Tuberculosis is completely curable disease now a days but one should follow the treatment regimens correctly .so for under graduate MBBS students it is clearly explained with animations.Hope you all this will be helpful.
Brief information about Tuberculosis, drugs used for its treatment including recent advances and drug regimen for patients of different categories of TB suggested by WHO (DOTS therapy) including national and international programes for preventing TB.
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.
Brief information about Tuberculosis, drugs used for its treatment including recent advances and drug regimen for patients of different categories of TB suggested by WHO (DOTS therapy) including national and international programes for preventing TB.
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.
synthetic antimicrobials having a quinolone structure that are active primarily against gram-negative bacteria, though newer fluorinated compounds also inhibit gram-positive ones.
Pharmacology of Penicllins (Beta lactam antibiotics), description of their mechanism of action, mechanism of resistance, classification, indications and adverse effects
synthetic antimicrobials having a quinolone structure that are active primarily against gram-negative bacteria, though newer fluorinated compounds also inhibit gram-positive ones.
Pharmacology of Penicllins (Beta lactam antibiotics), description of their mechanism of action, mechanism of resistance, classification, indications and adverse effects
My Powerpoint on Tuberculosis, includes:
What is the incidence and prevalence?
What are the symptoms?
How is it diagnosed?
How is it treated?
What are the treatment guidelines?
Anti mycobacterial drugs (tuberculosis drugs)Ravish Yadav
The all the content in this profile is completed by the teachers, students as well as other health care peoples.
thank you, all the respected peoples, for giving the information to complete this presentation.
this information is free to use by anyone.
Leprosy
Tuberculosis
TYB pharmacy
Pharmacology semester VI notes
Pharmacology VI semester
Pharmacology notes
Third year B pharmacy pharmacology notes
Pharmacology unit 3 notes
Pharmacology VI semester notes
Presentation about tuberculosis, it's epidemiology, pathology, antituberculosis drugs, and their mechanism of actions, ADR's and case study of a tuberculosis patient.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3. • TUBERCULOSIS is an infectious disease caused by
Mycobacteria; Mycobacterium tuberculosis &
Mycobacterium bovis.
MODE OF TRANSMISSION
Inhalation of droplets
Ingestion --self swallowing of infected sputum/ or
ingestion of unpasteurised milk of infected cow
Inoculation – of organism in to skin may occur
rarely from infected postmortem tissue.
Transplacental – ie tuberculosis of foetus from
mother.
4. Macrophage
with tubercle
bacilli
• Major portion of tubercle bacilli
become intracellular(i.e reside in
macrophage),so it is inaccessible for
majority of antibiotics as they cannot
penetrate easily in to the
macrophage.
• It was once considered to be an
incurable disease but now it is
curable by a number of
chemotherapeutic agents.
5. Classification of anti TB drugs
1st Line Essential
drugs
1st Line
supplemental
drugs
2nd Line drugs
Eg-
RIFAMPICIN
ISONIAZID
PYRIZINAMIDE
ETHAMBUTOL
(RIPE)
Eg-
Rifabutin
Rifapentin
streptomycin
Eg-
Fluroquinolones
Amikacin
Capreomycin
Ethionamide
p-Aminosalicylic
acid
Cycloserine
(FACEPaC)
6. • 1st line essential drugs– most effective & basic
components of anti tubercular treatment.
• 1st linesupplemental drugs– are quite effective &
posseses an acceptable limit of toxicity. These are
kept as reserved drugs & used in special settings.
