NTP II Flashcards
1
Q
What is the time frame for providing treatment to diagnosed drug-susceptible tuberculosis (DS-TB) cases?
A
Within five working days from collection of sputum.
2
Q
What determines the standard treatment for DS-TB?
A
Results of Xpert MTB/RIF.
3
Q
What should be ensured regarding the quality of anti-TB drugs?
A
Ordered from a source with a track record of producing first-line drugs according to national standards set by the FDA.
4
Q
How should treatment adherence be ensured?
A
Through patient-centered approaches with support from health workers, community volunteers, or family members.
5
Q
What is used to monitor treatment response?
A
Follow-up smear microscopy and clinical assessment.
6
Q
What should be reported and managed during treatment?
A
All adverse drug reactions (ADRs).
7
Q
What additional service should all TB patients aged 15 and above receive?
A
Provider-initiated HIV counselling and testing.
8
Q
What screening should be done for TB patients aged 25 years and above?
A
Screening for diabetes.
9
Q
What duration of treatment is recommended for DS-TB?
A
Six months.
10
Q
What is the treatment duration for severe drug susceptible extra-pulmonary TB (EPTB)?
A
12 months.
11
Q
What is the treatment duration for drug-resistant TB (DR-TB)?
A
9–20 months.
12
Q
What information should be provided to a patient diagnosed with TB?
A
Basic information about TB, duration of treatment, potential adverse events, relevance of contact investigation, and availability of free services.
13
Q
What should be determined and recorded as part of treatment initiation?
A
Baseline weight and clinical findings.
14
Q
What are the two regimens for DS-TB based on eligibility?
A
- Regimen 1: 2HRZE/4HR
- Regimen 2: 2HRZE/10HR
15
Q
What is the intensive phase dosage for adults weighing 25-37 kg?
A
2 tablets of 2 RHZE.
16
Q
What is the intensive phase dosage for children weighing 4-7 kg?
A
1 tablet of RHZ 75/50/150.
17
Q
How should total drug requirements be computed?
A
Based on dosage, regimen, and 28 calendar days per month.
18
Q
What is a key consideration for TB patients with co-morbidities?
A
Adjust the regimen based on presence of any co-morbidity.
19
Q
What should be done for all TB patients ≥ 25 years old regarding diabetes?
A
Screen for diabetes using blood glucose tests.
20
Q
What is the recommended approach for patients initiated on treatment outside a DOTS facility?
A
Get detailed clinical history and assess willingness to continue treatment under the program.
21
Q
What is the treatment protocol for TB patients living with HIV?
A
Start ART regardless of CD4 count; initiate TB treatment first.
22
Q
What should be done during follow-up visits after TB treatment initiation?
A
Clinical assessment, weight check, resolution of TB signs, and management of ADRs.
23
Q
What should be done if a patient experiences gastrointestinal intolerance?
A
Give drugs at bedtime or with small meals.
24
Q
What is the management for burning sensation in the feet due to peripheral neuropathy?
A
Give pyridoxine (Vit B6) 50–100 mg daily.
25
What is the management for arthralgia due to hyperuricemia?
Give aspirin or NSAID; consider gout if persistent.
26
What is a common treatment for mild or localized skin reactions caused by anti-TB drugs?
Give antihistamines
## Footnote
Mild skin reactions may occur with any of the anti-TB drugs.
27
What drug is associated with orange-colored urine?
Rifampicin
## Footnote
Patients should be reassured about this side effect.
28
What is the recommended treatment for burning sensation in the feet due to peripheral neuropathy?
Give pyridoxine (Vit B6) 50–100 mg daily for treatment
## Footnote
Pyridoxine can also be given 10 mg daily for prevention.
29
Which drug can cause arthralgia due to hyperuricemia?
Pyrazinamide
## Footnote
Aspirin or NSAID may be given; if persistent, consider gout and manage accordingly.
30
What symptoms are associated with flu-like reactions from Rifampicin?
Fever, muscle pains, inflammation of the respiratory tract
## Footnote
Antipyretics should be administered for relief.
31
What action should be taken for severe skin rash due to hypersensitivity?
