Tuberculosis 2
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Questions and Answers

What is the recommended dose of isoniazid for tuberculosis meningitis?

  • 35 mg/kg
  • 22.5-30 mg/kg
  • 10 mg/kg
  • 15-20 mg/kg (correct)

    • Which regimen is recommended for rifampicin-susceptible, isoniazid-resistant tuberculosis?

  • Bedaquiline, levofloxacin, clofazimine for 6 months
  • Rifampicin, ethambutol, pyrazinamide, and levofloxacin for 4 months
  • Rifampicin, ethambutol, pyrazinamide, and levofloxacin for 6 months (correct)
  • Linezolid, clofazimine, ethionamide for 12 months

    • What is the duration of treatment for pulmonary tuberculosis?

  • 6-9 months
  • 12 months
  • 2-3 months
  • 4-6 months (correct)

    • For patients with multidrug- or rifampicin-resistant tuberculosis, what is the shorter regimen?

    <p>Bedaquiline, levofloxacin, clofazimine, ethambutol for 4-6 months</p> Signup and view all the answers

    Which of the following is NOT a criterion for the BPAL regimen in resistant tuberculosis?

    <p>Recent exposure to ethambutol</p> Signup and view all the answers

    Which drug is not part of the longer regimen for multidrug- or rifampicin-resistant tuberculosis?

    <p>Ethionamide</p> Signup and view all the answers

    What is the maximum recommended dosage of pyrazinamide for tuberculosis meningitis?

    <p>45 mg/kg</p> Signup and view all the answers

    What is the recommended dose range for the medication mentioned?

    <p>15mg/kg 750-1500mg</p> Signup and view all the answers

    What precaution should be taken regarding the use of hepatotoxic drugs?

    <p>They may worsen hepatic impairment and increase hepatotoxicity risk.</p> Signup and view all the answers

    Which of the following is a common side effect of the medication?

    <p>Dizziness</p> Signup and view all the answers

    How should aluminum-, calcium-, or magnesium-containing antacids be managed in relation to TB drug administration?

    <p>They should be taken 4 hours before or after TB drug administration.</p> Signup and view all the answers

    What is a key reason for educating patients about their TB treatment and potential adverse effects?

    <p>To improve treatment adherence and outcomes.</p> Signup and view all the answers

    What is the maximum recommended dose of rifampicin for adults?

    <p>600 mg</p> Signup and view all the answers

    Which of the following side effects is most commonly associated with pyrazinamide?

    <p>Polyarthralgia</p> Signup and view all the answers

    What is the primary mode of action of ethambutol?

    <p>Inhibits incorporation of mycolic acid</p> Signup and view all the answers

    What potential interaction should be considered when taking rifampicin?

    <p>Induces CYP enzymes</p> Signup and view all the answers

    When should pyrazinamide be avoided?

    <p>In acute gout</p> Signup and view all the answers

    How does food affect the bioavailability of rifampicin?

    <p>Decreases bioavailability</p> Signup and view all the answers

    What is the common practice for dosing rifampicin in terms of weight?

    <p>Based on total body weight</p> Signup and view all the answers

    Which of the following is a significant precaution when using ethambutol?

    <p>Optic neuritis</p> Signup and view all the answers

    What symptom may occur due to rifampicin’s side effects?

    <p>Orange-red coloration of body fluids</p> Signup and view all the answers

    What is the maximum dose of pyrazinamide for adults?

    <p>2 g</p> Signup and view all the answers

    What is the primary mode of action of bedaquiline?

    <p>Inhibits the c subunit of ATP synthase</p> Signup and view all the answers

    Which of the following is a precaution when using bedaquiline?

    <p>QT prolongation due to blocking hERG channel</p> Signup and view all the answers

    What is a significant side effect of pretomanid?

    <p>Loss of appetite</p> Signup and view all the answers

    How should bedaquiline be administered to ensure good bioavailability?

    <p>With food</p> Signup and view all the answers

    What is the dosing regimen for pretomanid?

