TB

Question 1

Who are the most at risk of TB in Canada?

Answer 1

First Nations

Question 2

What organism causes TB?

Answer 2

mycobacterium tuberculosis

Question 3

How does TB spread?

Answer 3

air droplets

Question 4

What are risk factors for TB?

Answer 4

endemic areas, indigenous, homeless, prison, PWID, HIV, prior infection

Question 5

What factor puts you at highest risk?

Answer 5

HIV

Question 6

What is primary infection?

Answer 6

inhale droplet nuclei

Question 7

At what point in primary infection does INF-Y get produced?

Answer 7

3 weeks

Question 8

WHat is DTH?

Answer 8

delayed hypersensitivity- kills immature macrophages that help bacteria replicate

Question 9

What does a positive tubercukin skin test mean?

Answer 9

protection

Question 10

What extrapulmonary complications are likely?

Answer 10

lymph or pleural disease, Increases HIV, miliary TB, bones

Question 11

Sx of TB?

Answer 11

weight loss, hemoptysis- cough up blood

Question 12

How do you do a TB skin test?

Answer 12

measure bump, lots of false negatives

Question 13

What drug is best for extracellular TB?

Answer 13

INH, rifampin, streptomycin

Question 14

What is best drug for granulomas TB?

Answer 14

pyrazinamide, rifampin

Question 15

What is treatment of latent TB?

Answer 15

rifampin for 4 months and rifapentine and INH weekly for 3 months

Question 16

What is treatment of active TB?

Answer 16

isonazid, rifampin, pyrazinamide and ethambutol for 6 months the INH and RMP for 4 months total

Question 17

If latent treatment, what happens if i cant tolerate rifamycin?

Answer 17

INH for 9 months

Question 18

If active treatment, what happens if i cant use pyrazinamide?

Answer 18

9 months of RMP and INH

Question 19

Who cannot get thrice weekly continuation. phase treatment?

Answer 19

HIV positive

Question 20

How does Isoniazid work? BAd things about it?

Answer 20

stop wall synthesis
BAd- neurotox, hepatotox

Question 21

Rifampin MOA and issues?

Answer 21

MOA- stop RNA synthesis
Bad- hepatotx, secretions orange

Question 22

Why use rifabutin? What is bad about it?

Answer 22

less DI
hypersensitivity

Question 23

WHat is issue with pyrazinamide?

Answer 23

gi, uric acid increase, hepatotox

Question 24

How does ethambutol work?

Answer 24

bacteriostatic and lowers resistance

Question 25

What test is needed with ehtambutol?

Answer 25

eye exam

Question 26

When do we switch to quinolones?

Answer 26

when 1st line need to be d/c

Question 27

S/e of quinolones?

Answer 27

tendon rupture, qt prolong, insomnia, BG increase

Question 28

What is a great way to prevent TB? What are features?

Answer 28

BCG vaccine- Bovis strain, efficacy of 25%

Question 29

When can we d/c ethambutamol and pyrazinamide?

Answer 29

after 2 months if organism is sensitive

Question 30

What is dosing for active treatment?

Answer 30

OD or 5x weekly for first 1-2 months then 3 x weekly after with observation

Question 31

DI with rifamycins?

Answer 31

OC pills (with rifabutin too)
Levothyroxine- decrease
SSRI-decrease
CS- decrease (with rifabutin too)
Anticoags
phenytoin

Question 32

DI with isoniazid?

Answer 32

acetaminophen
warfarin
phenytoin
CBZ
VPA

Question 33

What monitoring is required?

Answer 33

Vision, chest xray, weight, labs, sputum, sensitivty, ADHERENCE

Question 34

How frequent does sputum testing need to be done?

Answer 34

1-2 weeks