Chapter 77: Drug Therapy for TB Flashcards
TB
Systemic disease caused by Mycobacterium tuberculosis.
Pulmonary disease is the most common clinical presentation.
Other sties of involvement include lymphatics, GU, bone, meninges, peritoneum, an heart.
at risk pop for TB
the institutionalized; HIV positive persons; and those with diabetes. CKD, malignancy, malnutrition and other forms of immunosuppression.
latent TB
TB lives but doesnt grow in body
doesnt make a person feel sick or have s/sx
cant spread from person to person
can adv to TB disease
active TB
tb is active and grows in the body
makes a person feel sick and have symptoms
can spread from person to person
can cause death if not treated
overview of TB tx
RIPE
rifampin, INH, pyrazinamide, ethambutol
need baseline LFT
** All Hepatotoxic
Isoniazid (INH)
Inhibits mycolic acid production for the cell wall
Take vitamin B6 (Pyridoxine) concurrently to prevent neuropathy
Monitor LFT’s; Risk of Seizures
Rifampin
Inhibits RNA polymerase
Monitor LFT’s; Can cause urine to turn orange -harmless.
Ethambutol
Cell wall inhibitor
Associated with Optic Neuritis and color blindness
Monitor LFTS and eye exams
Pyrazinamide
Anti-metabolite
Can flare gout,
active TB tx
DOTS: Directly Observed Treatment,
Intensive Phase
2 month of Rifampin Isoniazid, Pyrazinamide, Ethambutol then:
Continuous Phase
4 month of just Isoniazid, Rifampin
Someone from HD comes to them to give medication or vice versa
Drug resistance is common for these AB –that’s why therapy is so long
Prophylaxis Treatment (+ PPD only)
9 months of INH or 4 months of Rifampin
After + PPD, draw blood for t-spot to see if they have true TB Ag. After that, take CXR if CXR is clear, but we know they have latent bacteria in body, pt gets prophylaxis therapy.
