acid fast,

aerobic,

rod shaped,

slow growing,

waxy outer covering made of mycolic acids (fatty acids)

1.  mycobacterium tuberculosis

2.  mycobacterium leprae

by inhalation of droplet nuclei (aerosols), remain in air indefinitely

1.  lymph drainage

2.  hematological spread

tb bacteria cannot be killed by at least 2 of the best ABx, rifampin & isoniazid

multidrug resistant tuberculosis

tb bacteria cannot be treated with 2 best drugs, rifampin & isoniazid as well as most of the alternative drugs

1. directly- breathe in mdr tb bacteria

2.  have active tb and do not follow Abx regimen (inconsistent use of Abx)

1.  directly, and breathe in xdr tb bacteria

2.  have mdr tb or active and do not take Abx properly

1.  bacteria enter body causing Mtb infection and infection goes to lung

2.  immune system cannot stop tb from growing and spreading after initial infection

Mtb

-  only fraction of people with Mtb develop active dz

person has Mtb but does not get sick

will it test positive on skin test?

non-contagious latent tb

-dormant for months, years, etc. 

yes, will test positive 

weakened immune system (greatest risk)

HIV

chemo

children under 5

(due to overproduction of tnf) 

chronic cough

wt. loss & appetite

fever

chills

night sweats

hemoptisis

M. tuberculosis in clnical specimen (sputum, biopsy, bonchoscopy, CSF, fastric washing, culture, microscopic investigation= ziehl neelsen or auramine O stain)

tuberculin in extract of M. tuberculosis proteins (PPD)

PPD= delayed hypersensivity response

1.  isoniazid

2.  rifamycins (rifampin, rifabutin, rifapentin)

3.  ethambutol

4.  pyrazinamine

1.  Aminoglycosides (streptomycin first, amikacin)

2.  para-Aminosalicylic Acid

3.  Capreomycin

4.  Cycloserine

5.  Ethionamide

6.  Fluroquinalones (Levofloxacin)

7.  Macrolides (Azithromycin, Clarithromycin)

for tx of TB, begin 4 drugs and continue for 2 months

initial short term chemotherapy

inhibits cell wall synthesis

Tb drug, first line therapy

isoniazid

fast= 1 hour

slow= 3 hours

1.  Hepatotoxicity (increases with age)

2.  Peripheral neuropathy (most common)

3.  hypersensitivity rxn

What should you tell pt on how to take Isoniazid

acetylation

fast v. slow acetylator

malnourished and predisposed to neuritis (alcoholics & diabetics)

starts with parasthesia of hands/feet

starts with parasthesia of hands/feet

25-50 mg q day of pyridoxine (vit B6)

1. isoniazid

2.  rifampin

tb drug that is specific for prokaryotes

(intra & extra cellular)

tb drug that accelerates many, many drugs

rifampin (first line tb)

CYP 450 system (enterohepatic cycling)

first line tb drug

mostly GI

rifabutin

first line tb

rifapentine

dose weekly except during initiation (2 x weekly)

MOA for pyrazinamide

ethambutol--first line tb drug

can be uni, bilateral

eyes tested seperately and both

(reversed when drug d/c)

1.  streptomycin first

2.  kanamycin or amikacin

MOA:  PABA bacteriostatic

macrolides= azithromycin, clarithromycin

ethambutol & rifabutin

used to treat multidrug resistant tb

1.  capreomycin

2.  levofloxacin

1.  aminoglycosides (streptomycin)

2.  capreomycin

1.  cycloserine 

q 12 hours

SE= CNS, peripheral neuropathy

2.  ethionamide

q day

SE= peripheral neuropathy, optic neuritis

1.  candidiasis

2.  aspergillosis

3.  cryptococcosis

4.  mucormycosis

1.  sporotrichosis

2.  coccidiodomycosis

3.  blastomycosis

4.  histoplasmosis

1.  azoles= fluconazole, itraconazole, voriconazole

2.  polyenes= amphotericin B

3.  nucleoside analogues= flucytosine

4.  echinocandins= caspofungin

fluconazole (systemic infection)

also invasive candida, cryptococcal meningitis,

antifungal has good CNS penetration

fluconazole

good tx for cryptococcal meningitis

fluconazole MOA

antifungal, azole

inhibits fungal cytoplasmic membrane= pores

must give on acid stomach & no food.

drink coke before to increase absorption

(do not give with antacid, food, beta blocker)

antifungal, azole for cutaneous & mucosal candidiasis, dermatophytic infection, aspergillis, dimorphic fungi

**elevated LFTS, TGs, HA, dizziness, hypokalemia, N/V

amphotericin B (polyene)

used w/ flucytosine to dec. toxicity

never give with ketoconazole

IV slow infusion only

antifungal for life threatening systemic mycoses

**infusion related, fevere, chills, vomit, hypotension, normochromic, normocytic anemia

**renal damage (renal tubular acidosis with K and Mg wasting)

thrombophlebitis- add heparin

1.  nystatin

2.  azoles

3.  allylamines

what is nystatin Rx for?

