Antitubercular Drugs

Question 1

How is TB characterized

Answer 1

Granulomas in the lungs, accumulations of Macrophages and lymphocytes in the lungs, may have a cheesy or caseated consistency

Question 2

Common infection sites

Answer 2

• Lung (primary site)
• Brain (cerebral cortex)
• Bone
• Liver
• Kidney
• Gi tract
• All tissue and organs

Question 3

How is TB passed

Answer 3

Through infected human, cows(bovine) and birds(avian) by conveying droplets

Question 4

Why is mycobacterium Tuberculosis hard to kill/treat

Answer 4

It is slow growing making it hard to kill as most stop the growth, needing extended treatment

Question 5

Stages of infections

Answer 5

First infection: Primary TB infection
Reinfection: chronic form of disease
Dormancy: may test positive but are not necessarily infectious

Question 6

What is MDR-TB resistant to

Answer 6

Isoniazid(INH) and rifampin

Question 7

How long is treatment of MDR-TB after close contact

Answer 7

6-9months

Question 8

Two phases of Therapy

Answer 8

Initial intensive phase with two medications
Continuation phase with three or more medications

Question 9

First Line of Drugs (RIPE)

Answer 9

isoniazid: primary drug
ethambutol hydrochloride
pyrazinamide
rifampin

Question 10

Second-Line Drugs

Answer 10

amikacin sulphate
levofloxacin hemihydrate
moxifloxacin hydrochloride

Question 11

What is Isoniazid (Isotamine) used for

Answer 11

Primary choice for TB and used alone or in combination with other drugs

Question 12

How is Isoniazid (Isotamine) metabolized

Answer 12

metabolized through the liver by acetylators
If slow acetylators one might need to decrease the dose

Question 13

What are slow acetylators

Answer 13

Clears up the drug from the liver just takes longer than normal

Question 14

Adverse effects isoniazid (Isotamine®)

Answer 14

Peripheral neuritis, hepatotoxicity, hyperglycemia, discoloration of body fluids

Question 15

Why is B6 needed when taking isoniazid (Isotamine®)

Answer 15

To treat peripheral neuropathy

Question 16

What is Ethambutol hydrochloride used for

Answer 16

First line of therapy may be used for mycobacteria diseases

Question 17

Contraindication/Adverse effect Ethambutol hydrochloride

Answer 17

Contraindicated: 13 years and under
Adverse Effect: Visual changes

Question 18

What is Pyrazinamide used for

Answer 18

Part of first line therapy

Question 19

Contraindication of Pyrazinamide

Answer 19

Patients with gout and severe liver disease, and hesitantly pregnant patients as there is not enough data

Question 20

WHat is Rifampin used for

Answer 20

First line but also used against meningococcus, Haemophilus influenza B and leprosy

Question 21

Adverse effect of Rifampin

Answer 21

Discolouration of Skin, cerebrospinal fluid, tongue and bodily secretions. Also may cause hematological disorders

Question 22

What is Purified protein derivative (PPD) (Mantoux®)

Answer 22

An intradermal injection to detect exposure of TB organism

Question 23

What is Bacille Calmette-Guérin (BCG)

Answer 23

It is a vaccine for TB from an inactive strain
Used mainly in the first nations communities.
Reduces active TB
Can cause a fake positive test

Question 24

Main effect of drug therapy

Answer 24

Reduction of cough therefore reducing the risk of infecting others

Question 25

T or F: Most cases of TB can be cures

Answer 25

True

Question 26

How long is successful treatment

Answer 26

6 months of antibiotic's and can be as long as 12 months

Question 27

Onset of anti-tubercular drugs

Answer 27

2-3 wks

Question 28

Why would one perform a drug susceptibility test(test to see what drugs work on the bacteria) on the first Mycobacterium spp.?

Answer 28

To see if it is MDR-TB and to prevent development of it

Question 29

When would one start a regiment of antitubercular drug therapy? before or after the susceptiability test?

Answer 29

Before the results to reduce the chances of a development of resistance and then adjust after results are known

Question 30

Variables of effectiveness of the therapy

Answer 30

- TYpe of infection - Adequate dosing - Sufficient duration of treatment - Adherence to drug regimen - Selection of effective drug combinations

Question 31

Problems that may affect TB therapy

Answer 31

- Drug resistant organisms - Drug toxicity - Patient nonadherence - MDR-TB

Question 32

For those taking INH or Rifampin what kind of assessments should you be doing before therapy

Answer 32

Liver function assessment especially older adults who drink alcohol daily

Question 33

What should the patient not consume when taking these medications

Answer 33

Alcohol and OTC meds unless prescribes say otherwise

Question 34

Which drug causes oral contraceptives to be ineffective

Answer 34

Rifampin

Question 35

When should you obtain a sputum culture

Answer 35

morning