PHRM 865 Final Exam Study Guide
acid fast bacteria - ANSWER retains color after dyed/stained (cannot be decolorized)
tb transmission - ANSWER spread by aerosol droplets (speaking, coughing, or spitting)
tb can only be spread by - ANSWER people with active tb
Latent vs Active Tb: Symptoms - ANSWER only active has sx
Latent vs Active Tb: Skin test - ANSWER *both* positive
Latent vs Active Tb: X-ray - ANSWER active is *ab*normal
what does mycobacterium cell wall has that g(+) and g(-) cell walls do not? - ANSWER
arabinogalactan and mycolic acid rich layers are not found in g(+) or g(-) wall
Tb Tx: Isoniazid- MOA - ANSWER inhibits InhA and KasA to block mycolic acid synthase
causing defective cell wall
Tb Tx: Isoniazid- Activation - ANSWER by M. tb KatG protein
Isoniazid only works against - ANSWER growing M tb
Tb Tx: Pyranzinamide- MOA - ANSWER inhibit panD to inhibit CoA synthesis
Tb Tx: Pyranzinamide- Activation - ANSWER conversion by pncA
Tb Tx: Pyranzinamide- Resistance - ANSWER mutations in pncA
Tb Tx: Ethambutol- MOA - ANSWER inhibit mycobacterial arabinosyl transferases to
prevent arabinogalactan formation
Is ethambutol used alone? - ANSWER no, always used with rifampin
Tb Tx: Rifampin- MOA - ANSWER bind allosterically to RNA polymerase to prev
elongation
Tb Tx: Bedaquiline- MOA - ANSWER inhibit ATP synthase
Tb Tx: Pretomanid- MOA - ANSWER increased killing and ATP depletion in *anaerobic*
conditions
rifampin and bedaquiline are active against... - ANSWER growing AND stationary cells
most effective 1st line Tb tx - ANSWER rifampin
2nd line Tx for Tb - ANSWER streptomycin
,ethonamide
para-aminosalicyclic acid
cyclosporine
capreomycin
Which tb drugs are prodrugs? - ANSWER isoniazid
pyrazinamide
pretomanid
Why might 2nd line Tb agents be used over 1st line? - ANSWER resistance to 1st line
occurs
failed response to 1st line
intolerance to 1st line
ability to deal with toxic SE's
Treatment of Drug-Susceptible Tb: *Preferred* Intensive and Continuation - ANSWER
rifampin, isoniazid, pyrazinamide, and ethambutol *daily* or *5x/week* for 8 weeks
Treatment of Drug-Susceptible Tb: *Preferred* Continuation - ANSWER rifampin and
isoniazid daily or 5x/week for 18 weeks
Which Tb intensive and continuation regimens should not be used in HIV or cavitary
disease? Why? - ANSWER twice weekly doses should not be used because if any doses
are missed then the regimen is inferior
During Tb continuation phase of treatment, patients receiving isoniazid should also get -
ANSWER vitamin B6 (pyridoxine) 25-50mg QD
Tb Tx in Special Populations: Extrapulmonary - ANSWER same regimen as pulmonary
can extend to 9 or 12 months (HIV)
Tb Tx in Special Populations: Tb Meningitis - ANSWER same as pulmonary but can
extended tx to 9-12 months
Tb Tx in Special Populations: Infants and Children - ANSWER same as adults but can
extend to 9 months
ethambutol is not recommended in patients - ANSWER < 6
Tb Tx in Special Populations: Tb during pregnancy - ANSWER rifampin, isoniazid, and
ethambutol for a minimum of 9 months
Tb Drugs: Pk- Isoniazid - ANSWER genetically determined
, reduce dose in hepatic or renal failure
Tb Drugs: Pk- Ethambutol - ANSWER adjust in renal dysfunction
Tb Drugs: AE's- Isoniazid - ANSWER hepatitis
neurotoxicity
Tb Drugs: AE's- Rifampin - ANSWER hepatoxicity (increase bilirubin)
*discoloration of body fluids*
Tb Drugs: AE's- Rifabutin - ANSWER orange colored bodily fluids
arthralgias
leukopenia
Tb Drugs: AE's- Pyrazinamide - ANSWER hepatoxicity
hyperuricemia
Tb Drugs: AE's- Ethambutol - ANSWER peripheral neuropathy
*optic neuritis*
Tb Tx: Multi-drug resistant regimen - ANSWER bedaquiline + pretomanid + linezolid +
moxifloxacin for atleast 6 months
Tb Tx: Latent Tb regimen - ANSWER rifampin x4 months
isoniazid + rifapentine x12 weeks
isoniazid + rifampin x3 months
Toxicology treatment stages - ANSWER stabilization (ABC, vitals, oxygen) ---> exposure
(meds/illicit drugs, doses, etc) ---> assessment (phys exam, labs)
anion gap equation - ANSWER (Na+ + K+) - (Cl- + HCO3-)
