GI/Pulm Flashcards
Severe abdominal pain, fatigue, and nausea. Physical examination is significant for profound jaundice and tenderness to palpation of the right upper quadrant of the abdomen. The patient returned 2 weeks ago from a 1 month-long trip to India
Acute hepatitis
Causes of acute hepatitis
- Viral hepatitides (e.g., HAV, HCV, and HBV)
- Parasites (e.g., toxoplasmosis)
- Alcohol
- Drug-induced (e.g., acetaminophen)
- Autoimmune hepatitis
- Steatohepatitis
- Metabolic disease
Sx of acute hepatitis
- Initial prodrome of flu-like symptoms (fatigue, nausea, vomiting, headaches) followed by jaundice (1-2 weeks after)
- Right upper quadrant (RUQ) pain, jaundice, scleral icterus, hepatomegaly, splenomegaly, fever
Ultrasound findings of acute hepatitis
Ultrasound is a good initial imaging modality for rule out of other causes of abdominal pain
- Hepatomegaly (most sensitive sign) and gallbladder wall thickening
Labs associated with acute hepatitis
- Hepatic panel
- Mixed direct and indirect hyperbilirubinemia
- Dramatically elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
-
ALT usually higher than AST
- AST:ALT > 2, suspect alcoholic hepatitis
-
ALT usually higher than AST
Which serology markers will be elevated in acute hepatitis
Anti-HbC IgM
C for capsule; M for men go first
+
HBsAg = Subway
What is the first hepatitis serology marker that will indicate early acute hep b infection?
HBsAG
What are the 2 serology markers indicating resolved hepatitis
Anti-HbC IgG
+
Anti-HbS
Chronic Hep B Serology markers
Anti- HBc capsule IgG = men aleady tried so guys left
+
HBsAG = Subway still transporting virus
Which serology marker indicates hep B immunity?
Anti-HBs
Anti-Subway = Already went through subway and now created antigens
IgM or IgG for acute vs chronic hep
Men first = GO TO WAR
g= guys after whats left behind
MCC of pancreatitis (get smashed)
- The mnemonic GET SMASHHED is useful in recalling the most common causes: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia, Hyperlipidemia, ERCP and Drugs.
MCC for anorexia in ED
Appendicitis
Consider this in all patients over 50 with new-onset constipation
Colorectal cancer
hypomobility of the GI tract in the absence of mechanical obstruction, absent bowel sounds
Ileus
Choledocholithiasis accounts for 60% of cases
Cholangitis
MCC of cirrhosis
- The most common cause is alcoholic liver disease
- Second most common cause: chronic hepatitis B and C infections
Budd Chiari Syndrome
Hepatic vein thrombosis (Budd Chiari Syndrome): a triad of abdominal pain, ascites, and hepatomegaly
If pt has ascites what diagnostic test is performed next?
- Abdominal ultrasound, diagnostic paracentesis - measure serum albumin gradient
In what condition is Asterixis (flapping tremor) - have patient flex hands seen?
Hepatic encephalopathy: ammonia accumulates and reaches the brain causing ↓ mental function, confusion, poor concentration
Rome criteria for diarrhea/constipation (less than 3 BM per week)
Any of 2 of the following + last three months with symptom onset six months prior to diagnosis
- Straining
- Lumpy hard stools
- A sensation of incomplete evacuation
- Use of digital maneuvers
- A sensation of anorectal obstruction or blockage with 25 percent of bowel movements
- A decrease in stool frequency (less than three bowel movements per week)
Common secondary causes of constipation include:
- Think of causes of secondary causes of constipation: DM, hypothyroidism, MS, dehydration, medications are common
Bulk forming laxatives include:
psyllium seed (eg, Metamucil), methylcellulose (eg, Citrucel), calcium polycarbophil (eg, FiberCon®), and wheat dextrin (eg, Benefiber)
Osmotic laxatives include
Start with low-dose polyethylene glycol (PEG) as it has been demonstrated to be efficacious and well-tolerated in older adults.
Diarrhea breakout at daycare most likely organism
Rotavirus
MCC of diarrhea after hospital admission?
C. Diff
Which organism is MCC of diarrhea after picnic/egg salad?
Staphylococcus Aureus
MC organism found in Seafood, especially raw or undercooked shellfish
Vibrio cholerae, Vibrio parahaemolyticus
Which organisms are seen in ground beef or seed sprouts?
