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PHA 416 - Therapeutics IV > Exam 1 - Tuberculosis (8 points) > Flashcards

Exam 1 - Tuberculosis (8 points) Flashcards

1
Q

What bacterium causes Tuberculosis?

A

Mycobacterium tuberculosis, an aerobic, acid-fast bacilli

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2
Q

Describe the bacterium Mycobacterium tuberculosis.

A

It is an aerobic, acid-fast bacilli

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3
Q

T/F: Tuberculosis is a leading killer in patients with HIV.

A

TRUE

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4
Q

Tuberculosis presents as either ____ or _____ disease.

A

Tuberculosis presents as either ACTIVE or LATENT disease.

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5
Q

Define Latent Disease.

A

Absence of symptoms (active disease) but test positively on skin testing

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6
Q

What area of the body does Tuberculosis infect?

A

Predominately the lungs, but can infect any organ of the body

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7
Q

How is Tuberculosis spread?

A

By airborne particles (droplet nuclei) from infected individuals that are inhaled

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8
Q

Name the three risk factors for TB.

A

1) Non-US born higher than US born
2) Homelessness
3) HIV

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9
Q

T/F: Latent disease TB is the most common form of TB.

A

TRUE

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10
Q

List the characteristics of Latent TB.

A
  • Asymptomatic
  • Can’t transmit to others
  • Will have a positive TB skin test
  • May progress to ACTIVE disease in the absence of preventative treatment
  • May progress to ACTIVE disease if patient becomes immunosuppressed from disease or medications
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11
Q

T/F: You cannot be latent disease TB your entire life.

A

FALSE - you can be latent your entire life

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12
Q

T/F: In latent TB you cannot transmit to anyone else.

A

TRUE - can’t transmit to others in latent tuberculosis

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13
Q

T/F: In latent TB patients will have a negative TB skin test.

A

FALSE - in latent tuberculosis patients will have a positive TB skin test

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14
Q

Name the five categories of patients at risk for progression to active disease.

A

1) HIV disease
2) Recent infection (last two years)
3) Babies and young children
4) Elderly
5) Untreated

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15
Q

Name the typical clinical presentations (s/s) for active disease TB.

A
  • Fever
  • Night sweats
  • Weight loss
  • Fatigue
  • Productive cough
  • Hemoptysis
  • Elevated lymphocyte count
  • Thrombocytosis
  • Cavitary lesions on x-ray, commonly affecting the upper lobes
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16
Q

Name the atypical clinical presentations (s/s) of active disease TB.

A
  • Lymphadenopathy
  • HA
  • Seizures
  • Confusion
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17
Q

T/F: A progressive primary disease spreads beyond the lungs with the initial infection.

A

TRUE

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18
Q

T/F: A progressive primary disease also develops a latent period.

A

FALSE - progressive primary disease does not develop a latency period

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19
Q

What are the 3 risk factors for developing progressive primary disease?

A

1) Children
2) Elderly
3) Immunocompromised

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20
Q

How do we screen/diagnose TB?

A

Skin testing (Mantoux, PPD)

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21
Q

T/F: The skin testing for TB screening does not differentiate latent from active disease.

A

TRUE

22
Q

How many unit are injected intradermally for the TB skin test?

A

5 tuberculin units

23
Q

Positive responders should ______ receive the skin test again.

A

Positive responders should NEVER receive the skin test again.

24
Q

What is the name of the TB diagnostic skin test?

A

Manatoux, PPD

25
Q

Aside from the Mantoux, PPD skin test, what are three other additional tests for Tb?

A

1) Interferon gamma release test
2) QuantiFERON-Tb Gold test - MOST COMMON
3) T-Spot Tb test

26
Q

T/F: All of the tests available to diagnose Tb can differentiate latent from active infection.

A

FALSE - None of the tests can differentiate latent from active infection

27
Q

What is the “boost effect?”

A

When a patient has been exposed, have latent disease and their immunogenicity has worn off
-The additional tests for Tb are not subject to “boost effect”

28
Q

Name the three tests that test whole blood for antigens.

A

1) Interferon-gamma
2) Quantiferon
3) T-Spot test

29
Q

Who should be tested for Tb?

A

Moderate risk patients who are under 65 years of age

30
Q

T/F: Moderate risk patients, less than 65 years of age should be tested for Tb.

A

TRUE

31
Q

Who are considered “moderate risk patients” that should be tested for Tb?

A

1) DM

2) Receiving systemic glucocorticoids (>15 mg/day for >1 month)

32
Q

What three ways is diagnosis of patients suspected of active disease conducted?

A

1) Chest X-ray
2) Sputum
3) Bronchial lavage or biopsy

33
Q

Name the indications for a bronchial lavage or biopsy.

A
  • Negative sputum smear

- Unable to produce sputum

34
Q

What diagnostic procedure can you perform on a patient suspected of active disease if they cannot do a sputum test?

A

Bronchial lavage or biopsy

35
Q

Name the selected indications for treatment of LTBI (latent disease).

A
  • Individuals less than 50 years of age
  • Individuals 50-65 years of age who are at moderate to high risk of reactivation to active disease (immunosuppressed patients - i.e., HIV, chemo, DMARDs for RA, etc.)
  • Individuals >65 who are at high risk of reactivation to active disease
36
Q

Treatment of Latent Tuberculosis – Standard Regimen:

A

PREFERRED REGIMENS
-Isoniazid (INH) + Rifapentine for adults and children >2 years of age once weekly for 12 weeks

OR

-Rifampin daily for 3-4 months (HIV negative)

ALTERNATIVES
-INH daily for 6-9 months

37
Q

What is the alternative treatment for latent tuberculosis?

A

INH daily for 6-9 months

38
Q

What is the preferred regimen for treatment of latent tuberculosis?

A

Isoniazid (INH) + Rifapentine for adults and children >2 years of age once weekly for 12 weeks

OR

Rifampin daily for 3-4 months (HIV negative)

39
Q

What are the benefits to having INH and Rifapentine in combination?

A

They have shown a less incidence of liver toxicity and a shorter duration

40
Q

Name the side effects of Isoniazid.

A

1) Rash
2) Agranulocytosis, anemia, thrombocytopenia
3) Peripheral neuropathy

41
Q

What is the prevention treatment for peripheral neuropathy that can occur when taking Isoniazid?

A

25-50 mg pyridoxine (vitamin B6) po qd

42
Q

Peripheral neuropathy interferes with _______ _________.

A

Peripheral neuropathy interferes with PYRIDOXINE METABOLISM.

43
Q

Another name for vitamin B6 is?

A

Pyridoxine

44
Q

How is Isoniazid metabolized?

A

Isoniazid is metabolized by acetylation in the liver

45
Q

What two ethnicity’s are fast acetylators of Isoniazid?

A

Asian

Eskimo

46
Q

What two ethnicity’s are slow acetylators of Isoniazid?

A

African Americans

Caucasians

47
Q

What is the half-life of Isoniazid in fast acetylators?

A

<2 hours

48
Q

What is the half-life of Isoniazid in slow acetylators?

A

3-4 hours

49
Q

Which type of acetylators (fast or slow) of Isoniazid are at greater risk for side effects such as peripheral neuropathy?

A

SLOW acetylators

50
Q

Who is at risk of hepatotoxicity (increased liver enzymes) when taking Isoniazid?

A
  • Elderly
  • Pregnant or post partum
  • Possibly slow acetylators

PHA 416 - Therapeutics IV (10 decks)

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