Anti tubercular drugs PHARMACOLOGY REVISION NOTES
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This document discusses various anti-tubercular drugs used for treating tuberculosis. It describes first-line drugs like isoniazid, rifampicin, ethambutol, streptomycin and pyrazinamide. It also mentions second-line drugs used when patients develop resistance. The document provides details on the mechanisms of action, side effects, dosage adjustments and monitoring of tuberculosis patients through a web-based system called NIKSHAY.
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Anti tubercular drugs PHARMACOLOGY REVISION NOTES
- 1. Anti tubercular drugs TONYSCARIA 2010 KMC
- 2. First line • Isoniazid • Rifampicin • Ethambutol • Streptomycin • Pyrazinamide Second line • Cycloserine • Kanamycin • Amikacin • Ciprofloxacin • Ofloxacin • Clarithromycin TONYSCARIA 2010 KMC
- 3. INH • Drug of choice for TB • Inhibit synthesis of mycolic acid • DOC for prophylaxis of TB TONYSCARIA 2010 KMC
- 6. INH • Most effective antitubercular drug against intracellular & extracellular organism • Penetrates in to caseous material & perisist in therapeutic concentration TONYSCARIA 2010 KMC
- 7. INH • Metabolised by acetylation • Metabolism is under genetic control • Fast acetylation • Slow acetylation TONYSCARIA 2010 KMC
- 8. s/e of INH • Peripheral neuritis • Transient memory loss • Psychosis • Hepatitis • Optic neuritis TONYSCARIA 2010 KMC
- 10. Rifampicin • Tuberculocidal for both dividing & nondividing bacteria • Inhibiting beta subunit of DNA dependant rna polymerase • bactericidal for both intracellular and extracellular mycobacteria, including M.tuberculosis, and atypical mycobacteria, such as M. kansasii • Only bactericidal drugs active against dormant bacilli in caseous lesions TONYSCARIA 2010 KMC
- 11. • Also used in • Meningococcal prophylaxis • Staphylococcal carrier state • Treatment of leprosy TONYSCARIA 2010 KMC
- 12. • Rifampin is well absorbed after oral administration and excreted mainly through the liver into bile. It then undergoes enterohepatic recirculation, with the bulk excreted as a deacylated metabolite in feces and a small amount in the urine. • Dosage adjustment for renal or hepatic insufficiency is not necessary TONYSCARIA 2010 KMC
- 13. • s/e • Orange discolouration of urine & other secretion • Flu like syndrome • Hepatitis TONYSCARIA 2010 KMC
- 14. Rifampicin is an enzyme inducer Rifampicin induces metabolism of antiretrovirals hence in AIDS patients with TB rifabutin is used TONYSCARIA 2010 KMC
- 15. Rifabutin • derivative of rifampin, • less potent inducer of cytochrome P450 enzymes. • preferred drug for use in tuberculosis-infected patients with the human immunodefciency virus (HIV), who are concomitantly treated with protease inhibitors or nonnucleoside reverse transcriptase inhibitors • Rifabutin has adverse effects similar to those of rifampin, but can also cause uveitis, skin hyperpigmentation, and neutropenia • No dose adjustment needed in hepatic or renal failure TONYSCARIA 2010 KMC
- 16. Ethambutol • Only first line tuberculostatic drug • Fast multiplying bacilli are more susceptible • does not cross BBB TONYSCARIA 2010 KMC
- 17. Ethambutol inhibit arabinosyl transferase inhibit mycolic acid synthesis TONYSCARIA 2010 KMC
- 18. S/E • Retrobulbar neuritis • Red green colour blindness • Hyperuricemia • Peripheral neuritis ‘ TONYSCARIA 2010 KMC
- 19. Pyrazinamide • Tuberculocidal drug • Acts by inhibiting mycolic acid synthesis • active against slowly dividing organisms • Active drug against intracellular bacteria • Pyrazinamide is active against tubercle bacilli in the acidic environment of lysosomes, as well as, in macrophage TONYSCARIA 2010 KMC
- 20. • S/E • Arthralgia • Hyperuricemia • MOST HEPATOTOXIC ANTITUBERCULAR DRUG TONYSCARIA 2010 KMC
- 21. Ethionamide • Develops cross resistance to INH • S/E • Optic neuritis • Optic neuritis hypothyroidism TONYSCARIA 2010 KMC
- 24. No dose adjustment in renal failure • Rifapentine • Rifabutin • Rifamycin TONYSCARIA 2010 KMC
- 25. Hypothyroidism can be caused by • PAS • Ethionamide TONYSCARIA 2010 KMC
- 26. Hyperuricemia caused by • Pyrazinamide • Ethambutol TONYSCARIA 2010 KMC
- 30. NIKSHAY- A web based solution for monitoring of TB patients • SMS services have been used effectively for communication with patients and monitoring the programme on day to day basis. TONYSCARIA 2010 KMC