Anti-infective drugs 2

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Neda317
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235882
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Anti-infective drugs 2
Updated:
2013-09-19 20:35:26
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pharm
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Antituberculous Drugs
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  1. name Antituberculous Drugs
    • 1. Isoniazid (INH)
    • 2. Rifampin
    • 3. Ethambutol
    • 4. Pyrazinamide
    • 5. Aminoglycosides
    • 6. Capreomycin
  2. 1. Isoniazid (INH)
    MOA
    Inhibition of mycolic acid synthesis (Cell wall synthesis)
  3. 1. Isoniazid (INH)
    Resistance: high and low
    • High Resitance: Deletion in katG gene
    • encode catalase enzyme needed for INH bioactivation
    • Low resistance: Deletion in INHA gene
    • gene encoding acyl carrier protein (Target)
  4. Isoniazid (INH)
    Adverse Effects:
    • Hepatitis
    • Neuritis
    • Hemolysis in G6PD deficiency
    • SLE in slow acetylators
  5. Why Pyridoxine (Vit B6) is used with INH?
    • Help prevent numbness and tingling that occur
    • secondary to Isoniazid neuritis
  6. Rifampin
    MOA
    inhibits DNA-dependant RNA polymerase
  7. Rifampin
    Resistance
    Mutationin polymerase enzyme
  8. Rifampin
    Adverse Effects:
    • Red-orange discoloration of urine
    • sweat, and tears
    • Proteinuria
    • Flu-like symptoms
    • Thrombocytopenia
    • Induces p450
  9. Ethambutol
    MOA
    Inhibitssynthesis of Arabinogalactan (Component of cell wall)
  10. Ethambutol
    Adverse effects:
    • Loss of red green acuity
    • Retrobulbar neuritis
  11. Pyrazinamide
    Adverse effects:
    • Arthralgia due to hyperuricemia
    • Hepatotoxicity
    • Increase porphyrin synthesis
  12. Aminoglycosides
    MOA
    Inhibit protein synthesis
  13. Aminoglycosides
    Adverse effects buzz word:
    • Streptomycin: Hearing loss, ataxia, nephrotoxicity
    • Amikacin: Nystagmus
    • Kanamycin: Electrolyte abnormalities
  14. Capreomycin
    Adverse effects
    Hearing loss, ataxia
  15. Capreomycin
    Buzz word
    No cross resistance with aminoglycosides Used as 2nd line for Rx of resistant TB with Aminosalicylic acid and cycloserine
  16. name
    Disseminated Mycobacterium Avium Complex
    DMAC
    Azithromycin + Rifabutin + Ethambutol
  17. Rifabutin: Similar to
    Rifampin
  18. Disseminated Mycobacterium Avium Complex
    DMAC
    Adverse effects:
    • Rashes, GI effects
    • Neutropenia
    • Induces p450
    • No Hepatotoxicity
  19. Clinical TB
    TB screening
    • PPD=Purified Protein Derived
    • Screen Asymptomatic Population
  20. TB screening
    What's +ve?
    • > 10mm of induration
    • (not erythema)
  21. TB screening
    What's -ve risk?
    • > 5mm with HIV +ve
    • or Close contact
  22. For anyone PPD +ve
    What you do next?
    Chest X-Ray
  23. if  Chest X-Ray -ve
    Rx INH alone for 6 Months
  24. if  Chest X-Ray +ve
    • Sputum Cultures
    • if +ve --> Rx 4 drugs
    • if -ve --> Rx INH alone for 6 Months
  25. BCG immunization gives only
    3-4 mm induration for 5 years
  26. If after 10 years PPD >10mm induration
    • Don't blame it on BCG
    • You gotta follow protocol
    • Chest X-Ray
  27. How long you treat TB?
    4 Drugs X 2 months (INH-Rif-PZA-Ethamb) + 2 Drugs X 4 months (INH-Rif) = 6 months
  28. How long you treat TB?
    What if HIV +ve?