1.  thrush

2.  vaginal candidis

3.  intertriginous candidal infection (skin fold)

cream, ung, supp, susp, troches (losenge)

baby= 1-2cc spit out

adult= 1 tsp full swish & spit

powder, wash & dry dust shoes, socks

topical preparations of azoles

used to treat?? 

shampoo, lotion, cream, ung, gel

1.  vulvovaginal candidiasis

2.  oral thrush

3.  dermatophytes

4.  seborrheic dermatitis

5.  contact dermatitis

terbenaphine

for tinea cruris & corporus

ciclopirox

systemic antifungals used to tx topica infections

1.  griseofulvin

2.  allylamines

3.  terbenafine

Griseofulvin

enhances abs. with fat

AE:  parasthesia, photsensitivity, hypersensitivity

terbenafine

for dermatophyte infection

drug intxn= rifampin, cimeteinine, cyclosporine

nematodes

(ascaris lumbricoides= giant roundworm)

ancylostoma duodenale

necator americanus

pork roundworm= trichinella spiralis

filariae

giant round worm of small intestine

tx with mebendazole, albendazole, pyrantal (otc)

Enterobiasis

pinworm in ileum & lg intestine

**intense perianal itching*

tx with mebendazole, albendazole, pyrantal (otc)

pinworm= intense perianal itching

tx with mebendazole, albendazole, pyrantal

HOOKWORM in rural areas, poor hygiene & barefoot

wall of small intestine & suck blood

tx with mebendazole, albendazole, pyrantal

hook worm= ancylostomiasis & necatoriasis

barefoot, rural, poor hygiene

wall of small intestine & suck blood

tx with mebendazole, albendazole, pyrantal

whipworm of large intestine

tx with mebendazole

threadworm  of small intestine

common in southern US

tx with ivermectin

helminth can cause vomiting, massive diarrhea, dehydration, electrolyte imabalance, bacteremia

strongyloides, threadworm

in southern US

tx with ivermectin

pork roundworm (trichinella spiralis)

adults in intestine

larve encysted in skeletal mm

tx with mebendazole (adults and larve)

prednisone to decrease inflammation during migrate

helminth S/Sx:

GI, muscle pain, sore throat

trichinosis= pork roundworm

heart failure, meningitis, neuritis

tx with mebendazole & prednisone

beef & pork tapeworm (cestode)

small intestine

tx with praziquantal

undercooked fish (cestode)

of ileum

tx with praziquantal

trematode blood fluke of snail

acute phase= LAD, fever, anorexia, malaise, mm pain, rash

chronic phase in vascular of intestines & liver= polyps, hepatosplenomegaly, portal HTN

tx with Praziquantal

mebendazole

3 days between administer & death

adults & children for 3 days or at 500 mg once

pork roundworm repeat in 10 days

chewed, crushed, swallowed

Praziquantal

tell pts do not drive

works by spastic paralysis causing detachment

DOC for  nematodes

ivermectin

disrupts nerve & mm function by opening cloride channels to paralyze

ivermectin

tx of nematodes

open chloride channels to paralyze

Onchocerciasis

tx with ivermectin

major subtypes of malaria

1.  flaciparum malaria

2.  vivax malaria

1.  tx of acute

2.  prevention

3.  prophylaxis

1.  sensitivity of species

chloroquin sensitive= chloroquin

resistant= mefloquine, doxycycline, atovaquone/ profuanil

chloroquin

give one week before exposure, continue 4 weeks after leaving endemic area

give one per week

Quinine- comes from tree

SE= mild cinchonmism, tinnitis, HA, visual, N/D, cardiac, hypoglycemia

Mefloquine once/week

toxicity to CNS worry

one week before--> 4 weeks after

Atovaquone/ Proguanil

1-2 days before, 7 days after leaving

entamoeba

trichomonas

giardia

amebiasis

tx with metronidazole & tinidazole

Giardiasis

intestine

tx with metronidazole tinidazole

S/Sx protozoan

malaise, heartburn, vomiting, colicky pain after eating, belching, flatulance, diarrhea

giardiasis

mimics gallstones, appendicitis, ulcer, hernia

tx with metronidazole, tinidazole

trichomoniasis= STI

GU women= vaginitis

male= urethritis

tx metronidazole & tinidazole

metronidazole

impairs DNA in microbe

Metronidazole (antiprotozoan)

metallic taste

Drug itxn:  etoh & disulfiram

inhibits warfarin

phytoin & lithium levels increased

1.  Pyrethrins- chrysanthemum flower, only kill live lice, not eggs

shampoo hair, work into good lather, leave 10 min., rinse, nit comb.  repeat in 10 days.

