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Ashton Shared "RSM - TB Pharmacology" - 12 Picmonics

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RSM - TB Pharmacology

Mycobacterium Tuberculosis Characteristics
Characteristics
Mycolic Acid Cell Wall
Acid-fast
Carbolfuchsin Stain Red
Lowenstein-Jensen Agar
Serpentine Cord Factor
Primary TB
Primary TB
Caseating Granuloma
Ghon Focus
Hilar Lymph Nodes
Ghon Complex
Reactivation TB
Reactivation TB
Reactivation in Apex
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3 mins
Tuberculosis Skin Mantoux Test (PPD)
Delayed Hypersensitivity (Cell Mediated Response)
Intradermal Injection
Read 48-72 hours
Positive Results
≥ 5 mm Induration
Immunosuppressed
≥ 10 mm Induration
High Risk Patients
≥ 15 mm Induration
Considerations
Chest X-Ray
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3 mins
Mycobacterium Tuberculosis Treatments
Front Line
Isoniazid (INH)
Rifampin
Ethambutol
Pyrazinamide
Fluoroquinolones
Levofloxacin
Moxifloxacin
Injectables
Amikacin
Capreomycin
Kanamycin
Streptomycin
Core or Add-on 2nd Line
Ethionamide
Cycloserine
P-aminosalicylic acid (PAS)
Combination Drug Therapy (RIPE)
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Isoniazid
Indications
Tuberculosis (TB)
Mechanism of Action
Requires Catalase Peroxidase
Decreases Mycolic Acid Synthesis
Fast vs Slow Acetylators
Side Effects
B6 Deficiency
Neurotoxicity
Hepatotoxicity
Drug-induced Lupus
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1 min
Vitamin B6 (Pyridoxine) Deficiency
Deficiency From Isoniazid
Deficiency From Oral Contraceptives
Seizures
Hyperirritability
Peripheral Neuropathy
Sideroblastic Anemia
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3 mins
Rifampin
Tuberculosis (TB)
Blocks RNA Polymerization
Haemophilus influenzae Type B
Leprosy
Meningitis
P450 inducer
Red-orange urine
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55 secs
Ethambutol
Mechanism of Action
Bacteriostatic
Blocks Arabinosyltransferase
Arabinosyltransferase Polymerizes Carbohydrates
Carbohydrate Polymers Make Mycobacterium TB Cell Wall
Side Effects
Red/Green Color Blindness
Reversible with Drug Discontinuation
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40 secs
Pyrazinamide
Hyperuricemia
Hepatotoxicity
Mycobacterium tuberculosis
Effective in acidic pH of phagosomes of macrophages
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Fluoroquinolones Antibiotics
-floxacin
Mechanism of Action
Inhibits Topoisomerase II & IV
Bactericidal
Indications
Gram-negative Rods
Pneumonia
Gastrointestinal Infections
Urinary Tract Infection
Genital Infections
Drugs
Levofloxacin
Ciprofloxacin
Has Pseudomonas Coverage
Considerations
Avoid Polyvalent Cations
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3 mins
Fluoroquinolones Toxicities
Diarrhea
Skin Rash
Headache
Tendon Rupture in Adults
Myalgias in Kids
Damage to Cartilage
Teratogen
QT Prolongation
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1 min
Aminoglycosides
Drug Names
Gentamicin
Neomycin for Bowel Surgery Prep
Amikacin
Tobramycin
Streptomycin
Mechanism of Action
Bactericidal
Inhibit Formation of Initiation Complex
Cause Misreading of mRNA
Require O2 for Uptake
Resistance
Resistance by Transferase Enzymes
Acetylation
Phosphorylation
Adenylation
Indications
Gram-Negative Rod Infections
Synergistic with B-Lactam Antibiotics
Side Effects
Nephrotoxicity Especially When Used with Cephalosporins
Ototoxicity Especially When Used with Loop Diuretics
Teratogen
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5 mins
Tuberculosis Treatment Regiments
Standard
Intensive Phase: INH,RIF,EMB,PZA (2m)
Continuation Phase: INH,RIF (18w)
Latent
INH daily for 9m
Directly Observed Therapy: INH & RPT weekly for 3m
Pregnancy
Active TB must be treated
INH, RIF, EMB (& PZA outside of the US)
AIDS/HIV
Start TB Tx before HIV Tx
Avoid weekly INH-RPT
CD4 count <100/uL: Avoid biweekly INH-RIF
MDR-TB
Resistance to INH and RIF
1st Line & 2nd Line Agents for 20mo
Bedaquiline +3 other drugs
Inhibits bacterial ATP Synthase
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