ANTI-TB

Question 1

Before starting tx: baseline test

Answer 1

baseline liver function for pt>15yo

if starting on E, baseline visual acuity and colour vision

Question 2

What RIPES target

use

Answer 2

R: growing bact, stationary bact (CIDAL)
I: growing bact (CIDAL)
P: persistent bact (CIDAL)
E: growing bact (STATIC)
S: bind to 30s and cause conformational change so cause misreading of codon 

R: active + latent + leprosy
I: active+latent + prophylaxis
P: active
E: active
S; active

Question 3

CSF

Answer 3

R: poor but increase during meninges, so tx TB spread to brain
I: good
P: good
E: poor but increase during meninges, so tx TB spread to brain
S: (IM) poor

Question 4

supplement

Answer 4

R: vit K to neonates to avoid postpartum hemorrhage as rifampicin SE is thrombocytopenia
I: pyridoxine 10mg OD for at risk of peipheral neuropathy (DM, uraemic, alcoholics, malnourished, HIV)

Question 5

SE of rifamipicin

Answer 5

1. HEPATOTOXICITY
2. CUTANEOUS RXT
3. orange sweat/tears
4. flu-like sx (f&C, malaise, HA, bone pain) occur with intermittent tx
5. SOB (but rarely shock)
6. rare but evere immune-mediated rxt like thrombocytopenic purpura (purple dots), hemolytic anaemia, acute renal failure (D/C stat if immune-mediated rxt happens)

R (SOB) I (immune-mediated rxt) F (Flu)
Anaemia (all RBC lyse), purple dots, AKI

Question 6

SE of I

3 main ones and 4 rare ones

Answer 6

1. HEPATOTOXICITY (risk increase with age/alchol/committant use
2. CUTANEOUS RXT
3. peripheral neuropathy (common in DM/uraemia/ alcoholic/HIV /malnourished) esp with more doses of I –> take pridoxine 10mg OD supp
4. psychosis, convulsions, lupus lke, hematologic rxt

Question 7

why take pyridoxine 10mg supp for pregnant & infants and ppl at risk of peripheral neuropathy

Answer 7

at risk: DM/uremia, alcoholics, HIV, malnourished

bc isoniazid inhibit conversion of pyridoxine to pyridoxal phosphate (active vit b6), deficiency cause perieral neuropathy

STORY: HIV PT WHO IS SEVERELY MALNOURISHED CAME ACROSS A SUGAR, HE ATE AND DEVELOP DM THEN HE START TO HAVE GOUT ALSO, THAT SWEET IS URIC ACID

Question 8

DDI of isoniazid

2 food and 2 med

Answer 8

1. with carbs (decrease A)
2. with tyramine/hist rich food like red herrings and wine and tuna –> serotonin syndrome (HA, flushing)
3. with antacid (decrease A)
4. with carbamazepine, phenytoin

Question 9

SE of pyrazinamide

Answer 9

1. HEPATOTOXICITY
   - -> higher risk in pt with hx of liver D/elderly/alcoholic so closely monitor LFT, more PE and lab test but is usually avoided in them or must use cautiously
   - -> D/C or replaced for P-induced hepatitis
2. DOSE ADJ FOR RENAL IMPAIRED bc metabolite will accumulate in pt with kidney failure, need to decrease dose
3. hyperuricemia, anthralgia (pain in joint) bc P inhibit renal tubular secretion of uric acid, resulting in gout-like syndrome (P>E)
4. CUTANEOUS (pruritus + exanthema)
5. photosensitivity

Question 10

SE of ethambutol

Answer 10

1. DOSE ADJ FOR RENAL IMPAIRED bc metabolite AND UNCHANGED will accumulate in pt with kidney failure, need to decrease dose
2. VISION TOXICITY (clarity, red-green colour, bblurring, central scotoma)
   - -> higher risk in renal impaired/elderly
   - -> is dose dependent, rv if D/C earlier
   - > avoid in young children
3. hyperuricemia, anthralgia