FINAL 03 - Antimycobacterial Agents

Question 1

Agents used for Mycobacterium tuberculosis, M. leprae, and atypical mycobacteria

Answer 1

Antimycobacterial agents

Question 2

Inhibits mycolic acid synthesis (cell wall); activated by KatG (catalase-peroxidase) (1st line drugs for TB)

Answer 2

Isoniazid (INH)

Question 3

Bactericidal, hepatotoxic, and neurotoxic (1st line drugs for TB)

Answer 3

Isoniazid (INH)

Question 4

Antidote for isoniazid (INH); prevents neuropathy

Answer 4

Vitamin B6 (Pyridoxine)

Question 5

Mutation responsible for isoniazid (INH) resistance

Answer 5

KatG mutation

Question 6

Inhibits DNA-dependent RNA polymerase (1st line drugs for TB)

Answer 6

Rifampicin

Question 7

Bactericidal; induces CYP450; orange secretions (1st line drugs for TB)

Answer 7

Rifampicin

Question 8

Mutation responsible for rifampicin resistance

Answer 8

rpoB mutation

Question 9

Unclear MOA; active in acidic pH; disrupts membrane potential (1st line drugs for TB)

Answer 9

Pyrazinamide

Question 10

Hepatotoxic; hyperuricemia; used in initial phase only; works in acidic lysosomes (1st line drugs for TB)

Answer 10

Pyrazinamide

Question 11

Inhibits arabinosyl transferase (cell wall synthesis) (1st line drugs for TB)

Answer 11

Ethambutol

Question 12

Bacteriostatic; optic neuritis (lowered visual acuity, red-green color blindness) (1st line drugs for TB)

Answer 12

Ethambutol

Question 13

30S ribosomal inhibitor (1st line drugs for TB)

Answer 13

Streptomycin

Question 14

Ototoxicity, nephrotoxicity; mainly for severe/meningeal TB or drug-resistant cases (1st line drugs for TB)

Answer 14

Streptomycin

Question 15

Standard regimen for TB

Answer 15

HRZE for 2 months; HR for 4 months (total of 6 months)

Question 16

__________ is strongly recommended in public health settings

Answer 16

Directly observed therapy (DOT)

Question 17

Levofloxacin, moxifloxacin (2nd line drugs for MDR-TB)

Answer 17

Fluoroquinolones

Question 18

Inhibits DNA gyrase; QT prolongation; commonly used in MDR-TB (2nd line drugs for MDR-TB)

Answer 18

Fluoroquinolones

Question 19

Amikacin, capreomycin, kanamycin (2nd line drugs for MDR-TB)

Answer 19

Injectables (Aminoglycosides)

Question 20

30S inhibitors; ototoxic, nephrotoxic; parenteral only (2nd line drugs for MDR-TB)

Answer 20

Injectables (Aminoglycosides)

Question 21

Oxazolidinone (2nd line drugs for MDR-TB)

Answer 21

Linezolid

Question 22

50S inhibitor; risk of myelosuppression, peripheral neuropathy (2nd line drugs for MDR-TB)

Answer 22

Linezolid

Question 23

Diarylquinoline (2nd line drugs for MDR-TB)

Answer 23

Bedaquiline

Question 24

Inhibits mycobacterial ATP synthase; QT prolongation; reserved for MDR/XDR TB (2nd line drugs for MDR-TB)

Answer 24

Bedaquiline

Question 25

Nitroimidazole (2nd line drugs for MDR-TB)

Answer 25

Delamanid

Question 26

Inhibits mycolic acid synthesis; QT prolongation (2nd line drugs for MDR-TB)

Answer 26

Delamanid

Question 27

Alanine racemase inhibitor (2nd line drugs for MDR-TB)

Answer 27

Cycloserine

Question 28

Neurotoxicity (give pyridoxine); psychiatric effects (2nd line drugs for MDR-TB)

Answer 28

Cycloserine

Question 29

Other name for leprosy

Answer 29

Hansen's disease

Question 30

≥5 skin lesions (Types of leprosy)

Answer 30

Multibacillary (MB)

Question 31

<5 skin lesions (Types of leprosy)

Answer 31

Paucibacillary (PB)

Question 32

Pharmacotherapy for multibacillary (MB) leprosy (RDC)

Answer 32

Rifampicin + Dapsone + Clofazimine for 12 months

Question 33

Pharmacotherapy for paucibacillary (PB) leprosy (RD)

Answer 33

Rifampicin + Dapsone for 6 months

Question 34

Inhibits dihydropteroate synthase (folate pathway) (Anti-leprosy drugs)

Answer 34

Dapsone

Question 35

Hemolysis (esp. in G6PD deficiency); methemoglobinemia (Anti-leprosy drugs)

Answer 35

Dapsone

Question 36

RNA polymerase inhibitor; bactericidal; given monthly under supervision (Anti-leprosy drugs)

Answer 36

Rifampicin

Question 37

Binds DNA, anti-inflammatory; skin discoloration (red-brown), GI effects ; used in MB (Anti-leprosy drugs)

Answer 37

Clofazimine

Question 38

Meaning of MAC

Answer 38

Mycobacterium avium complex

Question 39

Mycobacterium avium complex (MAC), M. kansasii, M. fortuitum are examples of __________

Answer 39

Atypical mycobacterium

Question 40

Prophylaxis for atypical mycobacterium (AC)

Answer 40

Azithromycin, Clarithromycin (when CD4 <50/mm3 in HIV/AIDS)

Question 41

Atypical mycobacterium is treated for at least _________, often based on culture clearance and clinical response

Answer 41

12 months

Question 42

Backbone of MAC treatment; QT risk (Drugs for atypical mycobacterium)

Answer 42

Macrolides (Azithromycin, Clarithromycin)

Question 43

Used in combination (Drugs for atypical mycobacterium)

Answer 43

Ethambutol

Question 44

Rifabutin preferred in HIV (fewer CYP interactions) (Drugs for atypical mycobacterium) (RR)

Answer 44

Rifampicin, Rifabutin

Question 45

Agents involved - INH, Rifampicin, Pyrazinamide, PAS (Risk)

Answer 45

Hepatotoxicity

Question 46

Notes - Monitor LFTs; stop if ALT >5x ULN or symptoms develop (Risk)

Answer 46

Hepatotoxicity

Question 47

Agents involved - INH, cycloserine, linezolid (Risk)

Answer 47

Neurotoxicity

Question 48

Notes - Pyridoxine (Vitamin B6) supplementation recommended (Risk)

Answer 48

Neurotoxicity

Question 49

Agents involved - Streptomycin, amikacin, capreomycin (Risk)

Answer 49

Ototoxicity

Question 50

Notes - baseline audiometry for injectables (Risk)

Answer 50

Ototoxicity

Question 51

Agents involved - Bedaquiline, delamanid, macrolides (Risk)

Answer 51

QT prolongation

Question 52

Notes - ECG monitoring, avoid other QT-prolonging drugs (Risk)

Answer 52

QT prolongation

Question 53

Agents involved - Rifampcin > Rifabutin (Risk)

Answer 53

CYP450 interaction

Question 54

Notes - Decrease OCPs, warfarin, many antivirals, antiepileptics (Risk)

Answer 54

CYP450 interaction