Shiga toxin-producing E. coli (e.g., E. coli O157: H7)
MC organism seen in pork/poultry
Salmonella
MCC or travelers diarrhea
Enterotoxigenic E. coli is most common (traveler’s diarrhea)
MC organism with fried rice
Bacillus cereus
MC organism seen in camping, consumption of untreated water:
Giardia - incubates for 1-3 weeks, causes foul-smelling bulky stool and may wax and wane over weeks before resolving
Rice water stool is seen with which organism MC
V. cholerae
Afebrile, abdominal pain with bloody diarrhea: MC organism is:
Shiga toxin-producing Escherichia coli
MC location of diverticulitisq
Sigmoid colon
Dx of diverticular disease
Diagnose using abdominal and pelvic CT with oral, rectal, and IV contrast; do colonoscopy 1 to 3 months after the episode to look for cancer.
- CT revealing fat stranding and bowel wall thickening
Non-infectious causes of esophagitis
- Reflux esophagitis: mechanical or functional abnormality of the LES
- Medication-induced: think NSAIDS or bisphosphonates
-
Eosinophilic: Pt with Asthma symptoms and GERD not responsive to antacids. Allergic, eosinophilic infiltration of the esophageal epithelium.
- Diagnosed with a biopsy
- A barium swallow will show a ribbed esophagus and multiple corrugated rings
-
Radiation: radiosensitizing drugs include doxorubicin, bleomycin, cyclophosphamide, cisplatin
- Dysphagia lasting weeks-months after therapy
- Radiation exposure of 5000 cGy associated with increased risk for stricture
- Corrosive: Ingestion of alkali or acid from attempted suicide
odynophagia (pain while swallowing food or liquids) is the hallmark sign esophagitis MC from
- Fungal: Infectious Candida: linear yellow-white plaques with odynophagia or pain on swallowing. Tx with Fluconazole 100 mg PO daily
-
Viral:
- HSV: shallow punched out lesions on EGD, treat with acyclovir
- CMV: large solitary ulcers or erosions on EGD, treat with ganciclovir
- EBV, Mycobacterium tuberculosis, and Mycobacterium avium intracellular are additional infectious causes
MCC of gastritis (3)
Infection = H.pylori
Inflammation = NSAIDs/Alcohol
Autoimmune/hypersienisitivy = Pernicious anemia + schilling test → Decreased intrinsic factor
Hematochezia: bright red blood per rectum (BRBPR) causes
- Hemorrhoids: painless bleeding with wiping
- Anal fissures: severe rectal pain with defecation
- Proctitis: rectal bleeding and abdominal pain
- Polyps: painless rectal bleeding, no red flag signs
- Colorectal cancer: Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age
Tx of giardia
- TX with tinidazole (first line)
- Flagyl (Metronidazole) 250-750 mg PO TID
- Symptoms resolve within 5-7 days
- Flagyl (Metronidazole) 250-750 mg PO TID
GI symptoms and weight loss
- Transmission from raw or undercooked meat
- Associated with B12 deficiency
Tapeworm = tx w/ Praziquantel (anthelmintics)
cough, weight loss, anemia recent travel
Hookworm - Eosinophilia + Anemia
Tx= Mebendazole or pyrantel
Pancreatic duct, common bile duct, and bowel obstruction
Round worm = Most common intestinal helminth worldwide found in contaminated soil
Tx is TX: albendazole, mebendazole, pyrantel pamoate
- Fecal-oral, contaminated water/food, anal-oral
- Bloody diarrhea, tenesmus. abdominal pain
Amebia - Entamoeba histolytica (protozoa)
- TX: Iodoquinol or paromomycin and Flagyl for liver abscess
- Penetration of skin (contaminated freshwater) → enter the bloodstream and migrate to the liver, intestines, and other organs
Schistomiasis = parasitic flatworms
- TX: Praziquantel
MCC of hematemesis
- Peptic ulcer disease: hematemesis, abdominal discomfort, dull pain
- Esophageal varices: hematemesis, bleeding, difficulty swallowing
- Alcohol abuse: physical dependence, craving, vomiting
- Mallory-Weiss syndrome: a tear in the lining of the stomach just above the esophagus caused by violent retching or vomiting
- Coagulation disorders: characterized by a decreased ability to form a clot
- Esophageal cancer: progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis
- Gastrointestinal System Neoplasms: Abdominal pain and unexplained weight loss are most common symptoms along with reduced appetite, anorexia, dyspepsia, early satiety, nausea and vomiting, anemia, melena, guaiac-positive stool
Tx of external thrombosed (pain, pruritis, no bleeding) palpable perianal mass with purplish hue
External - lower 1/3 of the anus (below dentate line)
-
Thrombosed:
- Significant pain, and pruritus but no bleeding
- Palpable perianal mass with a purplish hue
- Treat with excision for thrombosed external hemorrhoids
Isolated to the colon starts at the rectum and moves proximally
- Continuous lesions
Ulcerative colitis
Sx of UC
- Hematochezia and pus-filled diarrhea, fever, tenesmus (feeling of incomplete defecation) anorexia, weight loss
Tx of UC
- Colectomy is curative
- Medications: Prednisone and mesalamine
A 24-year-old man with ulcerative colitis receives Lomotil for excessive diarrhea and develops fever, abdominal pain and tenderness
Toxic megacolon
Tx of toxic megacolon
Decompression of the colon is required
- In some cases, colostomy or even complete colonic resection may be required
Fifty-year-old with a history of coronary artery disease experiencing recurrent cramping with postprandial abdominal pain
Ischemic bowel disease
SMA → MC affected
Dx of ischemic boweldisease
- Plain films/CT: Bowel edema, pneumatosis intestinalis (gas within the bowel), portal venous gas
- Mesenteric angiography is the gold standard
- Increased indirect/unconjugated bilirubin, mild hyperbilirubinemia
- Dark urine due to hemoglobinuria; dark stool
What is the cause hemolytic or obstructive?
Hemolytic = prehepatic
Causes of obstructive post hepatic jaundice
- Cholestasis = bile duct blockage ⇒ increased conjugated bilirubin
- Cholestasis / pancreatic CA
- Increased direct/ conjugated hyperbilirubinemia
- GGT and ALP elevated
- Dark urine = increase direct bilirubin
- Acholic stools = biliary obstruction (white)
MCC of melena
- Gastric cancer, duodenal ulcers, right-sided colon cancer, portal hypertension with esophageal varices, severe erosive esophagitis, Mallory-Weiss syndrome.
4 cardinal signs of strangulated bowel (bowel obstruction)
The 4 cardinal signs of strangulated bowel: fever, tachycardia, leukocytosis, and localized abdominal tenderness.
MCC of sm bowel obstruction
MCC: adhesions or hernias, cancer, IBD, volvulus, and intussusception
When do you hospitalize for acute bronchitis
- Hospitalization if O2 saturation < 95-96%, age <3 months, RR > 70, nasal flaring, retractions, or atelectasis on CXR
Supportive tx for acute bronchitis
- Supportive ⇒ humidified O2, antipyretics, beta-agonist, nebulized racemic epinephrine, and steroids
What is the prophylaxis given for bronchitis in immunocompromised, premies, or neuromuscular disorder patients?
Palivizumab prophylaxis (once per month for five months beginning in November) for special populations (immunocompromised, premature infants, neuromuscular disorders)
MC bacteria in acute bronchitis
- Most common - viral (95%)
- Common bacterial = M. catarrhalis
- Chronic lung patients: H. influenzae, S. pneumoniae, M. catarrhalis
Supraglottic inflammation and obstruction of airway due to infection with Haemophilus influenzae type B (Hib)
Acute epiglottitis
3 Ds of epiglottitis:
Tripod positioning ⇒ 3 Ds of epiglottitis:
- Dysphagia
- Drooling
- Respiratory Distress
The classic finding on x-ray lateral neck film for epiglottitis
The classic finding is thumbprint sign on x-ray lateral neck film, secure airway then culture for H.flu
Pathophys for acute resp distress
- ⇑ Permeability of alveolar-capillary membranes ⇒ development of protein-rich pulmonary edema (non-cardiogenic pulmonary edema)
- Rapid onset of profound dyspnea occurring 12-24 hours after the precipitating event
- Tachypnea, pink frothy sputum, crackles
ARDS
Mild intermittent asthma occurs how often
(<2x/week or <2 night/month) – SABA prn
Mild persistent asthma occurs how often
(>2x per week or 3-4 night/month) – low dose ICS daily
Moderate persistent asthma occurs how often
Moderate persistent (daily sx or >1 night/week)
- Low dose ICS + LABA daily
- Medium dose ICS + LABA daily
Severe persistent asthma occurs how often?
