Anti-TB Drugs

Question 1

minimum of ___ drugs preferably both __ rather than ___

Answer 1

2 drugs, bactericidal > bacteriostatic

Question 2

what are the anti-tb drugs

Answer 2

h isoniazid
r rifampicin
s streptomycin
z pyrazinamide
e ethambutol

Question 3

drugs that are effective inside cavities

Answer 3

h r s - fast growth rate, big pop

Question 4

drugs that are effective inside a close lesions (granuloma)

Answer 4

h r z - slow growth rate, small pop

Question 5

drugs effecting inside macrophage

Answer 5

h r z e - slow growth rate, small pop

Question 6

most effective drugs in the different subpopulations

Answer 6

h and r

Question 7

dosing for first line drugs

Answer 7

h5 r10 es15 z25

Question 8

most hepatotoxic and ototoxic of all the first line drugs

Answer 8

hepatotoxic: z
ototoxic: s

Question 9

second line drugs

Answer 9

ofloxacin, levofloxacin, ciprofloxacin, coamoxiclav, clarthromycin

Question 10

short course chemotherapy

Answer 10

6 mos

• 2 mos: hrze
• 4 mos: hr

Question 11

fixed dose combination drugs dosage for hrze

Answer 11

37-54 kg: 3 tablets
55-70 kg: 4 tablets
>70 kg: 5 tablets

Question 12

fixed dose combination drugs dosage for hr

Answer 12

<50 kg: 1 tablet

>50 kg: 2 tablets

Question 13

benefits of single drug formulation

Answer 13

• can check adverse reactions
• comorbids that need dose readjustment
• for at risk patients!!

Question 14

bacteriologically confirmed tb

Answer 14

• xpert mtb/rif
• sputum smear
• tb lamp
• tb culture

Question 15

clinically diagnosed tb

Answer 15

• cxr
• ct/uts
• histo
• biochem
• physician’s discretion

Question 16

drug resistant tb

Answer 16

read table 5

Question 17

regimen 1 for treatment

Answer 17

2hrze/4hr - ptb or epth (except cns, bones, joints)

Question 18

regimen 2 for treatment

Answer 18

2hrze/10hr - eptb of cns, bones, joints

Question 19

standard regiments for ds-tb dosing

Answer 19

25-37 kg: 2 tab hrze, 2 tab hr
38-54 kg: 3 tab hrze, 3 tab hr
55-70 kg: 4 tab hrze, 4 tab hr
>70 kg: 5 tab hrze, 5 tab hr

Question 20

when to give corticosteroids

Answer 20

adjunct therapy for tb meningitis (dexamethasone) or tb pericarditis (prednisone)

Question 21

when to do sputum follow up

Answer 21

clinical: after 2 mos hrze, end of mo 5, end of treatment
bacterial: end of mo 2, end of mo 5, end of treatment

Question 22

treatment in special situations

Answer 22

• pregnant/lactating: avoid streptomycin and quinolones, give pyridoxine supplement
• chronic liver disease: 2 shre/6hr or 2 hre/6 he (defer if acute hepa)
• renal failure: 2 hrz/6 hr (after dialysis)
• hiv/aids: 2 hrze/4-7 hr

Question 23

t/f breastfeeding is discouraged

Answer 23

false

Question 24

minor adverse effects

Answer 24

• gi intolerance
• mild skin reactions
• orange/red urine
• pain at injection site
• burning sensation of feet
• arthralgia
• flu like symptoms

Question 25

major side effects

Answer 25

• severe skin rash
• jaundice
• optic neuritis
• tinnitus and vertigo
• oliguria or albuminuria
• psychosis and convulsion
• thrombocytopenia, anemia, shock

Question 26

drugs that can cause optic neuritis

Answer 26

ethambutol and isoniazid

Question 27

recommended and not recommended testing

Answer 27

• reco: alt, crea, fbs, rbs, 75g ogtt

- not reco: serum uric acid

Question 28

delay anti retroviral drugs for ___ after starting anti-tb treatment

Answer 28

4-8 weeks

Question 29

drug that affects glycemic control

Answer 29

isoniazid – needs dose adjustment