    <p>200mg once daily for 26 weeks</p> Signup and view all the answers

    Which drug interacts as a CYP3A4 substrate?

    <p>Both A and C</p> Signup and view all the answers

    What is the mechanism through which linezolid operates?

    <p>Binding to 23S ribosomal RNA of the 50S subunit</p> Signup and view all the answers

    Which adverse effect is specifically associated with linezolid?

    <p>Anaemia and thrombocytopenia</p> Signup and view all the answers

    What leads to the delayed effect of bedaquiline observed from day 4 onward?

    <p>The bacteria's ATP storage allowing for initial survival</p> Signup and view all the answers

    What is the primary mode of action of isoniazid?

    <p>Inhibiting synthesis of mycolic acids</p> Signup and view all the answers

    What is a common side effect of isoniazid treatment?

    <p>Hepatitis</p> Signup and view all the answers

    Which factor increases the risk of peripheral neuropathy in patients taking isoniazid?

    <p>Severe malnutrition</p> Signup and view all the answers

    In which group are fast acetylators at a higher risk during isoniazid treatment?

    <p>Increased risk of treatment failure due to low isoniazid levels</p> Signup and view all the answers

    What is the normal daily dose of isoniazid for adults?

    <p>5 mg/kg</p> Signup and view all the answers

    What is the action of rifampicin against M. tuberculosis?

    <p>Inhibiting bacterial RNA polymerase</p> Signup and view all the answers

    For slow acetylators, what is the suggested daily dose of isoniazid?

    <p>2.5 mg/kg</p> Signup and view all the answers

    Which of the following is a precaution for isoniazid administration?

    <p>Severe malnutrition</p> Signup and view all the answers

    What role does N-Acetyltransferase 2 play in the metabolism of isoniazid?

    <p>It activates isoniazid to its effective form</p> Signup and view all the answers

    What is the maximum dose of isoniazid for adults?

    <p>300 mg</p> Signup and view all the answers

    Study Notes

    Tuberculosis Treatment Regimens

    • Isoniazid: The recommended dose for tuberculosis meningitis is 10 mg/kg/day, up to a maximum of 900 mg/day.
    • Rifampicin-Susceptible, Isoniazid-Resistant Tuberculosis: The recommended regimen for rifampicin-susceptible, isoniazid-resistant tuberculosis involves a combination of rifampicin, pyrazinamide, ethambutol, and a fluoroquinolone (e.g., levofloxacin) for 2 months, followed by rifampicin, pyrazinamide, and ethambutol for 4 months.
    • Duration of Treatment for Pulmonary Tuberculosis: The standard duration of treatment for pulmonary tuberculosis is 6 months.
    • Shorter Regimen for Multidrug-Resistant Tuberculosis: For patients with multidrug- or rifampicin-resistant tuberculosis, a shorter regimen can be used, for example, 9 months, involving a combination of bedaquiline, pretomanid, and linezolid.
    • BPAL Regimen Criterion: The BPAL regimen (Bedaquiline, Pretomanid, Linezolid, and Amikacin) requires a minimum of one drug with activity against M. tuberculosis and resistance to both rifampicin and isoniazid.

