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Terms in this set (22)
MOA: inhibition of mycolic acid synthesis (cell wall synthesis)
Low resistance: Deletion in INHA gene (gene encoding acyl carrier protein (Target)
High resistance: Deletion in katG gene
(encode catalase enzyme needed for INH bioactivation
Hemolysis in G6PD deficiency
SLE in slow acetylators
Why is Pyridoxine (Vit B6) is used with INH?
Helps prevent numbness and tingling that occur secondary to Isoniazid neuritis
Why is Vit B6 contraindicated in Parkinson's disease?
Because it hinders the effect of L-Dopa
MOA: Inhibits DNA-dependent RNA polymerase
Resistance in polymerase enzyme
Red-orange discoloration of urine, sweat and tears
"R" for "red orange discoloration"
MOA: Inhibits synthesis of Arabinogalactan (component of cell wall)
Adverse effects: Loss of red green acuity
"E" for Eye, Ethambutol affects the eyes
Adverse effects: Buzz word: Arthralgia due to hyperuricemia
Increase porphyrin synthesis
Which other disease should you differentiate from the visual side-effects of Pyrazinamide?
MS due to the optic nerve neuritis
MOA: Inhibit protein synthesis
Streptomycin: Hearing loss, ataxia, nephrotoxicity
Kanamycin: Electrolyte abnormalities
Not all aminoglycosides
Adverse effects: Hearing loss, ataxia
No cross resistance with aminoglycosides
Used as 2nd line for Rx of resistant TB with Aminosalicylic acid and cycloserine
Disseminated Mycobacterium Avium Complex (DMAC)
Azithromycin + Rifabutin + Ethambutol
Rifabutin: Similar to Rifampin
Rashes, GI effects
*makes other drugs ineffective
In regards to Purified Protein Derived (PPD) which screens asymptomatic populations, what is considered a positive test?
>10mm of induration (not erythema)
In regards to Purified Protein Derived (PPD) which screens asymptomatic populations, what is considered a negative test?
>5mm with HIV +ve or close contact
What should be done if a patient is HIV positive and they have an induration <10mm?
If pt is HIV positive then any induration counts and should be sent for X-ray
If a patient shows and induration 4 years after BCG immunization, what should be the next step in treatment?
Noting because the induration is solely due to the BCG immunization.
If a patient shows and induration 10 years after BCG immunization, what should be the next step in treatment?
Don't blame it on BCG, you gotta follow protocol and perform a chest X-ray
How long do you treat TB?
4 drugs x 2 months (INH-Rif-PZA-Ethamb) + 2 Drugs x 4 months(INH-Rif)=6 months
*We usually combine INH with Rifampin
Which drug do we usually combine INH with?
A 37 year old Prisonner had cough, fever, sputum, long infiltrate, sputum AFB(acid fast bacillus)+ve. Recommended treatment?
4 drugs x 2 months + 2 drugs x 4 months
How should you handle a patient who is pregnant with PPD?
Chest X-Ray with lead Apron (2nd Trimester)
What should be done if the chest x-ray for the pregnant woman is negative?
Wait until delivery, then INH alone. This is because INH is bad for the baby (teratogenic)
What should be done if the chest x-ray for the pregnant woman is positive?
If positive, do sputum cultures. If the sputum cultures are negative, Rx INH alone. If the sputum cultures are positive, Rx 4 drugs.
Which drugs are used as 2nd line for Rx of resistant Tb with Aminosalicylic acid and cycloserine?
Capreomycin with Aminosalicylic acid and cycloserine
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