Severe persistent (sx several times / day + nightly) –
- High dose ICS + LABA Daily
- High dose ICS + LABA + oral steroids
Croup refers to an infection of the upper airway, which obstructs breathing and causes a characteristic barking cough
Croup
MCC of croup
Parainfluenza virus
Findings on cxr in a pt with suspected croup
- Steeple sign on PA CXR (narrowing trachea in the subglottic region)
Which type of bronchoscope is used in children vs adults
-
Rigid bronchoscopy preferred in children while flexible is diagnostic and therapeutic in adults
- Complications include pneumonia, acute respiratory distress syndrome, asphyxia
MCC of hemoptysis
- Bronchitis (50%): hemoptysis, dry cough, cough with phlegm
- Tumor mass (20%): hemoptysis, chest pain, rib pain, tobacco history, weight loss, clubbing
- Tuberculosis (8%): hemoptysis, chest pain, sweating
Other causes include bronchiectasis, pulmonary catheters, trauma, pulmonary hemorrhage
Tx of hemoptysis
- Massive hemoptysis warrants a more aggressive early consultation with a pulmonologist
- ABCs ⇒ Airway maintenance is vital because the primary mechanism of death is asphyxiation, not exsanguination
The most common presentation of acute or mild hemoptysis
Bronchitis
Older smokers with hemoptysis lung cancer must be ruled out with
High resolution CT
NEGATIVE CXRs DO NOT RULE OUT LUNG CANCER
Who is the flu vaccine contrainidcated in?
- Avoid vaccination: severe egg allergy, previous reaction, Guillain-Barré syndrome (GBS) within 6 weeks of previous vaccination, GBS in the past 6 weeks, <6 mo old. Avoid FluMist in pt with asthma
Which 2 medications treat both influenza A & B
- Zanamivir and Oseltamivir both treat influenza A and B ⇒ (think Dr. “OZ” treats the flu)
4 subtypes of non-small cell lung cancer
four subtypes include adenocarcinoma, squamous cell carcinoma, large cell carcinoma and carcinoid tumor
What is the most common location for small cell lung cancer and what is the best tretment?
- 99% smokers; doesn’t respond to surgery; metastases common at presentation
- Central location, very aggressive
- Associated with paraneoplastic syndromes; Cushing’s, SIADH
Tx: can’t have surgery; needs chemo
MC type of non-small cell CA
- Adenocarcinoma (35-40%): MOST COMMON, peripheral mass; smoking/asbestos exposure; thrombophlebitis
Where does large cell lung cancer occur?
Periphery → Associated with gynecomastia
What is carcinoid syndrome?
- Carcinoid syndrome = cutaneous flushing, diarrhea, wheezing, hypotension (telltale sign)
- Adenoma = MC type of carcinoid tumor (slow-growing, rare)
What is dx for carcinoid tumor
- Dx: bronchoscopy – pink/purple central lesion, well-vascularized; elevated 5-HIAA
If suspicious pulmonary nodule is noted what is the next step
Biopy → Ill-defined lobular or spiculated suggests cancer
If pulmonary nodule is not suspicious and less than 1 cm what is the next step?
If not suspicious < 1 cm it should be monitored at 3 mo, 6 mo, and then yearly for 2 yr
Calcification, smooth well-defined edges, suggests benign disease
highly contagious respiratory tract infection marked by a severe hacking cough followed by a high-pitched intake of breath
Whooping cough
MC organism associated with whooping cough
Gram negative - bordatella pertusisis
3 stages of whooping cough
- Catarrhal stage: cold-like symptoms, poor feeding, and sleeping
- Paroxysmal stage: high-pitched “inspiratory whoop”
- Convalescent stage: residual cough (100 days)
How is whooping cough diagnosed
Diagnosed by a nasopharyngeal swab of nasopharyngeal secretions – culture
Tx of whooping cough
Tx: macrolide (clarithromycin/azithromycin); supportive care with steroids / beta2 agonists
- Vaccination: 5 doses – 2, 4, 6, 15-18 mo, 4-6yrs (DTap)
- 11-18 yo = 1 dose Tdap
- Expectant mothers should get Tdap during each pregnancy, usually at 27-36 weeks
Accumulation of excess fluid between the layers of the pleura outside the lungs (pleural space)
Pleural effusion
dyspnea, and a vague discomfort or sharp pain that worsens during inspiration
Pleural effusion
How to differentiate between exudate and transudative pleural effusion?
