Please enable JavaScript.

Coggle requires JavaScript to display documents.

Anti-TB drugs (Standard 6 months regime (2 months of RIPE (4 months of…

- - - - First line drugs
        
        All will cause rash, RIP cause GI problem so give with a light meal or before bedtime
        
        Pyrazinamide :fire:
        
        Most important against the persister
        
        Prodrug converted by pyrazinamidase
        
        Accumulation of pyrazinoic acid which leads to decrease in pH and bacteria to die
        
        Resistance due to mutation of pyrazinamidase
        
        Category C but can give pregnant woman
        
        Neonates given vitamin K :pen: because baby may suffer thrombocytopenia to promote coagulation
        
        Monitor for jaundice :pen: because they cause liver problems
        
        Hepatotoxic :warning:
        
        Active metabolite removed by kidney :warning:
        
        Inhibit renal tubular secretion or uric acid result in Gout like symptoms :pen:
        
        RIfampicin :fire:
        
        Kills both growing and stationary phase bacteria
        
        MOA: Inhibit gene transcription by blocking DNA-dependent RNA polymerase so no mRNA and proteins
        
        Functions:
        
        Used to treat latent TB (those with high risk of getting active)
        
        Leprosy (M. Leprae)
        
        Carries of N. meningitis
        
        Well absorbed orally
        
        Hepatic metabolism :pen:
        
        Category C but can give pregnant woman
        
        Neonates given vitamin K :pen: because baby may suffer thrombocytopenia to promote coagulation
        
        Monitor for jaundice :pen: because they cause liver problems
        
        INDUCER of CYP450 enzymes :warning:
        
        increase metabolism of many drugs such as PI & NNRTI, warfarin, anti-arrhythmic agent, calcium channel blocker, sulfonylurea, fluconazole, hormonal contraceptive
        
        Additional side effects:
        
        Hepatitis :pen:
        
        ORANGE discolouration of body fluids :pen: etc contact lens turn orange
        
        Ethambutol :fire:
        
        Inhibit arabinosyltransferase enzyme
        
        Interfere with polymerization of aribinose which is the principle polysaccharide of cell wall
        
        50% of active metabolite passes through kidney :warning:
        
        25% metabolised by liver :warning:
        
        VISUAL TOXICITY :warning:
        
        Should not be taken with Antacids separate by 2 hours, delay absorption :warning:
        
        Inhibit renal tubular secretion or uric acid result in Gout like symptoms :pen:
        
        Not teratogenic
        
        Stretomycin
        
        Aminoglycoside inhibit 30S
        
        Nephrotoxicity and Ototoxicity :warning:
        
        Isoniazid :fire:
        
        For rapidly growing bacteria
        
        Prodrug activated by catalase-peroxidase by M. TB
        
        Resistance: Mutation in catalase-peroxidase
        
        Produces ROS to inhibit formation of mycolic acid if bacterial cell wall, causing DNA damage
        
        Functions:
        
        Used for Active TB
        
        Well absorbed orally
        
        Metabolised in the liver
        
        By N-acetyltransferase, may be metabolised into hydrazine :pen: TOXIC metabolite
        
        Interferes with pyridoxine metabolism :pen: (naturally occurring form of vitamin B6)
        
        Inhibit formation of active form of vitamin B6, result in peripheral neuropathy (weakness, numbness)
        
        Give high risk patient pyridoxine :warning: such as HIV, elderly, pregnant
        
        Increases concentration of phenytoin and carbamazepine :warning:
        
        Category C but can give pregnant woman
        
        Neonates given vitamin K :pen: because baby may suffer thrombocytopenia to promote coagulation
        
        Monitor for jaundice :pen: because they cause liver problems
        
        Can be used in liver patients but once they show some sign of problem, stop immediately :warning::
        
        INHIBITOR of CYP450 enzymes :warning:
        
        Should not take with food, carbs decrease absorption, should not take with food with tyramine and histamine will lead to flsuhing and headache :warning:
        
        Should not be taken with Antacids separate by 2 hours, delay absorption :warning:
      - Second line drugs
        
        For MDR = Resistant to R and I
        
        Common signs for MDRTB:
        
        People who were treated previously with TB
        
        Those who fail treatment
        
        Contact with those with MDR-TB
        
        Come from countries with high resistance (India, Philippines, Russia, South Africa)
        
        All have good CSF penetration except amikacin
        
        Fluroquinolones :fire:
        
        Ethionamide :fire:
        
        Mycolic acid inhibitor
        
        Used for active TB
        
        Orally
        
        Very little in urine :pen:
        
        Diarrhoea
        
        Cycloserine :fire:
        
        Causes Peripheral Neuropathy :warning: should be given pyridoxine
        
        Inhibit Cell wall synthesis
        
        Causes Folic acid deficiency :pen:
        
        Need to change for renal :pen: No need to change for liver 2/3 excreted in urine
        
        Amikacin :fire:
        
        Amikacin and Ethionamide Teratogenic not good for pregnant woman :warning:
      - XDR-TB Resistant to fluoroquinolones