    Specific Drug Considerations and Precautions

    • Longer Regimen for Multidrug-Resistant Tuberculosis: The longer regimen for multidrug- or rifampicin-resistant tuberculosis does not include pretomanid.
    • Pyrazinamide Dosing: The maximum recommended dosage of pyrazinamide for tuberculosis meningitis is 2 grams/day.
    • Pyrazinamide Dose Range: The recommended dose range for pyrazinamide for adults is 15-30 mg/kg/day.
    • Hepatotoxic Drugs: Monitor liver function tests closely when using hepatotoxic drugs like pyrazinamide and rifampicin.
    • Common Side Effect of Pyrazinamide: A common side effect of pyrazinamide is arthralgia (joint pain).
    • Antacids and TB Drugs: Administer aluminum-, calcium-, or magnesium-containing antacids at least 2 hours before or 4 hours after TB drug administration.
    • Patient Education: Educate patients about their TB treatment and potential adverse effects to ensure adherence and early detection of problems.
    • Rifampicin Maximum Dose: The maximum recommended dose of rifampicin for adults is 600 mg/day.
    • Ethambutol Mode of Action: Ethambutol’s primary mode of action is inhibiting the synthesis of arabinogalactan, a cell wall component of Mycobacterium tuberculosis.
    • Rifampicin Interaction: Consider potential interactions with rifampicin, which can induce the metabolism of certain drugs, affecting their efficacy.
    • Pyrazinamide Avoidance: Avoid the use of pyrazinamide during pregnancy, as it may be teratogenic.
    • Food and Rifampicin Bioavailability: Food does not significantly affect the bioavailability of rifampicin.
    • Rifampicin Dosing: Rifampicin is typically dosed based on body weight, with a common dose of 10 mg/kg/day.
    • Ethambutol Precaution: A significant precaution when using ethambutol is monitoring for optic neuritis, a potentially serious side effect.
    • Rifampicin Side Effect: A side effect of rifampicin can be orange discoloration of urine, sweat, and tears.
    • Pyrazinamide Maximum Dose: The maximum dose of pyrazinamide for adults is 2 g/day.
    • Bedaquiline Mode of Action: The primary mode of action of bedaquiline is the inhibition of ATP synthase, leading to disruption of bacterial energy production.
    • Bedaquiline Precaution: A precaution when using bedaquiline is the risk of prolongation of the QT interval on the electrocardiogram (ECG).
    • Pretomanid Side Effect: A significant side effect of pretomanid is peripheral neuropathy.
    • Bedaquiline Administration: Administer bedaquiline with a high-fat meal to ensure good bioavailability.
    • Pretomanid Dosing Regimen: The dosing regimen for pretomanid involves daily administration for 26 weeks.
    • CYP3A4 Substrate: Pretomanid acts as a CYP3A4 substrate, meaning it can be metabolized by this enzyme.
    • Linezolid Mechanism: Linezolid operates as a protein synthesis inhibitor, specifically targeting the 50S subunit of bacterial ribosomes.
    • Linezolid Adverse Effect: An adverse effect specifically associated with linezolid is the risk of drug-induced myelosuppression (suppression of bone marrow).
    • Delayed Effect of Bedaquiline: The delayed effect of bedaquiline observed from day 4 onward is attributed to the time required for drug accumulation in the mycobacterial cells.
    • Isoniazid Mode of Action: Isoniazid’s primary mode of action is inhibiting mycolic acid biosynthesis, an essential component of the mycobacterial cell wall.
    • Common Side Effect of Isoniazid: A common side effect of isoniazid treatment is hepatotoxicity.
    • Peripheral Neuropathy Risk: The risk of peripheral neuropathy in patients taking isoniazid increases with higher doses, prolonged treatment, and deficiencies in vitamin B6.
    • Fast Acetylators and Isoniazid: Individuals who are fast acetylators may be at a higher risk during isoniazid treatment because they quickly metabolize the drug.
    • Normal Daily Dose of Isoniazid: The normal daily dose of isoniazid for adults is 300 mg.
    • Rifampicin Action: Rifampicin specifically targets DNA-dependent RNA polymerase, a crucial enzyme for bacterial RNA synthesis, leading to the inhibition of protein synthesis.
    • Slow Acetylators and Isoniazid: For slow acetylators, the suggested daily dose of isoniazid may be reduced to 150 mg to prevent adverse effects.
    • Isoniazid Precaution: A precaution when administering isoniazid is to monitor patients regularly for signs of hepatotoxicity and peripheral neuropathy.
    • N-Acetyltransferase 2 Role: N-Acetyltransferase 2 (NAT2) plays a crucial role in the metabolism of isoniazid. Genetic variations in this enzyme influence the rate at which isoniazid is broken down.
    • Isoniazid Maximum Dose: The maximum dose of isoniazid for adults is 900 mg/day.

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