Anti TB meds
Terms
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- a person with positive PPD skin test with no active disease (meaning no granuloma) the DOC would be?
- INH
- If a perons has a positive PPD test with active disease you treat how?
- greater then 6 month regiment on four drugs
- if poor compliance in tb treatment what happens?
- resistance occurs very quickly... poor commpliance happens alot in this disease
- What are the four drugs used in the long term treatment of TB and why do you do this?
-
INH
Rifampin
Ethambutol
streptomycin
you do this do make sure resistnace doesn't occur - MOA of INH (Isoniazid)?
- cidal, kills tb organism
- Isoniazid in general
-
orally
penetrates tissue well including CNS for Tb meningitis
metabolized by liver no adjustmenet
Hepatitis is major concern!! can kill.
Make sure they don't have alcohol or cirrohsis issues
warn patient about this
acetylation process so people can be slow or fast acetylators. - Give isoniazid with what?
- B6 to prevent pyridoxine deficiency cause the drug inactivates it.
- INH toxicity?
-
hypersentiive reactions like rashes and fever.
Drug interaction with phenytoin which delays its clearnace - Rifampin MOA (RIF)
-
interferes with DNA synthesis of TB bacteria by binding to the DNA dependent RNA polymerase. This prevents enzyme from binding to DNA and thereby prevents subsequent DNA transcription. RIF does not bind to RNA polymerase of eukaryotic cells.
cidal - RIF general
-
orally
excreted through liver into bile into feces with small amount in urine
no dosage adjustmetns for moderate renal failure
pentrates CSF so good for Tb meningitis also - RIF side effets
-
urine, tear, sweat and salivia will turn red orange and contact lenses may discolor
effects P450 system
increasing hepatic excretion of drugs like:
oral contraceptives
warfarin
class C drug - Ethambutol MOA
-
interferes with cell wall synthesis
may allow other drugs to cross cell wall
static agent! - Ethambutol general
-
oral
adjust doses in renal failure, half excreted vai kidneys
does not penetrate csf well - Ethambutol side effects
-
optic neuritis
patient first wiill loose color vision
dose related
hyperuricemia can occur - Pyrazinamide (PZA) MOA
-
not really understood. maybe lowers ph to inhibit organism.
cidal
works intracelluarly - PZA general
-
orally
penetrates inflamed CNS
being used more was second line agent... deaths being reported though - PZA side effects
-
hyperuricemia
hepatoxicity in 2 months - Streptomycin MOA
-
inhibitor of protein synthesis
cidal
penetrates cell poorly active mainly against extracellular bacilli - Streptomycin general
-
2nd line drug for tb, plague, tularemia
IM use
can pentrate inflammed CNS ok
renally excreted so must adjust dose in renal failure - Streptomycin toxicity
-
ototoxicity
deafness can occur
increased risk with prolonged course and underlying renal failure - LTBI treatment is now this?
-
Non-hiv = 9 months of INH
prior 2 month RIF-PZA combo should be used with caution cause of hepatic damages
IF INH-PZA used must monitor carefully.