• 2nd line drugs—these drugs are used if there is
resistance to 1st line drugs or if 1st line drugs are
contraindicated for some reason. These drugs are
less effective & slightly more toxic than Ist line
drugs(except Fluoroquinolones)
• NEWER DRUG UNDER INVESTIGATION--
LINEZOLID
7. CATEGORY PATIENT TYPE DURATION OF
TREATMENT
DRUG REGIMEN
CATEGORY 1 NEW UNTREATED
SMEAR +VE
PULMONARY T.B
6 MONTHS RIPE FOR 2
MONTHS , THEN
R I FOR 4
MONTHS
CATEGORY 2 SMEAR +VE
RETREATMENT
GROUP(RELAPSE
OR TREATMENT
FAILURE)
8 MONTHS RIPE +
STREPTOMYCIN
FOR
2MONTHS;THEN
RIPE FOR 1
MONTH; THEN RIE
FOR 5 MONTHS
CATEGORY 3 SMEAR –VE
PULMONARY T.B
OR LESS SEVERE
EXTRA
PULMONARY TB
6 MONTHS RIP FOR 2
MONTHS THEN
R I FOR 4
MONTHS
8. Treatment of tuberculosis
• One of the main reason for threrapeutic failure
has been patients poor compliancen after having
symptomatic relief.
• WHO , therefore has recommended
DOTS(Directly Observed Therapy for Short
course) wherein the anti-TB drugs are given
under direct supervision of medical professional 3
days a week.
• This helps to ensure the right drugs are taken at
the right time for the full duration of treatment
9. • A Standardized recording and reporting
is maintained by health worker or
medical professional. This helps to keep
track of each individual patient and to monitor
overall programme performance.
• T.B therapy normally begins with 4 1st line
drugs: rifampicin + isoniazid + pyrizinamide +
ethambutol for 2months followed by a course
of isoniazid + rifampicin for next 4 months.
• Combination of drugs ensures prevention of
resistance by mycobacteria
10. Individual drugs.
Isonicotinic acid hydrazide
• INH is a pro drug & is converted into active
form by bacterial enzyme catalase peroxidase.
• SITE OF ACTION– Both intracellular &
extracellular ; also in casseous lesions.
• It is bactericidal to actively growing tubercle
bacilli but not to dormant organisms which
are only inhibited.
• It is active against mycobacterium tuberculosis
& mycobacterium kansasii
11. MECHANISM OF ACTION
INH is converted to active form by catalase
peroxidase (produced by mycobacterium) .
The active form inhibits mycolic acid in outer layer
of cell wall.
Also inhibits DNA, RNA & various oxidative
enzymes.
It is equally active in acidic & alkaline medium
12. Mycobaterium cell wall has the following layers viz.
– mycosides, mycolic acid, arabinoglycan,
peptidoglycan.INH inhibits mycolic acid synthesis
while ethambutol inhibit arabinoglycan layer
ARABINOGLYCAN
INH
(PRODRUG)
Catalase peroxidase
INH
(ACTIVE)
MYCOLIC
ACID
SYNTHESIS
INHIBITED
PEPTIDOGLYCAN
CELL MEMBRANE
13. MECHANISM OF RESISTANCE
• Resistance to INH is due to mutation in
CATALASE – PEROXIDASE GENE which is
responsible for activation of INH.
• Another mechanism responsible for resistance
is mutation in PROMOTER GENE , which is
involved in mycolic acid biosynthesis
14. Pharmacokinetics
• Absorption– well absorbed orally
• Distribution– readily distributed in pleural ,
peritoneal & synovial fluids.
CSF concentrations are reached up to 100% if
meninges are inflammed.
• Metabolism – metabolised in liver by N –
acetyl transferase
15. INH N- acetyl transferase Acetyl INH Hepatotoxic
The rate of above reaction varies in different people
i.e the reaction may be rapid or slow.
Accordingly people are classified as RAPID
ACETYLATORS( rate of reaction is rapid forming
acetyl INH eg.- 30-40% Indians, Japanese) &
SLOW ACETYLATORS (rate of reaction is sloweg.-
60-70% Indians, egyptians, jews,swedes).
Plasma half life– a)in rapid acetylators– T ½ = 1h
b)in slow acetylators– T ½ = 3h
16. • The acetylator status of an individual may
influence nature of INH toxicity but not
the anti tubercular response(if INH is
given once daily) because its plasma
concentration normally remains above
inhibitory concentration.
Peripheral neuritis --- commonly in slow
acetylators because accumulated INH
inhibits pyridoxine kinase which converts
pyridoxine to its active form pyridoxyl
phosphate.
