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afsha - infections > TB > Flashcards

TB Flashcards

1
Q

caused by which bacteria

A

mycobacterium tuberculosis complex

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2
Q

how is it spread

A

by breathing in infected respiratory droplets from a person with infectious TB

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3
Q

can you get TB from someone who has latent TB?

A

no they are not infectious and cannot spread it to other people

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4
Q

do all people with latent go on to develop active TB

A

no only a small proportion will develop active TB

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5
Q

how many phases of treatment of active TB are there and what are they called

A

two phases, initial phase (4 drugs) and continuation phase (2 drugs)

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6
Q

what are the two regimens in the UK recommended for the treatment of TB and how do you know which one to select

A

supervised and unsupervised
choice depends on risk assessment to identify if pt needs enhanced case management

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7
Q

initial phase of TB treatment is with the following drugs

A

RI(P)PE
- rifampicin
- isoniazid (+ pyroxidine)
- pyrazinamide
- ethambutol

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8
Q

how long is initial phase with RIPE taken for

A

2 months

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9
Q

a pt has clinical signs and symptoms consistent with a TB diagnosis. should you wait for culture results to start treatment?

A

no, start treatment without waiting for results

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10
Q

continuation phase of TB treatment is with ….

A

RI (rifampicin and isoniazid (+pyroxidine))

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11
Q

continuation phase of TB treatment with RI(P) is taken for how long

A

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

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12
Q

who would you give unsupervised regimen to

A

people who are likely to take anti-TB drugs reliably and willingly without supervision

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13
Q

who would you give supervised regimen (aka directly observed therapy DOT) to

A
  • 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
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14
Q

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

A

offer DOT because he was in a prison in the past 5 years

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15
Q

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

A

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.

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16
Q

Antituberculosis treatment dosing regimens in supervised treatment of fewer than ……. are not recommended

A

3x a week

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17
Q

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

A

shouldn’t routinely exceed 6 months
if CNS involvement it should not routinely exceed beyond 12 months

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18
Q

RIPE - which one colours bodily fluids, and may do it to soft contact lenses, red-orange?

A

rifampicin

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19
Q

this drug can stain soft contact lenses and cause bodily fluids to turn red-orange

A

rifampicin

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20
Q

rifampicin is an enzyme… which means

A

inducer so it can decrease the exposure of other drugs that are metabolised by CYP enzymes

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21
Q

side effects of rifampicin (3)

A

nausea
vomiting
thrombocytopenia

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22
Q

rifampicin and hormonal contraceptives

A

Effectiveness of hormonal contraceptives is reduced and alternative family planning advice should be offered.

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23
Q

monitoring requirements for rifampicin

A
  • 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
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24
Q

a patient who takes rifampicin comes to the pharmacy and complains of persistent nausea, vomiting, malaise and jaundice. what do you do

A

stop treatment and seek immediate medical attention
hepatic disorder

25
Q

rifampicin - 3 labels

A
  • do not stop taking unless dr says
  • may colour urine, harmless
  • take on empty stomach - 1 hour before or 2 hours after food
26
Q

isoniazid is contraindicated in

A

drug induced liver disease.

27
Q

pyridoxine should be given prophylactically in ALL patients from the start of treatment with this drug to reduce the risk of ….

A

isoniazid - to reduce risk of peripheral neuropathy

28
Q

peripheral neuropathy with isoniazid is more likely to occur when there are pre existing RF e.g.

A

diabetes
alcohol dependence
chronic renal failure
pregnancy
malnutrition
HIV

29
Q

isoniazid food interactions

A

Avoid tyramine-rich foods (such as mature cheeses, salami, pickled herring, Bovril®, Oxo®, Marmite® or any similar meat or yeast extract or fermented soya bean extract, and some beers, lagers or wines) or histamine-rich foods (such as very mature cheese or fish from the scromboid family (e.g. tuna, mackerel, salmon))
tachycardia, palpitation, hypotension, flushing, headache, dizziness, and sweating reported.

