TB Treatment and Contraception Complications

TB Infection and Contraception

• A 27-year-old female on a contraceptive pill gets TB infection and takes 1st line anti-TB drugs (RIF, INH, ETH, PYRAZ); however, she becomes pregnant after two months, indicating a failure of the contraceptive pill.

TB Infection and Skin Discoloration

• A 39-year-old male with TB infection takes 1st line anti-TB drugs and develops yellowish skin and sclera discoloration after one month, which is likely caused by RIF.
• Treatment involves stopping the drug and introducing alternative medications.

2nd Line Anti-TB Drugs

• For a 45-year-old male patient with TB infection, 2nd line anti-TB drugs can be used if the 1st line treatment is ineffective.
• Four examples of 2nd line anti-TB drugs are:

Anti-HIV Drugs

• There are several groups of anti-HIV drugs, including:
  • Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
  • Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
  • Protease Inhibitors (PIs)
  • Fusion Inhibitors
  • Integrase Inhibitors
  • CCR5 Antagonists
• Two examples of drugs for each group are:
  • NRTIs: Zidovudine, Lamivudine
  • NNRTIs: Nevirapine, Efavirenz
  • PIs: Atazanavir, Ritonavir
  • Fusion Inhibitors: Enfuvirtide, Maraviroc
  • Integrase Inhibitors: Raltegravir, Elvitegravir
  • CCR5 Antagonists: Maraviroc, Vicriviroc

Acyclovir Administration and Side Effects

• Acyclovir can be administered orally, topically, or intravenously.
• Two adverse effects of Acyclovir administration are:
  • Oral: Nausea, Vomiting
  • Topical: Skin irritation, Rash
  • Intravenous: Phlebitis, Nephrotoxicity

Neuroendocrine System

• The neuroendocrine system is controlled by the pituitary and hypothalamus.
• It coordinates body functions by transmitting messages between individual cells and tissues.
• The endocrine system releases hormones into the bloodstream, which carries chemical messengers to target cells throughout the body.

Hormones

• Hormones have a broader range of response times than nerve impulses, requiring from seconds to days or longer to cause a response that may last for weeks or months.
• The two regulatory systems (neuroendocrine and endocrine) are closely interrelated.
• Hormones secreted by the hypothalamus and pituitary are peptides or low molecular weight proteins that act by binding to specific receptor sites on their target tissues.

Hypothalamic and Anterior Pituitary Hormones

• The hormones of the anterior pituitary are regulated by neuropeptides that are called "releasing" or "inhibiting" factors or hormones.
• Therapeutic uses of hypothalamic and anterior pituitary hormones include:
  • Treatment of GH deficiency
  • Growth failure in children
  • Growth failure due to Prader-Willi syndrome
  • Management of AIDS wasting syndrome
  • GH replacement in adults with confirmed GH deficiency

Somatropin (Growth Hormone)

• Somatropin is administered by subcutaneous or IM injection.
• Adverse effects of Somatropin include:
  • Pain at the injection site
  • Edema
  • Arthralgias
  • Myalgias
  • Flu-like symptoms
  • Increased risk of diabetes

Somatostatin (Growth Hormone-Inhibiting Hormone)

• Somatostatin is a small polypeptide that inhibits GH and thyroid-stimulating hormone release.
• Synthetic analogs of somatostatin, such as octreotide and lanreotide, are used to treat acromegaly and diarrhea/flushing associated with carcinoid tumors.
• Adverse effects of octreotide include:
  • Diarrhea
  • Abdominal pain
  • Flatulence
  • Nausea
  • Steatorrhea

Gonadotropin-Releasing Hormone (GnRH)

• GnRH is essential for the release of the gonadotropins follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary.
• Synthetic GnRH analogs, such as leuprolide, goserelin, nafarelin, and histrelin, are used to treat prostate cancer, endometriosis, and precocious puberty.
• Adverse effects of GnRH analogs include:
  • Hot flushes
  • Sweating
  • Diminished libido
  • Depression
  • Ovarian cysts (in women)

Gonadotropins

• Gonadotropins are hormonally active medications used to treat fertility disturbances.
• Examples of gonadotropins include:
  • Menotropins (human menopausal gonadotropins or hMG)
  • Urofollitropin (FSH obtained from postmenopausal women)
  • Follitropin alfa and beta (human FSH products manufactured using recombinant DNA technology)
  • Human chorionic gonadotropin (hCG) and choriogonadotropin alfa (made using recombinant DNA technology)

Prolactin

• Prolactin is a peptide hormone that stimulates and maintains lactation.
• It decreases sexual drive and reproductive function.
• Dopamine agonists, such as bromocriptine and cabergoline, are used to treat hyperprolactinemia and pituitary microadenomas.
• Adverse effects of dopamine agonists include:
  • Nausea and vomiting
  • Headache
  • Psychiatric problems

Hormones of the Posterior Pituitary

• Oxytocin is a neuropeptide that plays roles in social bonding, reproduction, childbirth, and the period after childbirth.
• It is used in obstetrics to stimulate uterine contraction and induce labor, and to cause milk ejection.
• Adverse effects of oxytocin include:
  • Hypertension
  • Uterine rupture
  • Water retention
  • Fetal death

Vasopressin (ADH)

• Vasopressin is a nonapeptide that plays essential roles in the control of the body's osmotic balance, blood pressure regulation, sodium homeostasis, and kidney function.
• It has antidiuretic and vasopressor effects.
• The major use of vasopressin is to treat:
  • Diabetes insipidus
  • Management of cardiac arrest
  • Controlling bleeding due to esophageal varices
• Adverse effects of vasopressin include:
  • Water intoxication
  • Hyponatremia
  • Abdominal pain
  • Tremor
  • Vertigo

Desmopressin

• Desmopressin is an analog of vasopressin with minimal activity at the V1 receptor, making it largely free of pressor effects.
• It is used to treat diabetes insipidus and nocturnal enuresis.
• Adverse effects of desmopressin include:
  • Local irritation
  • Seizures (in children using the nasal spray formulation)