• Tuberculosis (TB) is an infectious disease usually caused by the bacterium Mycobacterium tuberculosis (MTB).
• Tuberculosis generally affects the lungs, but can also affect other parts of the body.
• Most infections do not have symptoms, in which case it is known as latent tuberculosis. About 10% of latent infections progress to active disease, which, if left untreated, kills about half of those infected.
• The classic symptoms of active TB are a chronic cough with blood-containing sputum, fever, night sweats, and weight loss.
• The historical term "consumption" came about due to the weight loss. Infection of other organs can cause a wide range of symptoms.
• Tuberculosis is spread through the air when people who have active TB in their lungs cough, spit, speak, or sneeze. People with latent TB do not spread the disease. Active infection occurs more often in people with HIV/AIDS and in those who smoke.
This PPT covers drug therapy for tuberculosis. It includes classification of antitubercular drugs, chemotherapy for tuberculosis, strategies for addressing resistance and pharmacotherapy of antitubercular drugs
• Tuberculosis (TB) is an infectious disease usually caused by the bacterium Mycobacterium tuberculosis (MTB).
• Tuberculosis generally affects the lungs, but can also affect other parts of the body.
• Most infections do not have symptoms, in which case it is known as latent tuberculosis. About 10% of latent infections progress to active disease, which, if left untreated, kills about half of those infected.
• The classic symptoms of active TB are a chronic cough with blood-containing sputum, fever, night sweats, and weight loss.
• The historical term "consumption" came about due to the weight loss. Infection of other organs can cause a wide range of symptoms.
• Tuberculosis is spread through the air when people who have active TB in their lungs cough, spit, speak, or sneeze. People with latent TB do not spread the disease. Active infection occurs more often in people with HIV/AIDS and in those who smoke.
This PPT covers drug therapy for tuberculosis. It includes classification of antitubercular drugs, chemotherapy for tuberculosis, strategies for addressing resistance and pharmacotherapy of antitubercular drugs
Anti Tubercular Drugs - Mechanism of Action and Adverse effects Thomas Kurian
A brief outline of the mechanism of action and adverse effects of anti tubercular drugs
Only First line and second line drugs are dealt with.First line drugs may be useful for MBBS students and the rest is directed for postgraduate students.
Hope you find it useful.
The current slide include the pharmacology og cephalosporins.
Contents
Introduction to Cephalosporins
Classification of Cephalosporins
Cefazolin
Cephalexin
Cefuroxime
Cefuroxime axetil
Cefotaxime
Cefixime
Cefpodoxime proxetil
Cefepime
Adverse effects of Cephalosporins
Uses of Cephalosporins
Anti Tubercular Drugs - Mechanism of Action and Adverse effects Thomas Kurian
A brief outline of the mechanism of action and adverse effects of anti tubercular drugs
Only First line and second line drugs are dealt with.First line drugs may be useful for MBBS students and the rest is directed for postgraduate students.
Hope you find it useful.
The current slide include the pharmacology og cephalosporins.
Contents
Introduction to Cephalosporins
Classification of Cephalosporins
Cefazolin
Cephalexin
Cefuroxime
Cefuroxime axetil
Cefotaxime
Cefixime
Cefpodoxime proxetil
Cefepime
Adverse effects of Cephalosporins
Uses of Cephalosporins
This presentation describes epidemiology of tuberculosis, classification of anti-tubercular drugs based on the efficacy and priority and the pharmacology of the anti-tubercular drugs.
This interesting, illustrative presentation is a preliminary guide for preparing medical & paramedical teachers for effective teaching and enable them to conduct different courses for medical & paramedical students
This interesting and useful ppt highlights different pharmacokinetic concepts with illustrations for easy understanding - an overview for revision for medical and paramedical students
This is an excellent ppt on Dermatological pharmacology highlighting types of formulations, topical preparations and the treatment of individual skin disorders with illustrations...!!
This interesting ppt is the continuation of the Pharmacology of Opioid analgesics I... This impressive ppt highlight the pharmacology, advantages and disadvantages of opioid analgesics other than morphine with illustrations....!!
This interesting ppt is about the Pharmacology of morphine and acute morphine poisoning dealt with illustrative pictures, diagrams to facilitate learning for medical/paramedical students....
This is an Inspiring presentation on cultural diversities of india and how to work in cohesion.. mainly for medical students studying Foundation course in medicine...
This is an interesting and novel PPT on the Pharmacology of NSAIDs, on drugs other than aspirin ( for Aspirin check NSAIDs PART I ) illustrated with beautiful pictures and flowcharts....!!
This is my latest PPT on the Principles of student assessment in medical education which is illustrated with suitable pictures, diagrams for understanding better..
