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Anti-TB Drugs

Four drugs ? *RIPE....* Rifampin -Isoniazid -Pyrazinamide -Ethambutol
Give for initial tmt ? * All 4 and can discontinue Ethambutol after 2mths if no resistance is found
For continued tmt ? * R and I for 4 more months
If INH resistant ? * RIF + PZA + ETB (6 months)
If RIF resistant ? * INH + ETB + FQ + PZA (2 months) ..... *INH + ETB + FQ (10-16 months)
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
Rifampin use ? * can be used alone in latent/asymptomatic patients ..... * Not to be used alone in active TB infections
Rifampin Spectrum ? * broad spectrum ABx that targets RNA Polymerase.... *can be used for Neisseria and in both G+/G-
Rifampins 3R side effects ? * Revs up CYP450s, so excretes other drugs faster.... * RED/Orange urine... *RNA Polymerase inhibitor
Same MOA as Rifampin and you give to HIV patients ? * Rifabutin... lower CYP450 increase, but super $$$
Isoniazid use ? * DOC for Asymptomatic/Latent TB... if can't use, then use Rifampin.... * Always combo with active TB
Isoniazid MOA ? * Inhibits synthesis of mycolic acids used to make the cell wall....Bactericidal
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
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
Pyrazinamide MOA ? * Bactericidal, moa really unknown
Pyrazinamide Side Effects ? * hepatotoxicity and hyperuricemia (watch out in gout ppl)
RIP to the Liver ? * R I and P all cause liver hepatotoxicty
Ethambutol use ? * The only bacteriostatic drug..... * helps if resistance and discontinued if no resistance
Ethambutol side effects ? * Optic Neuritis (E for eye)lose some vision and red/green colors.... * Hyperuricemia (in P and E)
Streptomycin use ? * used in only severe TB cases ..... * is an aminoglycoside that is a protein synthesis inhibitor (Bactericidal)
Streptomycin Side Effects ? * vertigo & hearing loss (can be permanent is left).... * Nephrotoxicity
Created by: thamrick800