    • Initial therapy stay the same then increase duration
    • 4 Drugs X 2 months (INH-Rif-PZA-Ethamb) + 2 Drugs X 7 months (INH-Rif)= 9 Months
  29. A 37y/old Prisonner, cough, fever, sputum
    SOB, lung infiltrate, sputum AFB +ve
    • Never answer PPD in a case of TB
    • Answer Rx
    • 4 Drugs X 2 months + 2 Drugs X 4 months
  30. Pregnant with +ve PPD Be careful here
    • Answer Chest X-Ray with lead Apron(2nd Trimester)
    • if -ve ->Wait until delivery Then INH alone bc INH is bad to the baby "Teratogenic"
    • if +ve -> Sputum Cultures if -ve Rx INH alone, if +ve Rx 4 drugs
  31. Side Effects of Isoniazid
    Neuritis
  32. name
    Antiprotozoal
    • 1. Giardiasis: Giardia Lamblia
    • 2.  Amebiasis: Entamoeba Histolytica
    • 3. Trichomoniasis: Trichomonas vaginalis
    • 4. Leishmaniasis: Leishmania Brasiliensis
    • 5. Trypanosomiasis: Trypanosoma cruzi
    • 6. Toxoplasmosis: Toxoplasma Gondii
    • 7. Pneumocystosis: Pneumocystis carinii
    • 8. Malaria
  33. 1. Giardiasis: Giardia Lamblia
    • Most common water born disease
    • Back-packer's diarrhea
  34. Metronidazole Rx for
    • 1. Giardiasis: Giardia Lamblia
    • 2.  Amebiasis: Entamoeba Histolytica
    • 3. Trichomoniasis: Trichomonas vaginalis
  35. 2.  Amebiasis: Entamoeba Histolytica
    Asymptomatic/non-invasive intestinal amebiasis
    Diloxanide
  36. 3. Trichomoniasis: Trichomonas vaginalis
    Rx?
    • Metronidazole
    • Gotta Rx the partner
  37. 4. Leishmaniasis: Leishmania Brasiliensis
    American mucocutaneous leishmaniasis
    Rx?
    Stibogluconate
  38. 5. Trypanosomiasis: Trypanosoma cruzi
    American Trypanosomiasis (Chagas disease)
    Rx?
    Nifurtimox
  39. 5. Trypanosomiasis: Trypanosoma cruzi
    African trypanosomiasis (Sleeping sickness)
    Rx?
    Suramin + Melarsoprol
  40. 6. Toxoplasmosis: Toxoplasma Gondii
    Rx?
    Pyrimethamine + Sulfadiazine
  41. 7. Pneumocystosis: Pneumocystis carinii
    Rx?
    • Trimethoprin-Sulphamethoxazole
    • IV Pentamidine
    • Atovaquone
  42. 8. Malaria
    PlasmodiumFalciparum: Rx?
    Chloroquine
  43. 8. Malaria
    Plasmodium Malariae Rx?
    Chloroquine
  44. 8. Malaria
    Plasmodium Vivax
    Rx?
    Chloroquine + Primaquine
  45. 8. Malaria
    Plasmodium Ovale
    Chloroquine + Primaquine
  46. Prophylaxis for chloroquine-sensitive Malaria:
    • Chloroquine +/- Primaquine
    • Second line: Pyrimethamine-sulfadoxine, Hydroxychloroquine
  47. Prophylaxis for Chloroquine-Resistant Malaria:
    • Mefloquine
    • Second line: Atovaquone-proquanil, Doxycycline
  48. Rx for Chloroquine-Resistant Malaria
    Quinine +/- Doxycycline
  49. Adverse effects of Antimalarial
    Chloroquine:
    Pruritis, ocular dysfunction, hemolysis (Avoid in psoriasis)
  50. Adverse effects of Antimalarial
    Mefloquine
    • Syncope,extrasystoles
    • Avoid in seizure and cardiac arrhythmias
  51. Adverse effects of Antimalarial
    Primaquine:
    • Neutropenia, hemolysis
    • Avoid in pregnancy, G6PD deficiency.
  52. Adverse effects of Antimalarial
    Quinine:
    • Cinchonism, CNS defects, hemolysis
    • Avoid in pregnancy
  53. Intestinal Nematodes: (Worms)
    Rx?
    • Mebendazole
    • Pyrantel pamoate
  54. Mebendazole MOA
    Decrease glucose uptake and microtubular structure
  55. Tissue Nematodes Rx?
    Ivermectin
  56. Cestodes (Tapeworms) & Trematodes (Flukes)
    Rx:
    Praziquantel
  57. Praziquantel
    MOA
    Increase Ca++ influx
  58. Thiabendazole: MOA
    inhibits fumarate reductase
  59. Dibucaine: MOA
    inhibits Na+ permeability
  60. Piperazine: MOA
    Inhibits acetylcholine leading to muscle paralysis
  61. Leprostatic Drugs
    name
    • Dapsone
    • Thalidomide
  62. Dapsone Rx of
    leprosyand dermatitis herpitiformis
  63. Thalidomide:
    FDA approved for Rx of
    Erythema nodosum leprosum
  64. Thalidomide:
    FDA pregnancy category
    • X
    • Physicians should alert male and female patients in effective methods of birth control
    • bc Risk of phocomelia (absent arms and legs)

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