17. • Also INH increases excretion of pyridoxine in
urine.
• This side effect can be prevented by giving vit-b6(
pyridoxine) prohylactically in 10-40 mg /
day.
• Hepatotoxicity --- common in fast acetylators
because INH is metabolised in to acetyl INH
which is hepatotoxic.
• Hepatotoxicity is a common side effect by INH
in alcoholics, liver diseases & in people aged
50-65 years.
18. • The drug has to be discontinued at onset of
symptoms like nausea, loss of apetite, abdominal
pain, & on rise of amino transferase enzymes by 3
fold.
• Other side effects are allergic reactions like fever,
rashes, & xerostomia , haematological changes &
convulsions in seizure – prone patients, drug
induced lupus erythematous.
Drug interactions
Aluminium hydroxide inhibits absorption of INH.
Alcohol increases risk of hepatitis.
INH inhibits metabolism of phenytoin &
carbamazepine
19. • DOSAGE
In adult– 300mg O.D or 5mg/kg/day
For serious infections or meningitis – 600mg O.D
Duration of treatment is related to drug
combination used.
RIFAMPICIN is a semisynthetic derivative of
macrocyclic antibiotic Rifamycin
20. Anti microbial activity- bactericidal against both
intracellular & extracellular tubercle bacilli. In
addition , it is active against M.leprae,
Staph.aureus, N meningitidis, H. influenza,
Brucella, Legionella.
Mechanism of action of Rifampicin
Rifampicin inhibits bacterial DNA DEPENDENT
RNA POLYMERASE.
Mammalian RNA polymerase is not inhibited , so
RNA synthesis of host cells is not affected.
21. MECHANISM OF RESISTANCE
Resistance develops mutation in rpo B gene which
prevents binding of rifampicin to RNA
polymerase.
Hence if used alone resistance develops rapidly. It is
a potent enzyme inducer
Pharmacokinetics
Absorption--well absorbed after oral administration
Distribution – it penetrates in all tissues , tubercular
cavities, placenta. Adequate CSF levels are
reached if meninges are inflammed.
It is significantly protein bound.
22. • Excretion – drug is excreted via bile &
undergoes entero hepatic circulation.
ADVERSE EFFECTS
• HEPATITIS is major side effect. It is dose
dependent & reversible. It is common in
patients with underlying liver disease. Risk
of hepatitis increses when used in
combination with INH.
• Occasional side effects include FLU-LIKE
SYNDROME characterised by fever chills ,
myalgias & thrombocytopenia,
• Rifampicin imparts RED ORANGE COLOR
TO URINE.
23. DOSAGE
For T.B- 600mg(10mg/kg/day) as a single dose
before breakfast.
For brucellosis – in combination with doxycycline
(first choice combination)
For leprosy – in combination with dapsone
For prophylxis of meningitis caused by
meningococcus—600mg B.D for 2 days.
For prophylxis of meningitis caused by H.influenza–
600mg/day for 4 days.
Rifampicin can also be used for prosthetic valve
endocarditis.
24. DRUG INTERACTIONS
Accelerates metabolism of oral contraceptives,
anticoagulants, protease inhibitors used in HIV
patients, which may result in therapeutic
failure.
Ethambutol is a synthetic tuberculostatic drug
active against M.tuberculosis, M.kamsasii &
M.avium intracellulare.
25. MECHNISM OF ACTION
ETHAMBUTOL inhibits polymerisation of
arabinoglycans of cell wall by inhibiting
arabinosyl transferase
MYCOLIC ACIDS
ARABINOGLYCAN
PEPTIDOGLYCAN
CELL MEMBRANE
26. MECHANISM OF RESISTANCE
Resistance develops due to point mutations in
emb B gene that encodes arabinosyl
transferases enzyme involved in mycobacterial
cell wall synthesis.
Pharmacokinetics
Bioavailability– 80%
Distribution– widely distributed in all body fluids
including CSF
27. DOSAGE
Should not be used alone as resistance
develops rapidly.
Usual daily dose is 800-1000mg orally
(15mg/kg/day).
