Osteomyelitis (TB) Flashcards
First line of TB drugs
Rifampicin. insonazid, pyrazinamide, ethambutol
Alternative to rifampicin due to intolerance/resistance
Rifabutol
MOA of rifampicin
Inhibition RNA synthesis
AE of rifampicin
Nausea, vomiting, flatulence, epigastric pain, diarrhoea, cramping, anorexia, orange discolouration of sweat, urine & tears, pseudomembranous colitis, heptatotxicity, hypeuricaemia, blood dyscrasia, acute renal failure, heartburn
Pt edu for rifampicin
Note of orange discolouration of sweat, urine & tears
Decrease alcohol intake to prevent hepatotoxicity
Skin eruption, fever and GIT symptoms are most common
MOA of isonazid
Inhibit mycolic acid synthesis
AE of isonazid
Blood dyscrasia, epigastric pain, optic neuritis, nausea, heptatotoxicity, anaphylaxis, pellagra, peripheral neuropathy, vomiting
Pt edu for isonazid
Reduce alcohol intake
Drug can pass through breast milk
Will experience tingling sensation due to peripheral neuropathy
Take pyridoxine/vitamin b6 to prevent pellagra
MOA of pyrazinamide
Inhibit bacteria cell membrane
AE of pyrazinamide
Gouty arthritis, increased uric acid, rash, anaphylaxis, fatal haemoptysis, hepatotoxicity, haemolytic anaemia
Pt edu for pyrazinamide
Put sunscreen
Reduced alcohol intake
Meds to take during initial phase and duration
RIPE for 2mths + supplement via b6 for pellagra
Meds to take during continuation phase and duration
Rifampicin & isonazid for 6mths, 2-3x a wk
MOA of ethambutol
Inhibit cell wall synthesis
AE of ethambutol
Nausea, vomiting, headache, anaphylaxis, optic neuritis, dizziness
Alternative med to ethambutol in case of resistance
Streptomycin
Who to not give ethambutol to
Colourblind and children
What can ethambutol cause
Visual acquire problem - can’t differentiate diff coloured dots tgt
Pt education for ethambutol
Watch for visual changes
What to do if experience hepatotoxicity (e.g. jaundice) during RIPE tx
Stop med for awhile and monitor liver enzyme lvl before starting to again when lvls have stabilised
What marker is the most accurate for hepatotoxicity
Serum alanine aminotransferase (ALT) - can also signify abnormalities in heart, kidney and muscle
What markers can be measured to check for hepatotoxicity
Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (APT) & total bilirubin
Signs of hepatotoxicity
Jaundice and elevated liver markers (ALT, AST, APT, total bilirubin)
When to do alternative tx of rifampicin & isonazid b4 pyrazinamide
When
1. ALT is 3 times higher than upper limit of normal (ULN) & presence of hepatitis symptoms/jaundice
OR
2. ALT is 5 times higher than ULN w/o presence of hepatitis symptoms/jaundice
Second line treatment for OM TB
Amikacin, Levofloxacin, Cycloserine
How long shd a therapy last for tuberculosis at different sites
Meningitis TB (12 mths with steroids)
Pericarditis TB (9 mths with steroids)
MSK TB (9 mths)
Lymph node TB (6-9mths)
Pleural TB (6-9mths)
What shd the process be like if hepatotoxicity is detected during LATENT TB tx
Stop med until ULN > 2 times
Rechallenge with isonazid
If can’t, use rifampicin for 4 mths
What should the process be like if hepatotoxicity is detected during ACTIVE TB tx
Stop med until symptoms subside
Rechallenge with rifampicin then isonazid 3-7days later then pyrazinamide 7 days later
Ethambutol can be given at any time
Alternative tx: ethambutol, fluoroquinolone, streptomycin
