TuberculosisSH1

Question 1

Tuberculosis

Answer 1

TB
1) active TB
2) latent TB : Dormant ( not contagious )

If someone has active TB coughing in the same room. If i inhale spore, then 1 ( 2-8 weeks incubation ) and have same sx myself or 2 ) more common latent TB infection. Dormant TB. Spore enters lung and lung forms wall around it, granuloma; stays dormant for years. Can flare up if immune system is down HIV etc

Question 2

Tests to dx

Answer 2

1) Intradermal skin test: TST : tiny bubble under the skin. Read 48 to 72 hours after it is given.

2) chest x ray CXR: if no sx chest x rays show negative.

3) TB blood tests. Expensive : gold in tube test and T-spot tb test

4) what if active TB? Cough / sputum acid fast bacilli can pick up spore in sputum

Question 3

LTBI tx

Answer 3

Positive skin test but chest x ray doesn’t show anything ( bc no sx )
By doing tx you reduce risk of active TB later

guidelines:
Rifamycin based regimen preferred
•Rifampin 10mg/kg ( max 600 mg ) for 4 months ( 4R )
• isoniazid and rifampin QD for 3 months ( 3HR )
• Isoniazid and Rifapentine Q week for 3 months

For patients with contraindications to use of rifamycins ( DDI or Hypersensitivity ) ISONIAZID 300 mg QD for 6 - 9 months

Question 4

RIPES

Answer 4

Rifampin ( rifadin )
Isoniazid ( INH )
Pyrazinamide
Ethambutol ( myambutol )
Streptomycin

Bedaquiline ( sirturo )

Combinations :
• Rifamate ( isoniazid + rifampin ) - empty stomach
•Rifater ( isoniazid + rifampin + pyrazinamide ) - empty stomach

Question 5

Isoniazid

Answer 5

INH

Never give alone. Give with pyridoxine ( to reduce peripheral neuropathy)

Monitor LFT: ( yellow skin, light stools , dark urine ) all sn/sx of hepatoxicity : so D/C

DDI: 1A2 inhibitor and 2C9 inhibitor. 1A2 inhibitor: theophylline increase ( seizure coma death) , 2C9 ( INR )

Question 6

Rifampin

Answer 6

Priftin
R for turns your urine Reddish/ORange

SE: hepatotoxicity ( thats why never given with a proteas inhibitor ) , fever flu like sx , GI , THORMBOCYTOPENIA ( increase in bleeding )

DDI: RIFAMPIN Is a MAJOR inducer. [ eg) estrogen goes through liver and rifampin can reduce it increase risk of pregnancy ) increase EE to 50 mcg or change to mini pill progesterone only

On empty stomach

Question 7

Pyrizinamide

Answer 7

SE: hepatotoxicity, hyperuricemia ( if gouty flare up look at this med )

Question 8

Ethambutol

Answer 8

E - for check eyes

Caution : in kidney disease ( isoniazid , rifampin and pyrizinamide have all gone through liver )

Uric acid and gouty flare caution

Question 9

Streptomycin

Answer 9

Same class as AG so worry about Neprotoxicity and ototoxcity ( Loops, cisplatin both cause ototoxicity )

Question 10

Bedaquiline

Answer 10

Sirturo

Only use if patient has failed other agents. ( resistant TB )
DOT therapy. Direct observed therapy. Patient goes in and nurse has to watch

SE: QT prolongation ( other: zirprasidone ( geodon ) )

Question 11

Regimen for TB

Answer 11

First: on all 4 RIPE ( for 2 months = 8 weeks )

Then for 18 weeks ( 4. 5 months ) : isoniazid and rifampin

Question 12

Tx of latent TB infection

Answer 12

No sx. Not contagious

Only sign is positive reaction

1 in 10 may get active TB so need to tx these patients

Tx is rifamycin based regimen
4R : qd rifampin 10mg/kg ( max 600 mg )
3HR: isoniazid and rifampin QD for 3 months
INH and rifapentin weekly for 3 months ( 12 doses )

Question 13

Newer TB medication

Answer 13

Pretomanid

As part of combo with Bedaquiline and linezolid for pulmonary extensively drug resistant TB