Stop anti-TB drugs and refer to specialist
## Footnote
This reaction can occur with any of the drugs.
32
What is the management for jaundice due to hepatitis from anti-TB drugs?
Stop anti-TB drugs and refer to specialist
## Footnote
This is particularly relevant for isoniazid, rifampicin, and pyrazinamide.
33
Which drug can impair visual acuity and color vision?
Ethambutol
## Footnote
Stop ethambutol and refer to an ophthalmologist.
34
What should be done for oliguria or albuminuria due to renal disorder?
Stop anti-TB drugs and refer to specialist
## Footnote
Rifampicin is the drug associated with this reaction.
35
What are the symptoms of psychosis and convulsion related to anti-TB drugs?
Psychosis and convulsion
## Footnote
This is associated with isoniazid; stop the drug and refer to a specialist.
36
What adverse effects are associated with Rifampicin?
Thrombocytopenia, anemia, shock
## Footnote
Immediate cessation of the drug and referral to a specialist is necessary.
37
What should be considered when reintroducing anti-TB drugs after major ADRs?
Identify the responsible drug and consider replacing it
## Footnote
Reintroduce using single dose formulations once the ADR has resolved.
38
What is the challenge dose for Isoniazid on Day 1 during reintroduction?
50 mg
## Footnote
The full dose is given on Day 3.
39
What is the maximum daily dosage of Isoniazid for adults?
Not to exceed 400 mg daily
## Footnote
Dosage varies for children.
40
What is the follow-up schedule for new, bacteriologically confirmed TB?
End of Intensive Phase (2nd month), End of 5th month, End of treatment (6th month)
## Footnote
Positive results at the end of the intensive phase require further testing.
41
What action should be taken if sputum smear follow-up results are positive after the fifth month?
Stop treatment and declare as treatment failure
## Footnote
Refer the patient to a Programmatic Management of Drug-resistant tuberculosis (PMDT) Treatment Center.
42
What is the time frame to start treatment for MDR-TB and RR-TB after diagnosis?
Within seven days
## Footnote
This is crucial for effective management.
43
What should be included in the pretreatment evaluation for DR-TB?
Clinical examination, smear microscopy, TB culture, first- and second-line LPA test, chest X-ray, ECG, and more
## Footnote
A comprehensive evaluation is essential for effective treatment.
44
What is the definition of 'Cured' in TB treatment outcomes?
A patient with bacteriologically confirmed TB at the beginning of treatment who was smear- or culture-negative in the last month of treatment
## Footnote
This includes at least one previous occasion in the continuation phase.
45
What are the treatment outcomes for TB categorized under 'Lost to follow-up'?
Treatment interrupted for at least two consecutive months or diagnosed with active TB but not started on treatment
## Footnote
Efforts should be made to trace these patients.
46
What is the regimen name for MDR-TB and RR-TB eligible for a standard short all oral regimen?
Regimen 3: Standard Short All Oral Regimen (SSOR)
## Footnote
This regimen includes specific drugs and duration.
47
What is the Standard Long All Oral Regimen for FQ Susceptible (SLOR FQ-S)?
Lfx-Bdq-Lzd-Cfz for 6 months; Lfx-Lzd-Cfz for 12–14 months.
## Footnote
Lfx = Levofloxacin, Bdq = Bedaquiline, Lzd = Linezolid, Cfz = Clofazimine
48
What is the eligibility for SLOR FQ-S?
MDR-TB and RR-TB cases without FQ resistance.
## Footnote
MDR-TB = Multidrug-resistant tuberculosis, RR-TB = Rifampicin-resistant tuberculosis
49
What is the Standard Long All Oral Regimen for FQ Resistance (SLOR FQ-R)?
Lzd-Bdq-Dlm-Cfz-Cs for 6 months; Lzd-Cfz-Cs for 12–14 months.
## Footnote
Dlm = Delamanid, Cs = Cycloserine
50
What is an Individualized Treatment Regimen (ITR)?
Construct with at least 4–5 likely effective drugs for retreatment MDR-TB and RR-TB cases not eligible for SSOR or SLOR.
## Footnote
SSOR = Standard Short All Oral Regimen
51
What must be evaluated for children under 15 diagnosed with MDR-TB and RR-TB?
