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Therapeutics > Mycobacteria > Flashcards

Mycobacteria Flashcards

1
Q

Transmission of M. tuberculosis only occurs from a person with infectious, active TB disease (T/F)

A

True

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2
Q

Risk of developing TB disease increases by ____% each year in HIV infection individuals

A

5-10%

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3
Q

Signs of pulmonary TB include a chronic, productive cough for _______

A

> 2 weeks

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4
Q

Advanced stages of pulmonary TB can cause ____ sputum

A

blood-tinged

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5
Q

Groups that are not high risk for TB should not be tested routinely (T/F)

A

True

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6
Q

Persons at higher risk for exposure to or infection with TB include:

A

Close contacts of a person known or suspected to have TB
Foreign-born persons from areas where TB is common
Residents and employees of high-risk congregate settings (ex. prisons)
Health care workers who serve high-risk clients
Medically underserved, low-income populations
High-risk racial or ethnic minority populations
Children exposed to adults in high-risk categories
Persons who inject illicit drugs

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7
Q

For patients who are HIV positive, recent contacts of TB cases, have fibrotic changes on chest x-ray, or organ transplant/other immunosuppressed patients, the classifying tuberculin reaction is ____ mm

A

≥5 mm

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8
Q

For recent arrivals from high-prevalence countries, injection drug users, residents and employees of high-risk congregate settings, children <4 years, the classifying tuberculin reaction is ___ mm

A

≥10 mm

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9
Q

For persons with no known risk factors for TB, the classifying tuberculin reaction is ___ mm

A

≥15 mm

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10
Q

Nontuberculous mycobacteria and/or BCG vaccination may result in a false-___ TST

A

false-positive

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11
Q

Very young age (<6months), live-virus vaccination, overwhelming TB disease, and immunosuppression may results in a false-____ TST

A

false-negative

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12
Q

TST is contraindicated for BCG-vaccinated persons (T/F)

A

False

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13
Q

Boosting occurs for patients who do not respond to the initial skin test. The initial skin test may stimulate the body’s ability to react to TB

A

True

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14
Q

People with LTBI may have a positive TST when tested years after infection (T/F)

A

False, LTBI patients may show a NEGATIVE TST when tested years after infection, which is why they require boosting

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15
Q

IGRA are not approved for use in children ___ years old

A

<5 years old

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16
Q

IGRA are accurate in persons recently exposed or immunocompromised patients (T/F)

A

False

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17
Q

IGRA can differentiate between latent and active infection (T/F)

A

False

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18
Q

IGRAs are more expensive than TSTs (T/F)

A

True

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19
Q

Chest radiographs can confirm TB diagnosis (T/F)

A

False, cultures are the gold standard for confirming TB diagnosis

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20
Q

___ sputum specimens for smear examination and culture should be obtained

A

3

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21
Q

TB uses the _____ bacilli smear

A

acid-fast bacilli

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22
Q

All specimens should be cultures, even if smears are negative (T/F)

A

True

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23
Q

The Nucleic Acid Amplification Test (NAAT) is more sensitive and specific than AFB smears (T/F)

A

True

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24
Q

You do not have to run a NAAT test if you get a positive smear (T/F)

A

False, you should run a NAAT test on at least one sputum culture

25
Q

NAAT results are available after:
A. within hours to days
B. in 10-14 days

A

A. within hours to days

26
Q

The molecular Detection of Drug Resistance (MDDR) test can be used to detect mutations frequently associated with _____ and _____ drug resistance

A

rifampin and isoniazid - if positive, the test will also detect resistance

27
Q

For patients whose initial evaluation suggests a liver disorder, have HIV, are either pregnant or in the immediate postpartum period (≤ 3 months), have a history of regular alcohol use, injection drug user, medications with possible interactions, you should run baseline _____ measurements for LTBI treatment

A

hepatic

28
Q

Preferred LTBI treatment that has moderate evidence for HIV + and _ patients: _____ + ______

A

isoniazid + rifapentine once weekly for 3 months

29
Q

Preferred LTBI treatment for HIV - patients only: _____

A

rifampin daily for 4 months

30
Q

Preferred LTBI treatment that has low evidence for HIV + and HIV- patients: _____ + ______

A

isoniazid + rifampin daily for 3 months

31
Q

LTBI patients receiving treatment should be evaluated every _____

A

month

32
Q

For active TB, a single drug should be added to a failing regimen (T/F)

A

False, usually 2 or more drugs are added

33
Q

1st line active TB therapy includes RIPE - what are the medications?

