PELVIS & SACRUM Dr. Dr. Essam Eldin Salama Dr. Jamila El- Medany.
Pulmonary TB. BY PROF. AZZA EL- MEDANY Department of Pharmacology.
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Transcript of Pulmonary TB. BY PROF. AZZA EL- MEDANY Department of Pharmacology.
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Pulmonary TB
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BY
PROF.
AZZA EL- MEDANY
Department of Pharmacology
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OBJECTIVES
At the end of lecture , the students should: Discuss the etiology of tuberculosis Discuss the common route for transmission of the
disease Discusses the out line for treatment of tuberculosis Discuss the drugs used in the first & second line
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OBJECTIVES ( continue)
Regarding : The mechanism of action Adverse effects Drug interactions Contraindication Discuss tuberculosis & pregnancy Discuss tuberculosis & breast feeding
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EtiologyMycobacterium tuberculosis, an acid fast bacillus
with three types known to infect man causing pulmonary TB:The human type, commonestThe bovine typeThe african type
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Robert Koch was the first
to see Mycobacterium tuberculosis with his staining technique in 1882.
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•Each Each
year, 1% year, 1%
of the of the
global global
population population
is is
infected. infected.
Disease information:Disease information:
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Tuberculosis
Common sites of infections Apical areas of lung Renal parenchyma Growing ends of bones
Where oxygen tension is high
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Treatment Of Tuberculosis
Preventing drug resistance is the most important reason to use drug combination.
Periods of treatment ( minimum 6 months)Drugs are divided into two groups:
1. First line 2. Second line
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Antimycobacterial drugs
First line Isoniazid (INH)RifampinEthambutolStreptomycinPyrazinamide
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Never use a single drug therapy
Isoniazid –rifampin combination administered for 9 months will cure 95-98% of cases .
Addition of pyrazinamide for this combination for the first 2 months allows total duration to be reduced to 6 months.
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Isoniazid ( INH)
Bactericidal Is effective against intracellular
& extracellular bacilli
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Mechanism Of Action
Inhibits the synthesis of mycolic acid
( inhibits bacterial cell wall )
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Clinical usesTreatment of TB .Treatment of Latent tuberculosis in patients
with positive tuberculin skin test
Prophylaxis against active TB in individuals who are in great risk .
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Adverse effects
Peripheral neuritis (pin & needles sensation in the feet )Optic neuritis & atrophy.
Pyridoxine should be given with INH
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Drug Interactions of INH
Enzyme inhibitor of hepatic microsomal enzymes
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Rifampin
Bactericidal
Inhibits RNA synthesis
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Site of Action
Intracellular bacilli
Extracellular bacilli
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Clinical uses
Treatment of TB
Prophylaxis of active TB.
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Adverse effects
Harmless red-orange discoloration of body secretions ( saliva, sweat …..).
Hepatitis
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Drug Interactions
Enzyme inducer of hepatic microsomal enzymes
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Ethambutol
Bacteriostatic
Inhibits mycobacterial arabinosyl transferase ( alters the cell barrier )
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Site Of Action
Intracellular & Extracellular bacilli
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Clinical uses
Treatment of tuberculosis in combination with other drugs.
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Adverse effectsImpaired visual acuity
Loss of discrimination of red-green color
Contraindicated in children under 5 years.
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Pyrazinamide
Bactericidal
Mechanism of action is unknown .
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Site Of Action
Active against Intracellular Bacilli
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Clinical uses
In multidrug resistance cases.Important in short –course (6 months)
regimen.Prophylaxis of TB .
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Adverse effects
Hepatotoxicity
Hyperuricemia ( gouty arthritis )
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Streptomycin
BactericidalInhibits protein synthesis Active on extracellular bacilli
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Clinical uses
Severe , life-threating form of T.B. as meningitis, disseminated disease.
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Adverse Effects
OtotoxicityNephrotoxicityNeuromuscular block
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Indication of 2nd line treatment
Resistance to the drugs of 1st line.Failure of clinical responseContraindication for first line drugs. Atypical tuberculosis
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Ethionamide
Inhibits the synthesis of mycolic acid
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Clinical uses
Treatment of TB
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Adverse Effects
Severe gastric irritation
Neurological side effect
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Fluoroquinolones (Ciprofloxacin )
Effective against multidrug- resistant tuberculosis.
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Rifabutin
Inhibits RNA synthesis
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Aminosalicylic Acid (PAS).
Bacteriostatic
Inhibits Folic acid synthesis.
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Clinical uses
Treatment of different forms of TB.
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Adverse effects
GIT upset
Crystalluria
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TB & Pregnancy
Untreated TB represents a great risk to the pregnant woman & her fetus than the treatment itself.
First line drugs are given for 9 months in normal doses
Streptomycin is the last alternative in treatment
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TB & Breast Feeding
It is not a contraindication to receive drugs , but caution is recommended
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