TB Flashcards
caused by which bacteria
mycobacterium tuberculosis complex
how is it spread
by breathing in infected respiratory droplets from a person with infectious TB
can you get TB from someone who has latent TB?
no they are not infectious and cannot spread it to other people
do all people with latent go on to develop active TB
no only a small proportion will develop active TB
how many phases of treatment of active TB are there and what are they called
two phases, initial phase (4 drugs) and continuation phase (2 drugs)
what are the two regimens in the UK recommended for the treatment of TB and how do you know which one to select
supervised and unsupervised
choice depends on risk assessment to identify if pt needs enhanced case management
initial phase of TB treatment is with the following drugs
RI(P)PE
- rifampicin
- isoniazid (+ pyroxidine)
- pyrazinamide
- ethambutol
how long is initial phase with RIPE taken for
2 months
a pt has clinical signs and symptoms consistent with a TB diagnosis. should you wait for culture results to start treatment?
no, start treatment without waiting for results
continuation phase of TB treatment is with ….
RI (rifampicin and isoniazid (+pyroxidine))
continuation phase of TB treatment with RI(P) is taken for how long
4 months in pt with active TB without CNS
longer treatment for 10 months should be offered in people with active TV of the CNS, with or without spinal involvement
who would you give unsupervised regimen to
people who are likely to take anti-TB drugs reliably and willingly without supervision
who would you give supervised regimen (aka directly observed therapy DOT) to
- non-adherence
- previous treatment for TB
- homelessness, drug or alcohol misuse
- in prison or young offender, or have been in past 5 years
- major psychiatric, cognitive or memory disorder
- denial of TB diagnosis
- MDR TB
- request it
- too ill to self administer
a 23 year old man has tuberculosis and you are in charge of his regimen. you are looking into whether you should give supervised DOT or unsupervised. he seems adherent, is not in denial of his diagnosis, and has no psychiatric, cognitive or memory disorder. he is not in prison, however he was in a young offender institution 3 years ago for 12 months. what do you offer him
offer DOT because he was in a prison in the past 5 years
with supervised treatment, the preferred option is ….. but a …….. schedule can be considered in individuals with TB if they require enhances case management and daily DOT therapy is not available
Daily supervised treatment is the preferred option wherever feasible.
A 3 times weekly dosing schedule can be considered in individuals with tuberculosis if they require enhanced case management and daily directly observed therapy is not available.
Antituberculosis treatment dosing regimens in supervised treatment of fewer than ……. are not recommended
3x a week
for pt who are HIV +ve and have active TB, treatment with standard regimen should not routinely exceed …… unless the TB has CNS involvement, in which case it should not routinely exceed beyond …. months
shouldn’t routinely exceed 6 months
if CNS involvement it should not routinely exceed beyond 12 months
RIPE - which one colours bodily fluids, and may do it to soft contact lenses, red-orange?
rifampicin
this drug can stain soft contact lenses and cause bodily fluids to turn red-orange
rifampicin
rifampicin is an enzyme… which means
inducer so it can decrease the exposure of other drugs that are metabolised by CYP enzymes
side effects of rifampicin (3)
nausea
vomiting
thrombocytopenia
rifampicin and hormonal contraceptives
Effectiveness of hormonal contraceptives is reduced and alternative family planning advice should be offered.
monitoring requirements for rifampicin
- renal before treatment
- liver before treatment. if no liver disease, further checks only need if pt develops fever, malaise, vomiting, jaundice etc. always monitor LFTs on prolonged therapy
- blood counts in pt on prolonged therapy
- alcohol dependance: frequent checks of hepatic function, esp in first 2 months, and also blood counts
a patient who takes rifampicin comes to the pharmacy and complains of persistent nausea, vomiting, malaise and jaundice. what do you do
stop treatment and seek immediate medical attention
hepatic disorder