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. COMPETENCY
ACHIEVMENT
1:44
PH 1.44 Describe the first
line antitubercular drugs,
their mechanism of action,
side effects and doses.
1:45
PH 1.45 Describe the drugs
used in MDR and XDR
tuberculosis
3. OUTLINE
What is tuberculosis ?
Symptoms
First line drugs
Second line drugs
Newer drugs
Treatment of tuberculosis : Goals & General principles
Drug resistant tuberculosis
Management ofADR
Chemoprophylaxis
TB in pregnancy & in AIDS
4. SPECIFIC LEARNING OBJECTIVES
At the end of the session, learners shall be able to
• Classify Antitubercular Drugs correctly.
• Describe the mechanism of action, adverse effects, drug interactions
and therapeutic uses of first line Antitubercular drugs rightly.
• Describe the mechanism of action, adverse effects of Antitubercular
drugs used in MDR and XDR tuberculosis rightly.
• Enumerate the Antitubercular drug regimen with dosage accurately.
5. TUBERCULOSIS
A chronic
granulomatous disease
caused by
mycobacterium
tuberculosis
Major health problem
1/3 of world population
infected
Increased incidence
because of HIV spread
MDR tuberculosis is
emerging
22. FIRST LINE DRUGS
INH (1952)
Rifampicin
(1962)
Pyrazinamide
Ethambutol
(1961)
Streptomycin
(1947)
Have high
efficacy and
low toxicity
Used routinely
23.
24.
25. SECOND LINE DRUGS
Thiacetazone Ethionamide PAS Kanamycin
Amikacin Capreomycin
Have low
efficacy or high
toxicity or both
Used in special
circumstances
only
32. INH –
TOXICITY &
PREVENTION
Hepatotoxicity is seen in
older people and alcoholics,
reversible on stoppage of drug
Pyridoxine given along with INH to prevent
neurotoxicity
34. RIFAMPICIN
Semisynthetic derivative of
Rifamycin B
Binds with beta subunit of
DNA dependent RNA
polymerase of bacteria
forms drug-enzyme
complex Inhibits mRNA
synthesis bactericidal
Orally absorbed, food
interferes, has to be taken
in empty stomach
undergo enterohepatic
circulation
Attains high concentrations
in CSF
36. RIFAMPICIN - Other uses
Important 1st line drug
in leprosy
Atypical mycobacterial
infections
2nd choice for MRSA
with doxycycline 1st line
for brucellosis,
prophylaxis of
meningococcal
meningitis, H.influenza
meningitis,
legionella pneumonia
Alternative drug for
anthrax
37.
38.
39.
40.
41.
42.
43.
44.
45. RIFAMPICIN –
DRUG
INTERACTIONS
it is a microsomal enzyme inducer failure of
OC pills,
decreases levels of
sulfonylureas,
anti HIV drugs,
theophylline
46. RIFAMPICIN - ADVANTAGES
Acts best on
spurters and
persisters
Also act on
semidormant
bacilli
Has good
sterilizing
action
Has resistance
preventing
action
Widely
distributed
48. PYRAZINAMIDE
Chemically similar to
INH
Weakly tuberculocidal
More active in acidic
medium
Have good ‘sterilizing’
activity
Inhibit mycolic acid
synthesis
Widely distributed &
penetratesCSF well
ADR – hepatotoxicity,
hyperuricemia, fever,
arthralgia, flushing,
rashes, loss of diabetes
control
C/I – liver disease
50. ETHAMBUTOL
Tuberculostatic As active as S
Inhibit arabinosyl
transferases and
Interfere with mycolic
acid incorporation into
cell wall
Resistance develop
slowly
ADR – loss of visual
acuity/colour vision due
to optic neuritis, rash,
fever, hyperuricemia
CAUTION – renal
disease
C/I - < 6 years of age
52. STREPTOMYCIN
1st AntiTubercular drug, supplemental 1st line drug
Less effective than INH, Rifampicin
Acts only on extracellular bacilli
Penetrates tubercular cavities
Does not cross CSF
Resistance develops rapidly when used alone
Has to be given I.M
Has lower margin of safety
ADR - Ototoxicity, nephrotoxicity
Usage has declined ( used for the maximum of 2 months )
57. SECOND LINE
DRUGS
• Thiacetazone
• Ethionamide
• PAS
• Kanamycin
• Amikacin
• Capreomycin
• Have low efficacy or high toxicity or both
• Used in special circumstances only
58. THIACETAZONE
Tuberculostatic, low
efficacy drug
Hepatotoxic
discarded in the west
Low cost
Used with INH to
prevent DRUG
RESISTANCE
ADR – hepatitis, bone
marrow depression,
stevens johnson
syndrome, cerebral
edema
Reserve anti-TB drug
Should not be used in
HIV patients
59. PAS
Related to sulfonamide
Tuberculostatic
Delays resistance
Cause Hypersensitivity reactions,
GI distress
Very high dose ( 10 – 12 grams / day )
Poor patient acceptability
Rarely used now ( only in resistantTB )
60. OTHER DRUGS
• ETHIONAMIDE – Hepatotoxic, cause allergy, neuritis,
gastric intolerance,CNS toxicity seldom used
used only in case of resistance
• CYCLOSERINE – An antibiotic with high CNS toxicity
(sleepiness, headache, tremor, psychosis, suicidal
tendencies, convulsions ) inhibits cell wall synthesis
• KANAMYCIN,AMIKACIN, CAPREOMYCIN – more
toxic antibiotics, reserve drugs in rare cases, given I.M
61. Second-line Anti-TB Drugs
Weaker than
first-line.