Eligibility for standard all oral regimens recommended for children.
## Footnote
Refer to specific guidelines for children.
52
What are the exclusion criteria for SSOR?
* Disseminated TB or severe/intractable EPTB
* Confirmed resistance to fluoroquinolone
* Exposure to specific drugs for > 1 month
* Risk of toxicity or intolerance to any drugs in SSOR
## Footnote
EPTB = Extrapulmonary tuberculosis
53
What is the maximum QTcF value for eligibility in SSOR?
QTcF > 500 ms.
## Footnote
QTcF = Corrected QT interval
54
What should be done if all exclusion criteria for SSOR are absent?
Start treatment with SSOR (Regimen 3).
55
What are the exclusion criteria for SLOR FQ-S?
* Confirmed resistance to fluoroquinolone
* Exposure to specific drugs for > 1 month
* Risk of toxicity or intolerance to any drugs in SLOR FQ-S
## Footnote
These criteria include history of heart disease and severe anemia.
56
What should be done if all exclusion criteria for SLOR FQ-S are absent?
Start treatment with SLOR FQ-S (Regimen 4).
57
What are the exclusion criteria for SLOR FQ-R?
* Exposure to specific drugs for > 1 month
* Risk of toxicity or intolerance to any drugs in SLOR FQ-R
## Footnote
This includes history of heart disease and severe anemia.
58
What should be done if all exclusion criteria for SLOR FQ-R are absent?
Start treatment with SLOR FQ-R (Regimen 5).
59
What is required for off-label use of anti-TB drugs?
Presentation to TB MAC for approval.
## Footnote
TB MAC = Tuberculosis Medical Advisory Committee
60
What is the recommended action upon receipt of first- and second-line DST results?
Revise the regimen accordingly.
61
What is the treatment initiation protocol for MDR-TB patients living with HIV?
Start TB treatment first, followed by ART within the first eight weeks.
## Footnote
ART = Antiretroviral treatment
62
What should be done if a patient has profound immunosuppression when starting ART?
Initiate ART within the first two weeks of MDR-TB treatment.
63
What is the potential risk when co-administering bedaquiline and nevirapine?
Nevirapine may replace efavirenz as it decreases Bdq blood concentration by 52%.
64
What should be monitored for children receiving TB treatment?
* Resolution of TB signs and symptoms
* Monthly weight gain and growth
* Follow-up chest X-ray
* CT scan/MRI for EPTB
## Footnote
Follow-up assessments are crucial for children under treatment.
65
What are the recommended regimens for FQ-susceptible MDR-TB in children under 3 years?
Lfx-Lzd-Cfz-Cs (PAS/Eto).
## Footnote
PAS = Para-aminosalicylic acid, Eto = Ethionamide
66
What is the treatment duration for non-severe TB disease in children?
Nine to 12 months depending on clinical progress.
67
What is the treatment duration for severe or extensive TB disease in children?
15–18 months.
68
What should be done if LPA results show MTB not detected?
Recollect sputum specimen for repeat LPA testing and continue initial regimen.
69
What is the monitoring protocol for children with no bacteriologic confirmation at baseline?
Monitor clinically for:
* Resolution of TB signs and symptoms
* Monthly weight gain and growth
* Baseline chest X-ray and follow-up at six months
* Follow-up CT scan/MRI scan at six months
* Healing of other EPTB lesions
## Footnote
EPTB stands for extrapulmonary tuberculosis.
70
What should be accomplished when initiating treatment for DR-TB?
Complete Form 4c. DR-TB Treatment Card and Form 5. TB and TPT Patient Card and assign case number.
## Footnote
TPT stands for Tuberculosis Preventive Treatment.
71
What are the options for treatment adherence mechanisms based on patient condition?
Options include:
* Location: home, community, workplace, health facility
* Treatment supporter: family member, trained lay volunteer, health worker
72
How should successful intake of daily doses be recorded?
Record in Form 4c. DR-TB Treatment Card and Form 5. TB and TPT Patient Card by affixing initials of health staff or treatment supporter.
73
What factors should be checked during treatment monitoring?
