Leprosy

Question 1

Leprosy?

Answer 1

Hansen’s disease (also known as leprosy) is an infection caused by slow-growing bacteria called Mycobacterium leprae

Question 2

Leprosy drugs?

Answer 2

RDC MOLM

1. Rifampicin
2. Dapsone
3. Clofazimine/ Clarithromycin
4. Minocycline
5. Ofloxacin
6. Levofloxacin
7. Moxifloxacin

Question 3

Rifampicin CYP450?

Answer 3

CYP450 Inducer

Question 4

Rifampicin MOA?

Answer 4

Inhibits RNA synthesis and binds to B-subunit of DNA dependent RNA polymerase

Question 5

Rifampicin resistance mechanism?

Answer 5

Mutations in rpOb gene

Question 6

Rifampicin DI?

Answer 6

HIV meds/ARVs

1. Protease inhibitors
2. Warfarin
3. Combined oral contraceptives

Question 7

Rifampicin S/E-3?

Answer 7

1. Red-orange discoloration of body fluids
2. Hepatitis
3. Hypersensitivity

Question 8

Dapsone

1. Derivative
2. Adjunct admin
3. MOA
4. Metabolism

Answer 8

1. Derivative:
   Sulfonamide
2. Adjunct admin:
   Taken with food
3. MOA:
   Inhibits dihydropteroate synthetase THEREFORE inhibits synthesis of dihydrofolic acid, thus inhibiting nucleic acid synthesis
4. Metabolism:
   Hepatic metabolism-acetylation

Question 9

Dapsone DI-2?

Answer 9

1. Didanosine( ↓ abs of dapsone)
2. Pyrimethamine(↑ risk of haem disorders)

Question 10

Dapsone S/E-5?

Answer 10

1. G6PD Deficiency
   -Haemolysis
   -Methamoglobinaemia
2. Skin rashes & puritis
3. Parasthesia
4. Sulfone syndrome
   -Jaundice
   -Rash
   -Fever
   -Eosinophila

Question 11

Cloafazimine MOA

Answer 11

Binds strongly to mycobacteria DNA-mechanism not fully understand

Question 12

Cloafazimine anti-inflammatory?

Answer 12

Some anti-inflammatory effects
-Management of type II reactions

Question 13

Cloafazimine bioavailability

Answer 13

Bioavailability ↑ with food

Question 14

Cloafazimine accumulation?

Answer 14

Accumulates in fat, skin, liver, kidneys & reticuloendothelial cells

Question 15

Cloafazimine t1/2?

Single Dose and Long-term therapy

Answer 15

10days(single dose)

OR

2-3months(long-term therapy)

Question 16

Cloafazimine elimination?

Answer 16

Bile & feaces

Question 17

Cloafazimine S/E-6?

Answer 17

1. Red-brown pigmentation of skin and conjunctiva
2. Darkening of leprosy skin lesions
   -Resolves few months after treatment
3. QT prolongation
4. Gastric irritation(Take with food/milk)
5. Dry skin
6. Ichythyosis

Question 18

Pregnancy drugs-3 + S/E?

Answer 18

1. Dapsone (3rd trimester)
   -Neonatal haemolysis
   -Methylaemglobinemia
2. Rifampicin
   -No adverse effects on fetus reported at normal
3. Clofazimine
   -Fetal pigmentation
   -Fades gradually over 12months in non-breastfed babies

Question 19

Alt agents usage?

Answer 19

In cases of Dapsone or Clofazimine intolerance

Question 20

Alt agents drugs?

Answer 20

(rdc) MOLM

1. Minocycline(30s)
2. Clarinthromycin (50s)
3. Ofloxacin
4. Levofloxacin
5. Moxifloxacin

Question 21

Treatment regimes and duration?

Answer 21

Multidrug therapy:

1. Paucibacillary leprosy(6months)
   -Rifampicin(monthly)
   -Dapsone(daily)
2. Multibacillary leprosy(12months)
   -Rifampicin
   -Dapsone
   -Clofazamine(daily)