Anti-TB Drugs
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| Four drugs ? | *RIPE....* Rifampin
-Isoniazid
-Pyrazinamide
-Ethambutol
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| Give for initial tmt ? | * All 4 and can discontinue Ethambutol after 2mths if no resistance is found
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| For continued tmt ? | * R and I for 4 more months
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| If INH resistant ? | * RIF + PZA + ETB (6 months)
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| If RIF resistant ? | * INH + ETB + FQ + PZA (2 months)
..... *INH + ETB + FQ (10-16 months)
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| Drug resistance ? | * even if there is 1 resistant bacteria cell and you kill off all the others , that one can reactivate an entire TB infection... reason why drug combos are used
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| Rifampin use ? | * can be used alone in latent/asymptomatic patients ..... * Not to be used alone in active TB infections
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| Rifampin Spectrum ? | * broad spectrum ABx that targets RNA Polymerase.... *can be used for Neisseria and in both G+/G-
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| Rifampins 3R side effects ? | * Revs up CYP450s, so excretes other drugs faster.... * RED/Orange urine... *RNA Polymerase inhibitor
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| Same MOA as Rifampin and you give to HIV patients ? | * Rifabutin... lower CYP450 increase, but super $$$
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| Isoniazid use ? | * DOC for Asymptomatic/Latent TB... if can't use, then use Rifampin.... * Always combo with active TB
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| Isoniazid MOA ? | * Inhibits synthesis of mycolic acids used to make the cell wall....Bactericidal
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| Isoniazid pharmokinetics ? | * Removed by the liver (acetylation), so fast acetylators can remove it faster or slow can have higher side effects bc of slower removal
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| Isoniazid Side Effects ? | * Peripheral neuropathy and CNS toxicity in pts that are alcoholics, diabetics, pregnant women, so supplement with B6..... * most common/most fatal is drug induced hepatitis as age increases bc drug lvls rise in declining liver fct
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| Pyrazinamide MOA ? | * Bactericidal, moa really unknown
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| Pyrazinamide Side Effects ? | * hepatotoxicity and hyperuricemia (watch out in gout ppl)
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| RIP to the Liver ? | * R I and P all cause liver hepatotoxicty
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| Ethambutol use ? | * The only bacteriostatic drug..... * helps if resistance and discontinued if no resistance
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| Ethambutol side effects ? | * Optic Neuritis (E for eye)lose some vision and red/green colors.... * Hyperuricemia (in P and E)
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| Streptomycin use ? | * used in only severe TB cases ..... * is an aminoglycoside that is a protein synthesis inhibitor
(Bactericidal)
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| Streptomycin Side Effects ? | * vertigo & hearing loss (can be permanent is left).... * Nephrotoxicity
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