Determine if the pleural fluid is exudative by meeting at least one of Light’s Criteria (increased protein, increased LDH)
- Pleural fluid protein / Serum protein >0.5
- Pleural fluid LDH / Serum LDH >0.6
- Pleural fluid LDH > 2/3
Common causes of exudative pleural effusion
Exudative = protein ratio ↑, LDH ↑: infection, malignancy, immune; MC cause = pneumonia, cancer, PE, TB
Causes of transudate pleural effusion
Transudate = transient → from changes in hydrostatic pressure: cirrhosis, CHF, nephrotic syndrome, ascites, hypoalbuminemia
Dx pleural effusion
Diagnose with lateral decubitus CXR, chest CT, U/S. Thoracentesis is the gold standard
PE findings of pleural effusion
- PE shows decreased tactile fremitus and dullness to percussion in pleural effusion
- Isolated left-sided pleural effusion likely exudative
- Right-sided = transudative
Tx of pleural effusion
Treatment is with thoracocentesis
- Effusions that are chronic or recurrent and causing symptoms can be treated with pleurodesis (pleural space is artificially obliterated) or by intermittent drainage with an indwelling catheter
Common causes of pleuritic chest pain
- Common causes include pneumonia, pericarditis, pericardial effusion, pancreatitis
MCC of viral pneumonia
Viral: adults ⇒ flu = MC cause; kids ⇒ RSV; comes on fast
fever, dyspnea, tachycardia, tachypnea, cough, +/- sputum
Bacterial pneumonia
What is seen on cxr if a pt has suspected bacterial pneumonia
- Dx: patchy, segmental lobar, multilobar consolidation; blood cultures x2, sputum gram stain
Tx of bacterial pneumonia
- Tx: outpatient = doxy, macrolides; inpatient = ceftriaxone + azithromycin/respiratory FQs
Valley fever pnuemonia is suspected if
non-remitting cough/bronchitis non-responsive to conventional tx
Fungal inhalation in western states; test with EIA for IgM and IgG
Tx of coccidioides or pulmonary aspergillosis pneumoina
Fluconazole or itraconazole
Where is cryptococcus found
CRYPTS = Tombs in the soil
Can cause disseminated meningitis → Perform LP for meningitis
Tx w/ Amphotericin B
pulmonary lesions that are apical and resemble cavitary TB; worsening cough and dyspnea, progression to disabling respiratory dysfunction; no dissemination
Histoplasma capsulatam
Where is histoplasma found
- Bird or bat droppings (caves, zoo, bird); Mississippi Ohio river valley
What are cxr findings associated with histoplasma
- Signs: mediastinal or hilar LAD (looks like sarcoid)
Which two weird types of pnuemonia are treated with amphortericin B
Cryptococcus + Histoplasma
What is the tx for PCP or PJP pneumonia
Bactrim + steroids
Seen in HIV pts with CD4 below 200
What is the CURB-65 score for pnuemonia severity
- confusion, urea >7, RR >30, Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg, age >65
- 0-1 = low risk, consider home tx
- 2 = probable admission vs close outpatient management
- 3-5 admission, manage as severe
ipsilateral chest pain and dyspnea with decreased tactile fremitus, deviated trachea, hyperresonance, diminished breath sounds
Pneumothorax
Causes of pneumothorax
Spontaneous vs traumatic
- Primary: occurs in absence of underlying disease (tall, thin males age 10-30 at greatest risk)
- Secondary: in presence of underlying disease (COPD, asthma, cystic fibrosis, interstitial lung disease)
Penetrating injury → air in pleural space increasing and unable to escape
- A mediastinal shift to the contralateral side and impaired ventilation
Tension pneumo
Tx of small vs large pneumothorax
- Small - < 15% diameter of hemithorax will resolve spontaneously without the need for chest tube placement
- Large - > 15% diameter and symptomatic pneumothoraces require chest tube placement
- Serial CXR every 24 hours until resolved
Tx of tension pneumothorax
- Tension pneumothorax is a medical emergency! Large bore needles to allow air out of the chest; chest tube for decompression
RF for pulmonary embolism
Virchow’s triad = hypercoagulable state, trauma, venostasis (surgery, cancer, oral contraceptives, pregnancy, smoking long bone fracture/fat emboli)
