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Details

PT test 10-14
Tuberculosis
23
Pharmacology
Graduate
10/09/2009

Additional Pharmacology Flashcards

 


 

Cards

Term
What is the primary treatment for a latent TB infection?
Definition

- Isoniazid 300mg/day x 9 months (some can do 6 months)

 

Term

What is the primary treatment for a latent TB infection in a patient with hepatotoxicity?

Definition

-Rifamycins

- Includes:  Rifampin 600mg/day x 4 months +/- INH (may replace INH with Pyrazinamide 15mg/kg/day x 2 months), or Rifabutin 300mg/day x 4 months +/- INH

Term
What is first line for an active TB infection?
Definition

- Acronym RIPE for 1st line

- Stands for Rifamycins (Rifampin, Rifabutin), Isoniazid, Pyrazinamide, Ethambutol

- 2nd Line includes:  Cycloserine, Ethionamide, LMG FQ's, P-aminosalicylic acid, Streptomycin, Amikacin/Kanamycin, Capreomycin

Term
In terms of the role of RIPE, what does INH do?
Definition
- Bacteriacidal against rapidly dividing cells
Term

In terms of the role of RIPE, what do Rifamycins do?

Definition
- Sterilizing activity against rapidly dividing and semi-dormant cells
Term

In terms of the role of RIPE, what does pyrazinamide do?

Definition
- Greatest effect on dormant/semi-dormant strains contained within macrophages and acidic environments
Term

In terms of the role of RIPE, what does ethambutol do?

Definition
- Helps prevent rifampin resistance when primary INH resistance present
Term
What is the typical dosage of INH and what does can not be used in HIV+ patients?
Definition

- 300mg QD or 900 mg BIW or TID.

- 900 mg BIW not for HIV+ patients with CD4 <100

Term
What are the adverse effects of INH?
Definition

- Hepatotoxicity (increased risk with Rifampin)

- Neurologic Toxicity (B6).  Supplement with B6 50-100mg/day

Term
What should one especially avoid when using INH?
Definition
- Alcohol
Term
What should we monitor when someone is on INH?
Definition

- LFT's monthly

- Opthalmic exam (optic neuritis)

- TDM of antiepileptic medications (carbamazapine, Phenytoin)

Term
What is the typical dosage of Rifampin, and which is not for HIV+ patients?
Definition

- 600 mg/day, BIW, or TIW

-  BIW not for HIV+ with CD4 <100

 

Term
What are the adverse effects of Rifampin?
Definition
- Most important are orange secretions and hepatotoxicity
Term
What is significant regarding Rifampin drug interactions
Definition

- STRONG INDUCER, not substrate.  Therefore, it reduces drug concentrations of other medications

- Saquinavir?

Term
What are the adverse reactions of Rifabutin?
Definition

- Orange Secretions

- Hepatotoxicity

- GI intolerance

- Neutropenia

- Dose-related uveitis (450mg/d)

Term
What are the drug interactions involving Rifabutin?
Definition

- Less potent inducer of CYP3A4

- Substrate of 3A4

-Increased Rifabutin levels with protease inhibitors

- Increase Rifabutin dose with NVP and EFV (300mg and 450mg, respectively)

Term
What is the dosing, A/E, and monitoring of Pyrazinamide?
Definition

- Weight based dosing

- Hepatotoxicity, GI symptoms, Hyperuricemia, acute gouty arthritis, rash

- Monitor uric acid, liver chemistry particularly with rifampin

Term
Is there a special dosing for renal disease in Pyrazinamide?
Definition
- Yes, in renal disease there is an accumulation of metabolites.  Therefore, dose reduce to TIW after dialysis
Term
What is the activity of ethambutol, what are the A/E's, and when do you adjust for clearance?
Definition

- Bacteriostatic

- Dose related ocular toxicity

- Dose adjust in CrCl < 50ml/min

Term
What is the duration of the initial phase of RIPE therapy?
Definition
Term
What is the dosing in the continuation phase?
Definition

nDosing may be done QD, QW, BIW, TIW
QW and BIW not for HIV+ patients
DOT not necessary for QD dosing
n4 months minimum (total 6 months)
n7 months recommended for:
Cavitation with (+) Cx at 2 months
No PZA in initial regimen
Once weekly INH/Rifapentine with (+) cx at 2 months 

Term
In second line treatments for TB, which ones are off-label usage?
Definition

- FQ's (LMG)

- Amikacin/Kanamycin

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