Osteomyelitis (TB)

Question 1

First line of TB drugs

Answer 1

Rifampicin. insonazid, pyrazinamide, ethambutol

Question 2

Alternative to rifampicin due to intolerance/resistance

Answer 2

Rifabutol

Question 3

MOA of rifampicin

Answer 3

Inhibition RNA synthesis

Question 4

AE of rifampicin

Answer 4

Nausea, vomiting, flatulence, epigastric pain, diarrhoea, cramping, anorexia, orange discolouration of sweat, urine & tears, pseudomembranous colitis, heptatotxicity, hypeuricaemia, blood dyscrasia, acute renal failure, heartburn

Question 5

Pt edu for rifampicin

Answer 5

Note of orange discolouration of sweat, urine & tears
Decrease alcohol intake to prevent hepatotoxicity
Skin eruption, fever and GIT symptoms are most common

Question 6

MOA of isonazid

Answer 6

Inhibit mycolic acid synthesis

Question 7

AE of isonazid

Answer 7

Blood dyscrasia, epigastric pain, optic neuritis, nausea, heptatotoxicity, anaphylaxis, pellagra, peripheral neuropathy, vomiting

Question 8

Pt edu for isonazid

Answer 8

Reduce alcohol intake
Drug can pass through breast milk
Will experience tingling sensation due to peripheral neuropathy
Take pyridoxine/vitamin b6 to prevent pellagra

Question 9

MOA of pyrazinamide

Answer 9

Inhibit bacteria cell membrane

Question 10

AE of pyrazinamide

Answer 10

Gouty arthritis, increased uric acid, rash, anaphylaxis, fatal haemoptysis, hepatotoxicity, haemolytic anaemia

Question 11

Pt edu for pyrazinamide

Answer 11

Put sunscreen
Reduced alcohol intake

Question 12

Meds to take during initial phase and duration

Answer 12

RIPE for 2mths + supplement via b6 for pellagra

Question 13

Meds to take during continuation phase and duration

Answer 13

Rifampicin & isonazid for 6mths, 2-3x a wk

Question 14

MOA of ethambutol

Answer 14

Inhibit cell wall synthesis

Question 15

AE of ethambutol

Answer 15

Nausea, vomiting, headache, anaphylaxis, optic neuritis, dizziness

Question 16

Alternative med to ethambutol in case of resistance

Answer 16

Streptomycin

Question 17

Who to not give ethambutol to

Answer 17

Colourblind and children

Question 18

What can ethambutol cause

Answer 18

Visual acquire problem - can’t differentiate diff coloured dots tgt

Question 19

Pt education for ethambutol

Answer 19

Watch for visual changes

Question 20

What to do if experience hepatotoxicity (e.g. jaundice) during RIPE tx

Answer 20

Stop med for awhile and monitor liver enzyme lvl before starting to again when lvls have stabilised

Question 21

What marker is the most accurate for hepatotoxicity

Answer 21

Serum alanine aminotransferase (ALT) - can also signify abnormalities in heart, kidney and muscle

Question 22

What markers can be measured to check for hepatotoxicity

Answer 22

Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (APT) & total bilirubin

Question 23

Signs of hepatotoxicity

Answer 23

Jaundice and elevated liver markers (ALT, AST, APT, total bilirubin)

Question 24

When to do alternative tx of rifampicin & isonazid b4 pyrazinamide

Answer 24

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

Question 25

Second line treatment for OM TB

Answer 25

Amikacin, Levofloxacin, Cycloserine

Question 26

How long shd a therapy last for tuberculosis at different sites

Answer 26

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)

Question 27

What shd the process be like if hepatotoxicity is detected during LATENT TB tx

Answer 27

Stop med until ULN > 2 times
Rechallenge with isonazid
If can’t, use rifampicin for 4 mths

Question 28

What should the process be like if hepatotoxicity is detected during ACTIVE TB tx

Answer 28

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