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Tuberculosis

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PriyaChandana2

Tuberculosis is potentially fatal, contagenous and chronic disease,that can effect any part of the body but is mainly an infections of their lungs.It is also a granulomatous disease. It is mostly seen in Africa and Asia. This tuberculosis is of 2 types - mycobacterium tuberculosis and pulmonary tuberculosis. 1) If lungs are affected that is pulmonary tuberculosis 2) If other than lungs are affected, it is extra pulmonary CONTENTS -Defniton -Etiology -Transmission -Signs and Symptoms -Pathophysiology -Diagnosis -Goals of therapy -Drug interactions

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PHARMACOTHERAPEUTICS TOPIC: TUBERCULOSIS D.PRIYA CHANDANA VIGNAN PHARMACY COLLEGE VADLAMUDI TUBERCULOSIS DEFINITION: Tuberculosis is a potentially fatal contagious disease that can be affect almost any part of the body but is mainly an infections of the lungs ? It is also known as granulomatous disease ? It more seen in Africa,asia ? Mycobacterium tuberculosis,pulmonarytuberculosis ? If lungs are effected Cpulmonary
? Mycobacterium avium complex-IIIV /immunocompressive [MAC] ? Other than lungs-extra pulmonary ? May occur at any age ETIOLOGY : 1. Causative organisams : mycobacterium tuberculosis C humans ,mycobacterium bovius- animals 2. Others- m.aficanum,m.ovium,m.canetti TRANSMISSION : ? Contaminated through food and water ? By sharing utensils ,cigerettes ? By shaking hands[ causualcontact] ? Using publictelephone SIGNS AND SYMPTOMS : 1. Chronic cough with blood tinged sputum [ hemoptosis ]
2 . fever ,chills 3. weight loss 4. fatigue 5. swollenglands 6. loss of appetite 7. pleuritic pain 8. malaisepain PATHOPHYSIOLOGY: Injury [ when exposure to source C m.tb ] ENTRY Failure to digest the foeigh body Weak acute inflammatory response
Persistence of injurious agents T-cells mediated poorly digest Immune response agent Activationof CD4 T-Cells [ release of IL -1,IL-2 Growth factors INFα, INFδ] Chemotacticfactor Accumulation of tissue macrophages in blood and which will proliferation These macrophages are activated by TNF α These macrophages are transformed to epitheiloid cell and cell formation
Granuloma tuberculosis DIAGNOSIS : ? Sputum for acid fast bacillus C early morning ? Chest x C ray ? Mantouse test [ purified protein derivatives] ? CBP-Completeblood picture ? Zeil-neelsons staining ? Fluorescence staining PHARMACOTHERAPYOF TB [ACCORDING TO RNTCP GUIDELINES] : Tuberculintest is performed , 5 C tuberculin units shouldbe taken ＾ revised nationaltuberculosiscontrol programme￣ GOALS OF THERAPY : TREATMENTFOR LATENT TB :
? Asymptomatic will no hiv infection [ HIV CVe] ? INH C Isotonic acid hydrazine C 300 mg / day -6 to 9 months , Rifampacin C 600 mg / day C 4 months ? DRUG COMBINATION; rifampacin C 900 mg + INH C 900 mg / week C for 12 ? INM C per 9 months / monotherapy C 300mg TREATMENTFOR ACTIVE TB INFECTION WITH NO HIV : Symptomatic TB or pulmonary TB with no HIV infection 4 drug regimen must used R C rifampacin C 10mg / kg H- Isoniazide C 5 mg for 4 months E C Ethambutol C 30 mg Z C Pyrazinamide C 35 mg R,H,E,Z C 4 Months , R,H C 2 Months TREATMENTFOR ACTIVE TB WITH HIV INFECTION : R,H,E,Z C 4 Months, R,H C 2 months
2 drugs are C rifabutin,isoniazide If patient with hiv are treated with protease inhibitory [ritnovir], nucleosidereverse trancecriptace inhibitoryin such cases rifampacin is replaced with rifabutinbecause rifampacin easily metabolises the hiv drugs and also leadsto dry ,also replace rifampacin after some period of time weeks after the elimationof metabolitesof rifampacin TREATMENTFOR TB IN PREAGNENT WOMEN : Duration of therapy C 9 months 3 days regimen C for 2 months C R,H,E was given For 7 months C R,H was given TREATMENTFOR TB IN RENAL FAILURE / RENAL IN CANDIDATES : While prescribing rote of elimination isand drug which have non renal route of eliminationprescribed Rifampacin Isoniazide Pyrozinamide Ethambutolis contra indicatedbecause it is through kidney [renal clearance] if ethambutol is necessary dose reduced and given to the patient
TREATMENTFOR TB IN LIVER FAILURE : All TB drugs have hepatotoxicity in liver failure enzymes like AST , ALT increases so , the activity of drugs must be monitored DRUGS : R,H 2 dose decrease frequency increase for 2 months After 2 months if level of enzymes increases stop the therapy for normal levels : 30 IU / L If with in 2 months level increases and restart treatment when enzyme levels become normal INH side effects : peripheral nephritis So INH and vit B6 should be given [B6 dose C 25-50 mg ]/ day to treat peripheral nephritissometimes streptomycin [ 15 mg / kg / day]is added DRUG INTERACTION WITH ＾ ANTI TB DRUGS￣ : ? Ethambutol+ al[oh]3 C complex formation , decrease absorbtionof ethambutolconcomittent use in encouraged ? Isoniazide + thiophilline/ carbamazepine / phenytoin /disulfurin - decrease the levels of isoniazide ? Isoniazide + Rifampicin C increase the chance of hepatotoxocity ? Pyrazinamide + Allopurinol C increase the pyrazinamide levels ( toxicity)
Tuberculosis