It can also be given in a dose of 1600mg/day
In the treatment of M.avium intracellulare
infection in AIDS patients– ethambutol is used
in combination with rifabutin + clarithromycin.
Higher doses are needed to treat tuberculous
meningitis.
28. ADVERSE EFFECTS
Ethambutol if used in a dose of
25mg/kg/day for more than 9
days can cause RETROBULBAR
NEURITIS IMPAIRING VISUAL
ACTIVITY & RED – GREEN COLOR
DISCRIMINATION.
This effect is dose related reverses
slowly after discontinuing the
drug.
Periodic visual activity testing is
desirable during is desirable
during treatment period.
29. • Ethambutol should be avoided
in in children below 5 years
where it is difficult to asses
visual activity & red – green
color discrimination.
• Ethambutol decreases renal
excretion of urates & may
precipitate gouty arthritis.
• Mild GIT intolerance , rashes,
fever & dizziness are also
possible.
30. Pyrazinamide(PZA)
• It is pyrazine derivative of nicotinamide.
• Because of its hepatotoxicity its use had declined
earlier.
• But recently pyrizinamide in reduced doses & in
combination re emerged as 3rd most important
anti tuberculosis agent.
o It is bactericidal to M.tuberculosis & is active only
at low pH only.
o It is highly effective only on intracellular
mycobacteria(due to acidic environment
intracellularly in macrophages)
31. MECHNISM OF ACTION
PZA is thought to enter enter M.tuberculosis by
passive diffusion & is converted to pyrizinoic
acid (its active metabolite) by bacterial
enzyme pyrizinamidase enzyme.
The active metabolite then inhibits
mycobacterial fatty acid synthase 1 enzyme &
disrupts mycolic acid synthesis needed for cell
wall synthesis.
33. • Mechanism of resistance
A mutation in the gene (pnc A) that encodes
pyrizinamidase is responsible for drug
resistance which can be minimised by drug
combination therapy.
Pharmacokinetics
Absorption– well absorbed orally
Distribution– widely diustributed in all tissues,
macrophages, tubercular cavities & in
meningitis.
Plasma half life– 9-10hrs.
34. Streptomycin
• It is the first antitubercular drug.
• It is bactericidal but because of poor
penetration it acts only on extracellular
tubercular bacilli.
• It is also active against M.kansasii & M.avium
intracellulare.
• It is less effective than INH or Rifampicin
Pharmacokinetics
Route of administration– I.M , cant be given
orally as it is highly polar
35. • Distribution – poorly distributed , do not
penetrate most cellular compartments.
• Metabolism -- as they do not penetrate most
cellular compartments , they do not undergo
significant metabolism.
• Excretion- nearly all of the drug is cleared by
kidneys as they do not undergo significant
metabolism.
• Plasma half life– 1.5 – 3 hrs(24-48 hrs in renal
insufficiency)
36. Mechanism of action
The mechanism of action of streptomycin is
inhibition of protein synthesis of mycobacteria in
the ribosome
Mechanism of resistance
Spontaneous resistance to streptomycin is related
to point mutation of the genes –rpsl or rrs that
encode for ribosomal proteins & ribosomal tRNA
respectively.
Dosage
1000mg/day I.M (15mg/kg/day)
Should be reduced to 500-750mg in elderly & in
renal insufficiency.
37. • Even for thrice a week dose schedule the
dose structure remains the same.
Adverse effects– nephrotoxicity & ototoxicity.
RIFABUTIN
IT IS a structural analogue of rifampicin.
It shares with rifampicin a common mechanism
of action , common spectrum of activity ,
aginst gram positive & negative organisms,
common molecular basis for development of
resistance.
38. • Hence there is cross resistance between
rifabutin & rifampicin.
• But rifampicin has better activity against
M.avium complex(MAC) .it is active against
rifampicin resistant strains such as M.leprae &
M.fortuitum. It has longer plasma half
life.(45hrs)
• It is used either alone or in combination with
pyrizinamide in the treatment of latent
tubercular infection.
39. • It can be used in place of rifampicin for the
treatmen of tuberculosis in HIV infected
patients.