Check:
* General well-being, weight, and height in children
* Resolution of symptoms
* Mental health screening
* Occurrence of adverse events
* Sputum specimen submission
74
What should be done if a patient is smear negative at the fourth month?
Shift to continuation phase (discontinue HdH and Pto).
75
What constitutes a serious adverse event (SAE)?
SAE includes:
* Results in death
* Life threatening
* Requires hospitalization
* Results in persistent disability/incapacity
* Congenital anomaly/birth defect
76
What are adverse events of special interest (AESI)?
AESI includes:
* Acute kidney injury
* Hepatitis
* Hypokalemia
* Myelosuppression
* Optic nerve disorder
* Ototoxicity
* Pancreatitis
* Peripheral neuropathy
* Prolonged QT interval
* Psychiatric disorders
77
When should a treatment regimen be modified?
Modification should be done if an anti-TB drug needs to be replaced due to:
* Intolerance
* Toxicity leading to negative consequences
* Life-threatening complications
78
What defines a treatment failure in DR-TB patients?
Treatment failure includes:
* Treatment terminated or need for regimen change
* Lack of evidence of negative cultures after extended intensive phase
* Positive sputum smear after > 6 months
79
What are the definitions of treatment outcomes for SSOR?
Outcomes include:
* Cure
* Treatment completed
* Failed
* Died
* Lost to follow-up
* Not evaluated
80
What follow-up procedures should be done post-treatment?
Follow-up at month six and twelve, including:
* Clinical evaluation of TB signs and symptoms
81
Fill in the blank: Active drug safety monitoring and management (aDSM) is essential for treating _______.
[DR-TB]
82
What should be done if a patient interrupts treatment?
Make a phone call upon missing one dose and follow up in person if multiple doses are missed.
83
What is the purpose of adherence counseling?
To assess compliance to treatment and explore potential issues related to adherence.
84
What is the definition of culture conversion?
Culture conversion is when two consecutive cultures taken at least 30 days apart are found to be negative.
85
What should be done if a patient is lost to follow-up?
If treatment is interrupted for > 2 consecutive months, the patient is not restarted on SSOR but on a longer MDR-TB regimen.
86
What are the key activities in aDSM?
Key activities include:
* Reporting serious adverse events (SAE)
* Active clinical and laboratory monitoring for adverse events
87
What is the culture conversion date based on?
The specimen collection date of the first culture when cultures taken at least 30 days apart are found to be negative.
## Footnote
This is crucial for tracking treatment progress in tuberculosis (TB) management.
88
What defines culture reversion in the context of treatment failure?
Two consecutive cultures taken at least 30 days apart that are found to be positive after an initial conversion, occurring after eight months of treatment.
## Footnote
This indicates that the treatment may not have been successful.
89
When should post-treatment follow-up evaluations occur?
At month six and twelve after successful completion of treatment.
## Footnote
This is to assess the patient's recovery and check for potential relapse.
90
What procedures are included in post-treatment follow-up?
* Clinical evaluation of TB signs and symptoms
* Chest X-ray
* SM and culture
## Footnote
These procedures help in monitoring the patient's health status post-treatment.
91
Define 'Non-relapsing cure' in post-treatment follow-up outcomes.
A successfully treated individual who remains culture-negative within six to twelve months post-treatment.
## Footnote
This indicates a successful resolution of the TB infection.
92
What is considered a 'Relapse' after TB treatment?
Recurrent TB disease in a successfully treated individual who becomes culture-positive within six to twelve months after cure or treatment completion.
## Footnote
This indicates that the TB infection has returned after initial treatment success.
93
What does the outcome 'Died' signify in post-treatment follow-up?
A patient who dies for any reason during the twelve months following treatment.
## Footnote
This outcome is important for evaluating the overall health impact of TB treatment.
94
What does 'Lost to follow-up after treatment completion' mean?
Individuals who had an outcome recorded but cannot be traced in the twelve months following treatment outcome.
## Footnote
Tracking this group is essential for understanding treatment success rates.
95
Where should the outcome of post-treatment follow-up be recorded?
In Form 4c. DR-TB Treatment Card.
## Footnote
Proper documentation is key for ongoing patient management and research.
