Pyrazinamide exhibits good activity within macrophages and plays a key role in

Pyrazinamide exhibits good activity within

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Pyrazinamide exhibits good activity within macrophages and plays a key role in killing intracellular organisms Streptomycin (aminoglycoside) is irreversible inhibitor of protein synthesis Ethionamide ultimately blocks the synthesis of mycolic acids Capreomycin inhibits RNA synthesis Bedaquiline inhibits mycobacterial adenosine triphosphate (ATP) synthesis and is active against replicating and dormant mycobacteria Para-aminosalicylic acid Pharmaco -kinetics Oral formula rapidly & well absorbed in GI tract; on empty stomach (INH); with or without meals (rifampin); high CSF penetration: pyrazinamide, INH Metabolism of isoniazid is highly variable and dependent on acetylator status Precautio n ADRs INH: peripheral neuropathy—pyridoxine (B6), nephrotoxicity (Pregnancy A others are C) INH, rifampin, ethionamide, and pyrazinamide: hepatotoxicity Ethambutol: optic neuritis (not approved for children < 13) Pyrazinamide: no sue during gout attack Streptomycin and capreomycin: ototoxic Rifabutin: neutropenia and thrombocytopenia Rational Drug Selection Rifampin: prophylaxis for close contact ppl w. meningococcal infection (N. meningitidis); mouth-to-mouth resuscitation oral rifampin 600 mg (children is 10 mg/kg) every 12 hours for four doses (two days) or H. influenzae type b Antivirals optimal clinical efficacy depends on early recognition and treatment or prevention; Nucleoside Analogues Antiviral for influenza Used mainly to treat herpes infections by interfering with DNA synthesis and inhibiting viral replication Acyclovir (Zovirax): HSV 1&2, varicella-zoster virus (VZV), Epstein-Barr virus (EBV), Herpes virus 6 Valacyclovir (Valtrex): HSV-1 &2 VZV, EBV, hep B Famciclovir (Famvir): Ribvavirin (Virazole) Zanamivir (Relenza), oseltamivir phosphate (Tamiflu) , peramivir (Rapivab) are approved for treatment of acute illness (onset 48 hr) in adults; purpose
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Precautio n & contra- indication Cautiously used in renal impairment; Acyclovir & valacyclovir are safe in pregnancy (B); in children: acyclovir > age of 2; Famciclovir > age of 18 Zanamivir > age of 7 (prophylaxis age of 5); Oseltamivir: > 2 wks (prophylaxis age of 1) Pregnancy C ADRs Acyclovir & Valacyclovir (converting to acyclovir)—HA, skin rash, N>V, diarrhea; crystalluria & tubular necrosis; neurologic effects (ataxia, dizziness, confusion, encephalopathy, tremor, Sz); Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) Zanamivir: (inhalation) bronchitis, cough, SOB Oseltamivir: N/V (most common) Clinical use Renal dosage depending on CCr; do not cure herpes infections but may shorten duration, decrease severity, and reduce the incidence of sequelae of the infection; initiate ASAP after onset of recurrent episode; frequent recurrences needs suppression therapy annually HSV 1: genital herpes, both initial outbreak & suppression therapy HSV 2 (shingles): Start within 3 days of outbreak Varicella (Chickenpox): start within 24 hrs of outbreak Gingivostomatitis in children Bell’s Palsy Oseltamivir & Zanamivir approved for prophylaxis & tx of Influenza type A & B in order to control outbreaks among high-risk No dosage adjustment for zanamivir for renal impairment Oseltamivir: renal dosing depends on CCr (10-30) drug selection Valacyclovir is the drug of choice Tx of Herpes Zoster Clinical Sx is not definitive; Rapid testing should be conducted to diagnose Monitorin g Baseline & periodical BUN/Cr for prolonged use Baseline renal function for older & debilitated pts taking oseltamivir & peramivir; lung sound for pneumonia & HF, heart sounds, weight Education W/o regard to meals, take with a full glass of
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  • Spring '14
  • Henrikson,J
  • Clostridium difficile, Renal function

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