• Most important use of rifabutin is in HIV
infected population for prevention &
treatment of disseminated MAC.
Dosage
300mg/day(5mg/kg/day)
Adverse effects– red orange color urine, skin
rash, hepatitis, neutropenia,
40. Drug interactions—
• May decrease plasma conc. Of theophylline,
oarl anti coagulants, protease inhibitors & non
nucleoside reverse transcriptase inhibitors
(but less than rifampicin).
• Fluconazole increases plasma concentration of
rifabutin resulting in pseudojaundice &
polymyalgia syndrome.
41. RIFAPENTINE
• Longer acting analogue of rifampicin(T ½ =13-
15hrs ).
• Its mechanism of action , cross resistance,
enzyme inducion, toxic profile & clinical use is
identical to rifampicin.
• It is not used alone but in 3-4 drug
combination regimen.
• Drug interactions are lower than rifampicin
but greater than rifabutin
• Dosage– 600mg once or twice weekly
42. Fluoroquinolones
• Specially used in multidrug resistant strains.
• Very effective when used as a part of
combined regimen in HIV infected patients.
• Ciprofloxacin, ofloxacin, levofloxacin &
moxifloxacin inhibit 90 – 95% of strains of
tubercle bacilli including MAC & M.fortuitum.
• They kill intracellular pathogens because of
good penetration.
• These can be substitued in drug combinations
if any Ist line drugs are contraindicated.
43. Dosage-
Ciprofloxacin– 750mg BD or 500mg TDS
Ofloxacin– 400mg BD
Levofloxacin500mg OD (preferred over
ofloxacin because of once daily dose schedule)
Moxifloxacin—400mg OD recent studies
suggest use of moxifloxacin with other drugs
reduces duration of therapy for drug
susceptible tuberculosis.
44. Amikacin
• It is an aminoglycoside antibiotic.
• It is 2nd choice after streptomycin &
capreomycin for multi drug resistant
tuberculosis.
• Most M.tuberculosis strains are that are
resistant to streptomycin are sensitive to
amikacin.
• It is also used in disseminated MAC
• Dose– 15mg/kg/day IM or IV for 5 days a
week for 2 months. Then 1g/day thrice weekly
for another 4 months.
45. Capreomycin
• It is tuberculocidal polypeptiode antibiotic.
• Effective against M.tuberculosis, M. kansassi,
M.avium .
• It is poorly absorbed from GIT , so should be
given parenterally( 1g/day IM).
• Side effects- ototoxicity & nephrotoxicity
46. • Rarely used tuberculostatic drug.
• It is hepatotoxic, neurotoxic & produces intense
gastric irritation.
• It blocks mycolic acid synthesis.
PARA-AMINO SALICYLIC ACID
It is a structural analogue of PABA.
Acts by inhibiting folate synthesis of bacteria.
Disadvantages – poor compliance due to GIT
intolerance, hypersensitivity reactions like skin rash,
lupus like reactions, drug fever , joint pain, hepatitis
Dose- 8-12g/ day in 2 or 3 divided doses
47. Cycloserine
• It is tuberculostatic drug.
• It is excreted unchanged in urine so it is used
for renal tuberculosis.
• Also Used in multi drug resistant tuberculosis
• Dose- 500 mh BD
• Side effects- psychotic behavioural changes ,
dizziness, peripheral neuropathy
48. NEWER ANTI TUBERCULAR DRUGS
LINEZOLID it is an antibiotic with 100% oral
bioavailability
VERY effective against drug susceptible & drug
resistant strains.
Adverse effects on prolonged use (which becomes
necessary for treatment of tuberculosis) may
limit its usefulness.
Adverse effects– reversible bone marrow
suppresion, peripheral neuropathy.
Dose- 600mg OD
49. R-207910
• it is di aryl quinoline derivative developed in
year 2004 & completed phase II trials.
• It inhibits proton pump for ATP synthase of M.
tuberculosis.
• It remarkably shortens duration of treatment
to 2 months or less.
• It is not yet available in the market.