Rx for head lice

1.  malathion lotion 0.5%

2.  lindane shampoo 1%

1.  malathion lotion 0.5%

kills lice and some eggs

lindane shampoo 1% 

not first line therapy, can be toxic

scabes= mites

tracks near wrists, butt, arms, groin, between fingers

1.  permethrim 5% cream**

2.  crotamiton lotion 10%, cream 10%

lindane lotion 1%

Permethrim 5% cream

apply, leave on overnight, wash off in AM

1.  Osetamivir

2.  Zanamivir

neuroamidase inhibitors (antivirals)

1.  oseltamivir

2.  zanamivir

oseltamivir

prevent type A&B, do not interfere with vaccine

prevent before exposure or within 24-48 hours of sx onset

Zanamivir--neuroaminidase inhibitor (antiviral for flu)

prevent A&B, before exposure or 24-48 hours after sx onset

inhale

zanamivir--antiviral for A&B flu

AE: bronchospasm with asthma & COPD

1.  amantadine

2.  rimantidine

tx & prevention of A if prior to exposure

reduce duration and severity if within 48 hours after exposure to virus

supplement to vaccine

amantadine & rimantadine

**inhibitors of viral uncoating**

block ion channels

supplement to vaccine

inhibitor of viral uncoating

crosses BBB

amantadine--tx & prevention of type A

decr. duration and severity--> adjunct to vacc.

significant side effects, not metabolized

caution in renal, may accumulate

inhibitor of viral uncoating-

more GI SE

rimantadine

extensively metabolized

ribavirin

only severe RSV infections

MOA:  interferes with duplication of viral dna

AE:  transient anemia,

teratogenic

tx of hep B & C

interferon

alpha 2b

glycoproteins inhibit viral RNA tsln

AE  flu sx, bone marrow suppression, thyroiditis, CNS

lamivudine

monitor renal fctn

sores, ecephalitis, genital infections

only effective during acute phase

Acyclovir

HSV 1, 2, VZV, epstein barr, shingles

stops replication of viral DNA

genital herpes

stops replication of viral DNA

CMV (herpes family)

mimics mono-->fever, swollen glands, feel tired

Foscarnet

inhibits viral enzymes

**nephrotoxicity and electrolyte disturbance

approved for acyclovir-resistant HSV

foscarnet

inhibits viral enzymes

**nephrotoxicity & electrolyte disturbance

1.  HIV positive and

a.  CD4 < 200

b.  Aids defining illness (CMV retiniss, histoplasmosis, tb, kaposis sarcoma, toxoplasmosis, candidis)

1.  reverse transcriptase inhibitors

NRTIs- nucleoside/tide RTIs

NNRTIs- non nucleoside RTIs

2.  protease inhibitors

3.  HIV fusion inhibitors

ABC

abacavair

NRTI antiretrovial for HIV

didanosine-NRTI

antiretroviral for aids

lamivudine

antiretroviral NRTI

Stavudine

antiretroviral NRTI

Zidovudine

antiretroviral NRTI

inhibits synthesis of viral DNA

undergo intracellular converson to active triphosphate form

all orally, AZT IV

antiretroviral with fewest drug intx

AZT/ZDV = zidovudine

1st antiretroviral

give with CNS

ok for pregnancy & infancy

AZT/ZDV-zidovudine

causes bone marrow supp, anemia & neutropenia

CBC before and q month

CNS infection (penetratoin)

AZT/ZDV--zidovudine

penetrates CNS--infection

GI sx

ok for pregn. & infancy

DDi- didanosine combo therapy

**eat few crackers before**

reduced by food & gastric activity

stavudine d4t--NRTI antiretroviral

weight based dosing

lamivudine

small risk of lactic acidosis

Abacavir (ABC)- NRTI antiretroviral

N/V/ D/ sleep disturbance

Increase risk MI

FDA warning: risk of MI

abacavair (ABC) & didanosine (ddi) NRTI antiretroviral

1.  Tenofovir--nucleotide RTI 

DIxn:  atazanavir, ddi, nephrotoxic agents

2.  Emtricitabine

hyperpigmentation of palms, soles

NRTI= emtricitabine (analogue of lamivudine)

dosing adj. for crCl<50

1.  nevirapine

2.  delavirdine

3.  efavirenz

nevirapine NNRTI antiretroviral

inhibits RT without intracellular phosphorylation

cyp34A inducer, itxn with BZDPs, oral contraceptives

efavirenz-NNRTI antiretroviral

only HIV1

take on empty stomach

CNS sx, nightmares, mania, insomnia

CYP3A4 inducer, accelerate own metabolism

NNRTI-efavirenz only 1st line approved NNRTI

CNS sx-nightmares, mania, insomnia

st johns wort decrease