Cause adverse
reactions.
Difficult for
patient to
tolerate
Should be
taken for long
periods
Very expensive.
Cure rates are
much lower
than of patients
susceptible to
the first-line
drugs.
64. NEWER DRUGS
• CIPROFLOXACIN,OFLOXACIN, LEVOFLOXACIN,
SPARFLOXACIN, MOXIFLOXACIN – Combination
regimen in MDR tuberculosis, MAC infection in HIV
patients, good tolerability, penetrates cells
• MACROLIDES – CLARITHROMYCIN,AZITHROMYCIN
- MDR tuberculosis, non tubercular mycobacteria
• RIFABUTIN – Related to rifampicin, cross resistance
seen, More active on MAC in AIDS, weak enzyme
inducer
• ADR cause rash, myalgia, uveitis, granulocytopenia
65.
66.
67. BEDAQUILINE
• Recent diarylquinoline drug
• Act by novel mechanism
• Inhibits mycobacterial ATP synthase limits energy
production within the mycobacterial cell
• MICs are very low
• No cross resistance
• Well absorbed orally
• Due to redistribution terminal half life is very long ( 160
days )
• Only for MDR-TB
• ADR NAUSEA, headache, arthralgia, prolongation
of QTc interval, hepatotoxic
74. THE GOALS OFTREATMENT
Kill dividing bacilli
– to relieve
symptoms and
non-contagious
Kill persisting
bacilli – to prevent
relapse
& to provide cure
Prevent
emergence of
resistance –
to prevent
treatment failure
• to provide adequate
response
77. GENERAL
PRINCIPLES
Use Combinations of 2 or more drugs
Combination of INH and R is synergistic which shortens
the duration of therapy
Single daily dose of all 1st line drugs is preferred
Response is fast in the 1st few weeks
Follow DOTS (directly observed treatment short course )
87. MDRTB
(MULTIDRUG
-RESISTANT)
Some die in 4-16 weeks
1 or more 2nd line drugs for 12-24 months
Total of 5-6 drugs are given
Intensive phase ( 6-9 months )
Continuation phase ( 18 months )
H resistance – RZE for 12 months
H+R resistance – ZE+S/Kmc/Am/Cpr + Cipro/Ofl+- Etm
88.
89.
90. EXTENSIVELY DRUG RESISTENTTB
MDR-TB CASES
Resistant to at
least 4 cidal drugs
Virtually
untreatable
Mortality high
Intensive phase
( 6-12 months ) –
7 DRUGS
Continuation
phase( 18 months )
– 6 DRUGS
94. MANAGEMENT
OF ADR
Z – arthralgia ----- NSAIDs
H- peripheral neuritis ------ pyridoxine
E-optic neuritis ---- stop E
R - hemolysis, thrombocytopenia- stop R
H,R,Z – hepatotoxicity ---- stop all drugs till reaction
clears , add S+E or C
99. ROLE OF
CORTICOSTEROIDS
Ordinarily should not be used
Used under chemotherapeutic cover in
MiliaryTB
Hypersensitivity reactions
MeningealTB, renalTB, pleural effusion
Severe forms in AIDS patients
CONTRAINDICATED IN INTESTINAL TB
101. TB IN
PREGNANCY
H,R, Z, E SAFE
2HRZE +4 HRE
S is contraindicated ( Ototoxic )
To Avoid Z 2HRE +7HR
During lactation baby should be watched, infant has to
be given BCG vaccine + INH prophylaxis,+ Pyridoxine
102.
103.
104.
105.
106.
107.
108. TUBERCULOSIS
IN AIDS
More severe
ADR and drug interactions more common
ATT duration longer
HRZE for 2 months +HRE for 4- 7 months
Pyridoxine to be added
Also receive co-trimoxazole
Rifabutin for Rifampicin
109.
110.
111. MAC INFECTION IN
AIDS
• Clari/azithro + E + Rifabutin + one FQ for 2-6 months
followed by clari /azithro + E/ one FQ for 12 months