30
Q

tyramine rich foods and histamine rich foods should be avoided with this drug because there have been reports of tachycardia, palpitations, hypotension, flushing, headache, dizziness and sweating

A

isoniazid

31
Q

isoniazid is …. toxic

A

hepatotoxic

32
Q

hepatitis with isoniazid is more common in

A

pt ages over 35 and those with daily alcohol intake

33
Q

monitoring requirements of isoniazid

A
  • renal before
  • hepatic before
  • if no evidence of HI, further checks only needed it pt develops fever, malaise, vomiting, jaundice etc
  • alcohol dependence: frequent checks of hepatic function esp in first 2 months
34
Q

isoniazid instructions - with food or before food or after food

A

30-60 mins before food

35
Q

pyrazinamide is contraindicated in

A

acute attack of gout

36
Q

monitoring requirements or pyrazinamide

A
  • renal before
  • hepatic before
  • if no evidence of HI, only need to check when indicated by pt presentation
  • alcohol dependence: freq checks of hepatic function, esp in first 2 months
37
Q

RIPE - with ones are hepatotoxic and which one is oculotoxic

A

RIP - hepatotoxic
E - oculotoxic

38
Q

ethambutol contraindications

A

poor vision
optic neuritis

39
Q

isoniazid increases the risk of ….. when given with ethambutol

A

optic neuropathy

40
Q

ocular toxicity with ethambutol is more likely if …..

A

excessive dosage or renal function impaired

41
Q

will early discontinuation of ethambutol recover eyesight

A

Early discontinuation of the drug is almost always followed by recovery of eyesight.

42
Q

what to do if a pt develops deterioration in vision with ethambutol

A

The earliest features of ocular toxicity are subjective and patients should be advised to discontinue therapy immediately if they develop deterioration in vision and promptly seek further advice.

43
Q

monitoring of pt parameters with ethambutol

A

Renal function should be checked before treatment.

Visual acuity should be tested by Snellen chart before treatment with ethambutol.

44
Q

Visual acuity should be tested by …… before treatment with ethambutol.

A

Snellen chart

45
Q

what is Snellen chart

A

used to test visual acuity before ethambutol treatment

46
Q

what is the treatment and how long is treatment of TB for people with CNS TB

A
  • initial phase RI(P)PE for 2 months
  • then continuation phase RI(P) for another 10 months
  • total 12 months
  • also give initial high dose of dexamethasone or prednisolone at the same time as anti-TB treatment, then slowly withdraw over 4-8 weeks
47
Q

when would you refer pt with CNS TB for surgery

A

only consider in pt who have raised intracranial pressure; or spinal TB with spinal instability or evidence of spinal cord compression

48
Q

additional treatment for pericardial TB

A

initial high dose of oral prednisolone should be offered to individuals with active pericardial tuberculosis, at the same time as antituberculosis treatment, then slowly withdrawn over 2–3 weeks

49
Q

some individuals with latent TB are at increased risk of developing active TB:

A

HIV positive
diabetic
injecting drug users
receiving treatment with an anti-tumour necrosis factor-a inhibitor

50
Q

what is a close contact

A

prolonged, frequent or intense contact e.g. household contacts or partners

51
Q

do close contacts need to be tested and treated for latent TB

A
  • anyone under 65 who is a close contact of a person with pulmonary or laryngeal TB needs to be tested for latent TB
  • offer drug treatment to all pt under 65 with evidence of latent TB, if the close contact has suspected infectious or confirmed active pulmonary or laryngeal drug sensitive TB
52
Q

immunocompromised pt are tested for latent TB. if they test positive then assess them for active disease. if active disease is negative, do you offer them any treatment

A

yes offer treatment for latent TB

53
Q

treatment of latent TB (for people under 65, including those with HIV where treatment for latent TB id indicated)

A

either 3 months of RI(P) or 6 months of I(P)

54
Q

test for these 3 before starting latent anti TB treatment as this may affect choice of therapy

A

HIV
Hep B
Hep C

55
Q

latent TB - only offer treatment in pt 35-64 if …… not a concern

A

hepatotoxicity

56
Q

latent TB - what treatment to offer pt where interactions with rifampicin are a concern (e.g. HIV or transplant)

A

6 months I(P)

57
Q

latent tb - under 35, what treatment if hepatotoxicity is a concern after assessment of LFTs including transaminases and RF

A

3 months I (P) and rifampicin if hepatoxicity is a concern after assessment of both LFTS (including transaminases) and RF

58
Q

what is treatment interruption classified as

A

break in anti TB treatment of at least 2 weeks during initial phase, or missing >20% prescribed doses

59
Q

Name the vaccine that is indicated for prevention of TB, and the type of vaccine it is

A

BCG vaccine contains a live attenuated strain derived from Mycobacterium bovis and is indicated for the prevention of Tuberculosis.

afsha - infections (57 decks)

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