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Second line drugs for TB - answer;-aminoglycosides, fluoroquinolones, para-aminoslicyclic acid (PAS),
capremycin, amikacin
Isoniazid MOA - answer;-inhibits mycolic acid synthesis, which a part of the mycobacterial cell wall.
Isoniazid indications - answer;-active and latent TB
Isioniazid drug interactions - answer;-Inhibits P450, so metabolism of some drugs will be slowed.
Phenytoin , diazepam, theophylline, warfarin.
Isoniazid adverse effects - answer;-hepatotoxicity, peripheral neuropathy, multipolar necrosis
Ethambutol MOA - answer;-decrease carbohydrate polymerization of mycobacterium cell wall by
blocking arabinosyltransferase. So, impairs mycobacterial cell wall synthesis.
Ethambutol adverse effects - answer;-optic neuritis, GI upset, inhibits renal excretion of uric acid.
Ethambutol indications - answer;-M. tuberculosis. Even those strains that are resistant to isoniazid and
rifampin.
Pyrazinamide indications - answer;-Part of multi-drug regimen for TB, especially latent.
,Pyrazinamide adverse effects - answer;-Most hepatotoxic of all the first line drugs.
Rifampin MOA - answer;-Inhibits DNA-dependent RNA polymerase (transcription.) consequently, it
suppresses protein synthesis. Highly selective to TB bacterium.
Rifampin indications - answer;-TB. Lipid soluble so it can attack intracellular or quiescent bacilli.
Rifampin adverse effects - answer;-hepatitis, discoloration of urine, stools, and other body fluids to
red/orange color. GI side effects, cutaneous reactions.
Rifabutin (Mycobutin) indications - answer;-Treats TB in patients with HIV. Does not interact with
antivirals.
Rifabutin adverse effects - answer;-skin rash, body fluids discoloration, neutropenia, GI upset
Aminoglycosides for TB - answer;-2nd line drug. Needs heroic. Damage to 8th cranial nerve.
Extensive Drug Resistant TB (XDR-TB) - answer;-resistant to all 1st line oral drugs + at least one 2nd line
given by IV. Treatment is prolonged to at least 24 months with 2nd and 3d line drugs that are highly
toxic and less effective. Therapy may consist of up to 7 drugs. 40-60% rate of death.
Antiulcer agents - answer;-used in the treatment and prophylaxis of peptic ulcer and gastric
hypersecretory conditions, e.g., Zollinger-Ellison syndrome. Include meds such as antibiotics that treat h.
Pylori, antisecretory meds such as proton pump inhibitors, histamine 2 receptor antagonists; mucosal
protectants such as sucralfate, and antacids.
Proton Pump Inhibitors (PPIs) - answer;-A group of drugs whose main action is a pronounced and long-
lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion
available today. Include drugs like omepraze, and pentoprazole
Proton pump inhibitors indications - answer;-Gastric/duodenal ulcers, GERD, erosive esophagitis,
Zollinger-Ellison syndrome.
, Proton Pump inhibitors MOA - answer;-IRREVERSIBLY Block H+/K+ ATPase in Parietal Cells of the
Stomach --> block acid production in parietal cells
Proton Pump Inhibitors adverse effects - answer;-Fractures, PNA, acid rebound, intestinal infections
with C. diff, hypomagnesemia, diarrhea,
Sucralfate (Carafate) MOA - answer;-forms a *physical barrier* over an open ulcer
Sucralfate (Carafate) drug interactions - answer;-•Decreases the absorption of tetracycline, phenytoin,
fat-soluble vitamins, and some antibiotics
•Antacids decrease the effects of sucralfate
- take Sucralfate at least 2hrs apart from these other drugs.
H. pylori treatment - answer;-PPI + 2 of the following antibiotics
--Clarithromycin
--Metronidazole
--Amoxicillin
One week treatment: 90% cure rate
Hpylori treatment regimens - answer;-PPI+Clarith+Amox
PPI+Clarith+Metro
PPI/H2+Bismuth+Metro+Tetra if clarithromycin allergy (quadruple therapy)
10-14 days
Antacids MOA - answer;-Neutralize gastric acid to bring the pH above 3 and inactivate pepsin
Most preparations not absorbed
Excreted through feces