acid fast bacteria - ANSWER retains color after dyed/stained (cannot be decolorized)
tb transmission - ANSWER spread by aerosol droplets (speaking, coughing, or spitting)
tb can only be spread by - ANSWER people with active tb
Latent vs Active Tb: Symptoms - ANSWER only active has sx
Latent vs Active Tb: Skin test - ANSWER *both* positive
Latent vs Active Tb: X-ray - ANSWER active is *ab*normal
what does mycobacterium cell wall has that g(+) and g(-) cell walls do not? - ANSWER
arabinogalactan and mycolic acid rich layers are not found in g(+) or g(-) wall
Tb Tx: Isoniazid- MOA - ANSWER inhibits InhA and KasA to block mycolic acid synthase
causing defective cell wall
Tb Tx: Isoniazid- Activation - ANSWER by M. tb KatG protein
Isoniazid only works against - ANSWER growing M tb
Tb Tx: Pyranzinamide- MOA - ANSWER inhibit panD to inhibit CoA synthesis
Tb Tx: Pyranzinamide- Activation - ANSWER conversion by pncA
Tb Tx: Pyranzinamide- Resistance - ANSWER mutations in pncA
Tb Tx: Ethambutol- MOA - ANSWER inhibit mycobacterial arabinosyl transferases to
prevent arabinogalactan formation
Is ethambutol used alone? - ANSWER no, always used with rifampin
Tb Tx: Rifampin- MOA - ANSWER bind allosterically to RNA polymerase to prev
elongation
Tb Tx: Bedaquiline- MOA - ANSWER inhibit ATP synthase
Tb Tx: Pretomanid- MOA - ANSWER increased killing and ATP depletion in *anaerobic*
conditions
rifampin and bedaquiline are active against... - ANSWER growing AND stationary cells
most effective 1st line Tb tx - ANSWER rifampin
2nd line Tx for Tb - ANSWER streptomycin
,ethonamide
para-aminosalicyclic acid
cyclosporine
capreomycin
Which tb drugs are prodrugs? - ANSWER isoniazid
pyrazinamide
pretomanid
Why might 2nd line Tb agents be used over 1st line? - ANSWER resistance to 1st line
occurs
failed response to 1st line
intolerance to 1st line
ability to deal with toxic SE's
Treatment of Drug-Susceptible Tb: *Preferred* Intensive and Continuation - ANSWER
rifampin, isoniazid, pyrazinamide, and ethambutol *daily* or *5x/week* for 8 weeks
Treatment of Drug-Susceptible Tb: *Preferred* Continuation - ANSWER rifampin and
isoniazid daily or 5x/week for 18 weeks
Which Tb intensive and continuation regimens should not be used in HIV or cavitary
disease? Why? - ANSWER twice weekly doses should not be used because if any doses
are missed then the regimen is inferior
During Tb continuation phase of treatment, patients receiving isoniazid should also get -
ANSWER vitamin B6 (pyridoxine) 25-50mg QD
Tb Tx in Special Populations: Extrapulmonary - ANSWER same regimen as pulmonary
can extend to 9 or 12 months (HIV)
Tb Tx in Special Populations: Tb Meningitis - ANSWER same as pulmonary but can
extended tx to 9-12 months
Tb Tx in Special Populations: Infants and Children - ANSWER same as adults but can
extend to 9 months
ethambutol is not recommended in patients - ANSWER < 6
Tb Tx in Special Populations: Tb during pregnancy - ANSWER rifampin, isoniazid, and
ethambutol for a minimum of 9 months
Tb Drugs: Pk- Isoniazid - ANSWER genetically determined
, reduce dose in hepatic or renal failure
Tb Drugs: Pk- Ethambutol - ANSWER adjust in renal dysfunction
Tb Drugs: AE's- Isoniazid - ANSWER hepatitis
neurotoxicity
Tb Drugs: AE's- Rifampin - ANSWER hepatoxicity (increase bilirubin)
*discoloration of body fluids*
Tb Drugs: AE's- Rifabutin - ANSWER orange colored bodily fluids
arthralgias
leukopenia
Tb Drugs: AE's- Pyrazinamide - ANSWER hepatoxicity
hyperuricemia
Tb Drugs: AE's- Ethambutol - ANSWER peripheral neuropathy
*optic neuritis*
Tb Tx: Multi-drug resistant regimen - ANSWER bedaquiline + pretomanid + linezolid +
moxifloxacin for atleast 6 months
Tb Tx: Latent Tb regimen - ANSWER rifampin x4 months
isoniazid + rifapentine x12 weeks
isoniazid + rifampin x3 months
Toxicology treatment stages - ANSWER stabilization (ABC, vitals, oxygen) ---> exposure
(meds/illicit drugs, doses, etc) ---> assessment (phys exam, labs)
anion gap equation - ANSWER (Na+ + K+) - (Cl- + HCO3-)