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Tuberculosis

  • 1. PHARMACOTHERAPEUTICS TOPIC: TUBERCULOSIS D.PRIYA CHANDANA VIGNAN PHARMACY COLLEGE VADLAMUDI TUBERCULOSIS DEFINITION: Tuberculosis is a potentially fatal contagious disease that can be affect almost any part of the body but is mainly an infections of the lungs ? It is also known as granulomatous disease ? It more seen in Africa,asia ? Mycobacterium tuberculosis,pulmonarytuberculosis ? If lungs are effected Cpulmonary
  • 2. ? Mycobacterium avium complex-IIIV /immunocompressive [MAC] ? Other than lungs-extra pulmonary ? May occur at any age ETIOLOGY : 1. Causative organisams : mycobacterium tuberculosis C humans ,mycobacterium bovius- animals 2. Others- m.aficanum,m.ovium,m.canetti TRANSMISSION : ? Contaminated through food and water ? By sharing utensils ,cigerettes ? By shaking hands[ causualcontact] ? Using publictelephone SIGNS AND SYMPTOMS : 1. Chronic cough with blood tinged sputum [ hemoptosis ]
  • 3. 2 . fever ,chills 3. weight loss 4. fatigue 5. swollenglands 6. loss of appetite 7. pleuritic pain 8. malaisepain PATHOPHYSIOLOGY: Injury [ when exposure to source C m.tb ] ENTRY Failure to digest the foeigh body Weak acute inflammatory response
  • 4. Persistence of injurious agents T-cells mediated poorly digest Immune response agent Activationof CD4 T-Cells [ release of IL -1,IL-2 Growth factors INFα, INFδ] Chemotacticfactor Accumulation of tissue macrophages in blood and which will proliferation These macrophages are activated by TNF α These macrophages are transformed to epitheiloid cell and cell formation
  • 5. Granuloma tuberculosis DIAGNOSIS : ? Sputum for acid fast bacillus C early morning ? Chest x C ray ? Mantouse test [ purified protein derivatives] ? CBP-Completeblood picture ? Zeil-neelsons staining ? Fluorescence staining PHARMACOTHERAPYOF TB [ACCORDING TO RNTCP GUIDELINES] : Tuberculintest is performed , 5 C tuberculin units shouldbe taken ＾ revised nationaltuberculosiscontrol programme￣ GOALS OF THERAPY : TREATMENTFOR LATENT TB :
  • 6. ? Asymptomatic will no hiv infection [ HIV CVe] ? INH C Isotonic acid hydrazine C 300 mg / day -6 to 9 months , Rifampacin C 600 mg / day C 4 months ? DRUG COMBINATION; rifampacin C 900 mg + INH C 900 mg / week C for 12 ? INM C per 9 months / monotherapy C 300mg TREATMENTFOR ACTIVE TB INFECTION WITH NO HIV : Symptomatic TB or pulmonary TB with no HIV infection 4 drug regimen must used R C rifampacin C 10mg / kg H- Isoniazide C 5 mg for 4 months E C Ethambutol C 30 mg Z C Pyrazinamide C 35 mg R,H,E,Z C 4 Months , R,H C 2 Months TREATMENTFOR ACTIVE TB WITH HIV INFECTION : R,H,E,Z C 4 Months, R,H C 2 months
  • 7. 2 drugs are C rifabutin,isoniazide If patient with hiv are treated with protease inhibitory [ritnovir], nucleosidereverse trancecriptace inhibitoryin such cases rifampacin is replaced with rifabutinbecause rifampacin easily metabolises the hiv drugs and also leadsto dry ,also replace rifampacin after some period of time weeks after the elimationof metabolitesof rifampacin TREATMENTFOR TB IN PREAGNENT WOMEN : Duration of therapy C 9 months 3 days regimen C for 2 months C R,H,E was given For 7 months C R,H was given TREATMENTFOR TB IN RENAL FAILURE / RENAL IN CANDIDATES : While prescribing rote of elimination isand drug which have non renal route of eliminationprescribed Rifampacin Isoniazide Pyrozinamide Ethambutolis contra indicatedbecause it is through kidney [renal clearance] if ethambutol is necessary dose reduced and given to the patient
  • 8. TREATMENTFOR TB IN LIVER FAILURE : All TB drugs have hepatotoxicity in liver failure enzymes like AST , ALT increases so , the activity of drugs must be monitored DRUGS : R,H 2 dose decrease frequency increase for 2 months After 2 months if level of enzymes increases stop the therapy for normal levels : 30 IU / L If with in 2 months level increases and restart treatment when enzyme levels become normal INH side effects : peripheral nephritis So INH and vit B6 should be given [B6 dose C 25-50 mg ]/ day to treat peripheral nephritissometimes streptomycin [ 15 mg / kg / day]is added DRUG INTERACTION WITH ＾ ANTI TB DRUGS￣ : ? Ethambutol+ al[oh]3 C complex formation , decrease absorbtionof ethambutolconcomittent use in encouraged ? Isoniazide + thiophilline/ carbamazepine / phenytoin /disulfurin - decrease the levels of isoniazide ? Isoniazide + Rifampicin C increase the chance of hepatotoxocity ? Pyrazinamide + Allopurinol C increase the pyrazinamide levels ( toxicity)