The document summarizes chemotherapy for tuberculosis. It discusses first and second line drugs used to treat TB, including isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin. It describes the mechanisms of action, dosages, and categories of TB treatment, which involve a two-month intensive initial phase followed by a four to six-month continuation phase. Guidelines are provided for treating different TB cases based on disease severity and drug resistance.

1. CHEMOTHERAPY OF TUBERCULOSIS

3. Second line drugs Either low antitubercular efficacy or high toxicity or both Thiacetazone Paraaminosalicylic acid (PAS) Ethionamide Cyclosporin Kanamycin Amikacin Capreomycin

12. Category III These are new cases of smear negative pulmonary TB With less severe form of extrapulmonary TB, viz,skin Bone,peripheral joint TB. Category IV These are chronic cases who have become smear Positive after completing fully supervised retreatment. These are mostly MDR cases.(multi drug resistant)

13. TB Category Initial phase Continuation phase Total duration I 2 HRZE (S) 4 HR/ 4 H 3 R 3 Or 6 HE 6 8 II 2 HRZES + 1 HRZE 5 HRE or 5H 3 R 3 E 3 8 8 III 2 HRZ 4 HR/ 4 H 3 R 3 0r 6 HE 6 8 IV Chronic case

14. In chronic case therapy depends upon the drugs used in the earlier regimen,dosage and regularity with which they were taken, presence of associated disease like AIDS/diabetes/leukemia etc. TB in pregnant women HRZ & E are safe to foetus. Standard 6 month regimen 2HRZ+ 4HR should be given.

16. Other topical agents Tolnaftate, benzoic acid, sodium thiosulfate. Amphotericin B Source- streptomyces nodosus. MOA- Combine with the ergosterol present in the fungal cell membrane and form a micropore thus increase the cell permeability. USE Topically for oral and cutaneous candidiasis.

19. DISEASE DRUGS 1 st choice 2 nd choice Candidiasis FLU/NYS/CLO ITR Histoplasmosis AMB FLU Blastomycosis ITR/AMB KTZ/FLU Sporotrichosis AMB ITR

22. ACYCLOVIR (deoxyguanosine analogue) MOA Acyclovir Herpes virus specific thymidine kinase Acyclovir monophosphate Cellular kinase Acyclovir triphosphate Inhibits herpes virus DNA Gets incorporated in viral DNA Polymerase competatively & stops lengthening of DNA strand.the terminated DNA inhibits DNA-polymerase irreversibly.

24. b) NNRTIs Nevirapine & Efavirenz MOA - They directly inhibit HIV reverse transcriptase without the need for intracellular phosphorylation. Their locus of action on the enzyme is also different. c) Protease inhibitors Ritonavir, Nelfinavir MOA- protease act at the late step in HIV replication. They bind to protease molecule and interfere with its cleaving function.

25. HIV treatment guidelines HAART - highly active antiritroviral therapy Combination of 3 or more drug replace monothrerapy. Therapeutic regimens 2-NRTIs + 1-PI 2-NRTIs + 1-NNRTI 3- NRTIs

26. Anti-influenza virus Amantadine Inhibits replication of influenza A virus Nonselective Antiviral Drugs Ribavirin - Purine nucleoside analogue - Its mono & triphosphate derivatives generated Intracellularly inhibit GTP and viral RNA synthesis.