesis --> inc cell wall permeability
  19. ethambutol bacteria killed
    • kills actively growing organisms
    • bacteriostatic
  20. ethambutol use
    used when INH resistance is unknown or present to prevent RIF resistance

    can d/c if INH susceptible
  21. ethambutol dose adjustments
    • yes
    • CrCl <30 ml/min
  22. ethambutol dosing
    fixed dose and frequency by IBW
  23. ethambutol hepatotoxicity
    no
  24. ethambutol AEs
    • retrobulbar neuritis (red-green color blindness, dec visual acuity)
    • peripheral neuritis - rare
    • rash - d/c if this happens
  25. definition of MDR TB
    resistant to RIF and INH
  26. definition of XMDR TB
    • resistant to RIF and INH plus
    • any FQ plus
    • resistance to one of the following:
    • ---amikacin
    • ---kanamycin
    • ---capreomycin

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