A

Rifampin 10 mg/kg daily, Isoniazid 5 mg/kg once daily, Pyrazinamide 20-25 mg/kg daily, Ethambutol 15-20 mg/kg daily

34
Q

Things to look out for regarding rifampin include

A

DDIs - CYP3A4 inducer
Discoloration of secretions
Hepatotoxicity

35
Q

Things to look out for regarding isoniazid include

A

Peripheral neuropathy

36
Q

This drug for active TB treatment is the most hepatotoxic

A

Pyrazinamide

37
Q

Which 2 active TB drugs require renal adjustments and also use lean body weight measurements?

A

Pyrazinamide and Ethambutol

38
Q

This drug for active TB treatment is the least hepatotoxic

A

Ethambutol

39
Q

This active TB drug can cause ocular toxicity (green color and visual acuity issues)

A

Ethambutol

40
Q

What is usually prescribed with isoniazid at 25-50 mg/day to help in malnourished patients or those prone to neuropathy?

A

Vitamin B6

41
Q

RIPE meds should be given with food because food increases absorption (T/F)

A

False, empty stomach because food decreases absorption

42
Q

The regimen for TB therapy includes:

RIPE for ___ months (initial phase), then rifampin + isoniazid for ___ months (continuation phase)

A

2 months, then 4 months

43
Q

In HIV- persons, regimen should be adjusted once drug susceptibility results are known: If isoniazid + rifampin susceptible, ____ can be dropped during the initial phase but ____ should be kept on for a total of 8 weeks

A

can drop ethambutol but should keep pyrazinamide for a total of 8 weeks

44
Q

In HIV+ persons who are not taking any protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs), they should be on ___-based regimens

A

rifampin (RIPE)

45
Q

In HIV+ persons who are receiving protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs), they should be given initial RIPE therapy with rifampin substituted with _____

A

rifabutin

46
Q

For pregnant women with TB, what is their treatment and what should be avoided?

A

9-month regimen of isoniazid, rifampin, and ethambutol. AVOID pyrazinamide

47
Q

Children with TB should be in most cases treated with the same regimen used for adults (T/F)

A

True

48
Q

Children with bone and joint TB, miliary TB, or TB meningitis should be treated for a minimum of ___ months

A

12 months

49
Q

The two most common resistant TB drugs are

A

isoniazid and rifampin

50
Q

If isoniazid resistant, what should replace it in the therapy?

A

discontinue isoniazid and add LEVOFLOXACIN. Continue regimen for the entire 6 months

51
Q

What kind of therapy should be considered for all patients to help with treatment adherence issues?

A

DOT (Direct Observed Treatment)

52
Q

How often should patients be monitored bacteriologically?

A

Monthly until cultures convert to negative

53
Q

After ___ months of therapy, positive cultures should be re-evaluated for resistance and/or nonadherence

A

2 months

54
Q

Patients are no longer infectious with TB if these 3 criteria are met:

A

They are on adequate therapy, have had a significant clinical response to therapy, have had 3 consecutive negative sputum smear results

55
Q

Slow growing non-TB mycobacterium (NTM) is what duration? Rapidly growing NTM is what duration?

A

Slow: >1 week
Rapid: within 1 week

56
Q

The most common clinical presentation of NTM is pulmonary disease (T/F)

A

True, and often occurs when there is underlying structural airway disease

57
Q

Diagnosis of NTM includes pulmonary or systemic symptoms, nodular or cavity opacities on a CT scan, and positive culture results from at least ____ separate sputum samples

A

TWO

58
Q

There is a possibility that you may not treat NTM at all and instead, use the watch and wait method (T/F)

A

True

59
Q

NTM requires a longer treatment duration (T/F)

A

True, around 12 months

Therapeutics (10 decks)

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