What is homans sign
- Homan’s sign: (Dorsiflexion of the foot causes pain in calf) indicative of deep vein thrombosis
What findings are seen on EKG for suspected PE
- EKG: TACHYCARDIA (most common), S1Q3T3 (rare), non-specific ST wave changes
Gold std tx for pulmonary embolism
- Pulmonary angiography = gold standard definitive
- CXR: Westermark sign or Hampton hump (triangular or rounded pleural base infiltrate adjacent to hilum)
- VQ scans are “old school”= perfusion defects with normal ventilation (normal VQ rules out PE; abnormal – non-specific)
- Venous duplex ultrasound of lower extremities (normal test does not exclude PE)
Anticoag of choice for pulmonary embolism
Heparin is the anticoagulant of choice for the acute phase with factor Xa inhibitors (eg, rivaroxaban, apixaban, edoxaban) and oral direct thrombin inhibitors (dabigatran) thereafter
Duration of tx for anticoagulation after pulmonary embolism
- Duration of treatment: minimum of anticoagulation 3 months with reversible risk factor
- Unprovoked: anticoagulation recommended for at least 6 months then reevaluate
- Two episodes unprovoked, long term with anticoagulation
Indications for hospitalization in kids with RSV
Indications for hospitalization ⇒ tachypnea with feeding difficulties, visible retractions, oxygen desaturation < 95-96%
Tx of RSV
- Supportive measures include albuterol via nebulizer, antipyretics and humidified oxygen, steroids (controversial), resolves in 5-7 days
- Vaccine for children with lung issues or born premature/immunocompromised at birth should get Synagis prophylaxis (palivizumab) = once per month for five months beginning in November
General tx of SOB
- Oxygen (high flow nasal canal or rebreathing mask)
- Albuterol for asthma and COPD
- Lasix for CHF
- BIPAP for respiratory difficulty and low O2 saturations
- Intubation for severe cases
Tuberculosis presentation
Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis (acid-fast bacilli)
- Presentation: fatigue, productive cough, night sweats, weight loss, post-tussive rales
How is TB transmitted
Transmission: inhalation of aerosolized droplets
TB test >5mm would be positive in what population
- > 5 mm at high risk, fibrotic changes on CXR, immunocompromised HIV/drugs, steroids/TNF antagonists daily, or close contact with pt with infectious TB
TB test of > 10 mm would be positive in what population?
- > 10 mm in patients age < 4 or some risk factors = hospitals and other healthcare facilities, IVDU, recent immigrants from high prevalence area, renal insufficiency, prison, homeless shelter, diabetes, head/neck cancer, gastrectomy/jejunoileal bypass surgery
TB test of > 15 mm is positive in what population
No other risk factors
How is TB diagnosed
Diagnosis with sputum for AFB smears and Mycobacterium tuberculosis cultures – have to be 3 AFB negative
- NAAT helps diagnosis better and sooner
- CXR: cavitary lesions, infiltrates, ghon complexes in the apex of lungs
- Biopsy ⇒ caseating granulomas
- Miliary TB = spread outside lungs ⇒ vertebral column: Pott disease; scrofula (TB to cervical lymph nodes)
PPD positive + CXR negative:
Latent TB = latent TB ⇒ Isoniazid for 9 months (+ B6 to prevent neuropathy)
PPD positive + CXR positive
active TB** ⇒Quad therapy (RIPE):** rifampin, isoniazid, pyrazinamide, ethambutol – all are hepatotoxic
How is RIPE tx prescribed for TB?
How is RIPE tx prescribed for TB?
What are the side effects to the RIPE drugs
Rifampin = Red/orange urine
Isoniazid = I SO NUMB = Peripheral neuropathy cant feel hands *take B6
Pyrazinamide = Pyramid → Egyptians love salt = GOUT
Ethambutol = EYES = Optic neuritis
Patients with active TB will need two negative AFB smears and cultures in a row negative for therapy cessation
- Prophylaxis for household members ⇒ Isoniazid for 1 year
- D/C therapy if transaminases > 3-5 × ULN
- Pt’s on INH should take supplemental Vitamin B6 (pyridoxine 25-50mg/day) to prevent neuropathy
