Antibiotics for TB and Leprosy
Terms
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- Name first line antibiotcs
- Isoniazid, Rifampin, Pyrazinamide, Ethambul & Streptomycin.
- Name second line antibiotics.
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Para-aminosalicycic acid, capreomycin sulfate, cycloserine, ethionamide, kanamycin, amikacin, & quinolones(ciprofloxacin & olfloxacin)
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How does Isoniazid work and what are it's effects?
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Oral/IN/IV, penetrates into fluids & tissues, metabolized in liver by acetylation, excreted in urine with pyrodoxine (vitamin B6) ? Interferes w/the production of the mycolic acid component of cell wall in TB.
Effects – Hepatotoxicity increases the chance of hepatitis (chances increase w/age and alcohol). Also B6 deficiency.Pellagra(peripheral neuritis, rash and anemia)
- What does Rifampin cause?
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All body fluids like urine & saliva turn bright red-orange; not harmful.
- How does Rifampin work?
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Oral/IV, penetrates, metabolized via microsomal oxidase system(increasing it's own metabolism),& excreted via liver. Stops the DNA- dependent RNA polymerase.
- Besides TB and leprosy, what other disease is Rifampin given to?
- Meningitis
- To what diseases is Rifampin second line for?
- Legionella Pneumophila & Ehrlichia
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What antibiotic cannot be given for more than 2 months and why?
- Pyrazinamide because it causes hepatotoxic & gout(arthritis of the [big] toes)
- How does pyrazinamide work through the body?
- It is unknown.
- How is Ethambul different from the other first line drugs?
- It's bacteriostatic which means it stops the disease but wont't kill it.
- Pharmokinetics of Ethambul.
- Oral, can cross blood/brain barrier & renal excretion.
- Ethambul can be used for kids?
- False
- What are the effects of Ethambul?
- Decreased visual acuity, color vision loss, and loss of central vision(central scotoma)
- What is the mechanism of action of Streptomycin?
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Binds to 30S ribosomal subunit and prevents protein synthesis.
- What is Streptomycin?
- Aminoglycoside
- What are the effects of Streptomycin?
- Vestibular & Ototoxic(ears & nerves)
- How are second line drugs used?
- When multidrug resistant Mycobacterium Tuberculosis appears
- What are the symptoms of Active TB?
- fever, cough,& night sweats (2 months)
- What is the 6 month regimen of Active TB?
- 2 months of isoniazid, rifampin & prazinamide; followed by 4 months of isoniazid & rifampin
- What is the 9 month regimen of Active TB?
- 9 months of isoniazid and rifampin.
- What does PPD stand for?
- purified protein derivative
- What does it mean when a person has ppd?
- They have a latent Mycobacterium Tuberculosis that develop a reactivation tuberculosis
- What is the two treatments for PPD reactors and why do they differ?
- Isoniazid alone for 6-12 months (prophylactic therapy).Rifampin & Pyrazinamide for 2 months has a high rate of non-compliance
- What must be taken into account before treating PPD Reactors?
- Risk of developing isoniazid-induced liver injury VS. Risk of developing reactivation TB
- Who has a higher risk of developing Isoniazid Hepatitis?
- Alcohol consumers & people over the age of 35
- What percentage do 20 years or younger people have of developing isoniazid hepatitis?
- No percentage just very rare
- What percentage do people 20-34 years of have of developing Isoniazid Hepatitis?
- less than .3 percent
- What percentage do people 35- 49 years of age have of developing Isoniazid Hepatitis?
- less than 1.2 percent
- What percentage of people over the age of 50 have a risk of developing Isoniazid Hepatitis?
- 2.3 percent
- What increases a persons chance of having reactivation TB?
- PPD conversion, fibrotic scars on chest XR, exposure to someone with active TB and being immunosuppressed
- What is another name for the PPD test?
- Tuberculin Test
- How does the PPD test work?
- A tuberculin reaction is classified as positive based on the diameter of the induration in conjunction with certain patient-specific risk factors.
- What is a normal PPD test?
- 15 millimeters
- Who are the people who are at the greatest risk of Reactivation TB?
- People with a PPD test lower than 5mm, people with HIV, fibrotic changes in the XR & people who come in close contacts with people with TB.
- If the PPD test is negative who should still be treated and for how long?
- Kids for three months.
- Who is at moderate risk of Reactivation TB?
- People with a PPD less than 10 mm, peoplw who with medical conditions that lower their immune system(diabetes & renal failure),people with recent skin conversion w/in 2 years & people who inject drugs.
- What people are at at lesser risk of Reactivation TB?
- People 35 and under with a PPD less than 10, homeless, prisoners, nursing homes and foreign born with a prevalence of TB.
- What people have been exposed to Isoniazid Resistant organisims?
- People from Africa, Asia and South America; homeless or others
- What should be done is Isoniazid resistance is suspected?
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4 or more first line drugs should be used; Never add just a single drug always add two.
- What happens in hepatotoxicity?
- Enzymes that are injured leave the liver and into the blood
- How do all TB antibiotics work?
- All penetrate into most tissue and reach caseous granulomas (infected area)
- What are some symptoms of TB antibiotics? Name 5
- Nausea,vomiting, abdominal pain, loss of appetite, diarrhea, feeling tired or weak, jaundice & hepatomegaly
- What is used to treat Leprosy?
- Sulfones which are Dapsone & Sulfoxone.
- What is the mechanism of action of Sulfones?
- Block dihydrofolic acid(DFH) synthesis, precursor to tetrahydrofolic acid(TH4);therefore killing bacteria
- What are the effects of Sulfones?
- Skin rash, drug fever & agranulocytosis(infection vulnerability)
- What two other drugs are used for leprosy?
- Rifampin & Clofazimine
- What is the mechanism of action of Clofazimine?
- It binds to DNA and is anti inflammitory for leprosy reactions?
- What are the effects of Clofazimine?
- Since it's a red compound it turns the body parts where there's leprosy lesions tan, black and/or red.
- How many people develop Leprosy reactions?
- 50%, 1/2, half
- What causes these reactions in leprosy?
- It's an immune mediated response to the increase in dead organisms due to the treatment.
- During what time does type 1 leprosy reaction occur?
- During the 1st year of treatment
- What is the name of type 2 leprosy reaction?
- Erythema Nodosum Leprosum
- What are the symptoms of type 1 leprosy reaction?
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Skin lesions swell, accumulate fluid, ulcerate and neuropathy
(sensory or motor nerve loss) - What is the treatment for type 1 reaction leprosy?
- Prednisone or Clofazimine
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What is type 2 leprosy reaction?
- A painful nodular rash erupts in a previously normal area of skin, along with high fever, neuropathy, orchitis, arthritis, iritis & lymphadenopathy.
- What three drugs can be used for type 2 leprosy reaction?
- Prednisone or Clofazimine but most of the time THALIDOMIDE
- What diseases is type 2 leprosy reaction associated with?
- Borderline Leproatous & Lepromatous Leprosy
- What two drugs should pregnant women avoid?
- Pyrazinamide & Streptomycin
- Which drug for leprosy develops a quick resistance?
- Sulfones
- Pyrazinamide is related to _________.
- Nicotinamide
- What type of bacterium is TB & Leprosy?
- Mycobacterium
- Why is Thalidomide accepted in the U.S?
- It has a potent teratogen