Question
Prasad, 40-year-man weighing 60 kg suffering from chronic cough with expectoration and
fever was diagnosed to have cavitary pulmonary tuberculosis.
(
(a) Classify the drugs used in the treatment of tuberculosis.
( 4 mark(s) (b) Discuss in detail on the mechanism of action and adverse effects of first line
antitubercular drugs.
( 8 mark(s) (c) Add a note on the drug therapy of Multi Drug Resistant tuberculosis 3 mark(s)
Q2 15 marks Essays ★ ✓
Answer
a) Classification of antitubercular drugs
Line Drugs First-line Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, Streptomycin Second-line Fluoroquinolones, Aminoglycosides (Kanamycin, Amikacin), Ethionamide, Cycloserine, PAS, Bedaquiline, Linezolid
b) Mechanism of action and adverse effects of first-line drugs
Isoniazid — a prodrug, activated by mycobacterial KatG, inhibits InhA (mycolic acid synthesis), bactericidal against actively dividing organisms. AE: peripheral neuropathy (prevented by pyridoxine), hepatotoxicity.Rifampicin — inhibits bacterial RNA polymerase, active against both dividing and semi-dormant organisms. AE: hepatotoxicity, orange-red body fluid discoloration, potent CYP450 induction.Pyrazinamide — active specifically in the acidic intracellular/caseous environment, mechanism incompletely understood. AE: hepatotoxicity, hyperuricemia.Ethambutol — inhibits arabinosyl transferase (arabinogalactan synthesis), bacteriostatic. AE: optic neuritis (dose-related, red-green color blindness — the specific reason visual acuity/color vision monitoring is recommended).Streptomycin — aminoglycoside, inhibits bacterial protein synthesis (30S ribosomal subunit). AE: ototoxicity, nephrotoxicity.
c) Drug therapy of MDR-TB
MDR-TB (resistant to at least isoniazid and rifampicin) requires a longer, more toxic second-line regimen combining fluoroquinolones, second-line injectables, and other agents (ethionamide, cycloserine, PAS), often supplemented with newer drugs (bedaquiline, linezolid), for 18-24 months (or shorter regimens where available), with poorer outcomes and greater toxicity than standard therapy.
1 Quinolones
Other Years Asked
1 Ritu, 40-year-old female with complaints of high fever with chills. On asking, she revealed
dysuria, urgency etc. A diagnosis of Acute lower urinary tract infection was made.
( 2023 July (Supplementary) (2019 Scheme) Essay · 15 marks 2 A 30-year-old male patient with history of productive cough, evening rise of temperature
and weight loss since 1 month visits a physician in a tertiary care hospital. On
investigation, patient was positive for acid fast bacilli in the sputum and a diagnosis of
pulmonary tuberculosis was made.
( 2023 January (Supplementary) (2019 Scheme) Essay · 11 marks 3 ( 2023 January (Supplementary) (2019 Scheme) Short Essay · 8 marks 4 Classify fluoroquinolones. Explain the mechanism of action, uses and adverse effects
of fluoroquinolones. (2+1+2+1) 2020 February (Supplementary) (2010 Scheme) Essay · 6 marks 5 Classify drugs used in the treatment of Tuberculosis. Outline the mechanism of
action, adverse effects and uses of Rifampicin. (2+4) 2025 August (Supplementary) (2010 Scheme) Essay · 6 marks 6 A 20 years old pregnant women developed a mild bacterial upper respiratory tract
infection. She was given cap. tetracycline 250 mg thrice daily for 3 days. Answer the
following questions: 2017 August (Supplementary) (2010 Scheme) Essay · 6 marks 7 Enumerate the second generation fluoroquinolones. What is their mechanism of
action. What are the adverse effects produced by them. (2+2+2) 2022 October (Supplementary) (2010 Scheme) Essay · 6 marks 8 Read the clinical problem and answer the following questions. A 20 years old pregnant woman
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adverse effects of sparfloxacin. (2 + 2+ 2 =6) 2014 September (Supplementary) (2010 Scheme) Essay · 6 marks 11 Classify the drugs used in Chemotherapy of Tuberculosis. Write the mechanism of
action, therapeutic uses and adverse effects of Rifampicin (3+3) 2025 March (Supplementary) (2010 Scheme) Essay · 6 marks 12 A 40 years old female patient admitted to hospital with a complaint of fever with chills
and right loin pain since 5 days. She is a known diabetic. Urine microscopy shows
plenty of pus cells and gram negative bacilli. Her serum creatinine is moderately
elevated. Ultra sonogram of abdomen suggestive of acute pyelonephritis of right
kidney. 2022 May (Supplementary) (2010 Scheme) Essay · 6 marks 13 A 24-year-old female with fever and chills came to causality. Gives history of
urinary urgency and dysuria. Urine examination confirmed acute lower urinary
tract infection and urine sample given for culture and sensitivity.
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