192.2 📚 國考版

192.2.0.1 必背 — RIPE 4 Drugs

Drug	Mech	Key Toxicity
R Rifampin	RNA polymerase	Hepatotoxic, orange secretions, CYP3A4 inducer (warfarin, OC, ART)
I Isoniazid	Mycolic acid (KatG/InhA)	Hepatotoxic, peripheral neuropathy → B6, lupus, sideroblastic anemia
P Pyrazinamide	Pyrazinoic acid (acid env)	Most hepatotoxic, hyperuricemia
E Ethambutol	Arabinosyl transferase	Optic neuritis (color, acuity)

192.2.0.2 必背 — Pyridoxine (B6) with INH

• 25-50 mg/d prophylaxis
• Prevent peripheral neuropathy

192.2.0.3 必背 — Ethambutol Optic Neuritis

• Monthly Snellen + Ishihara (color)
• Stop if red-green discrimination loss

192.2.0.4 必背 — Rifampin CYP3A4

• Reduces levels: OCs (use barrier), warfarin, ART (must adjust), steroids, DOACs
• Don’t forget to advise patients

192.2.0.5 必背 — Bedaquiline

• ATP synthase inhibitor
• MDR-TB cornerstone
• QTc prolongation monitor

192.2.0.6 必背 — BPaL Regimen

• Bedaquiline + Pa Pretomanid + Linezolid × 6 mo
• MDR / Pre-XDR / XDR TB
• 90% cure rate
• 2024 WHO first-line MDR

192.2.0.7 必背 — 2024 WHO 4-Month Regimen

• Rifapentine + Moxifloxacin + INH + PZA (intensive) → Rifapentine + Moxi + INH (continuation)
• For drug-sensitive non-cavitary smear-neg pulmonary TB
• 4 months total

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