TB Flashcards
1
Q
TB Epi
A
- Used to be death sentence
- Sanatoriums
- Drugs discovered in 40s-50s, death rates dropped
- Came back in 80s (HIV, immigration, multi drug resistance)
- Drug resistance is still a problem (not really in US)
- Reportable disease
- Vaccine (not given in US)
2
Q
TB Pathophys
A
- Mycobacterium TB
- Spread via airborne particles (droplets containing 1-3 bacilli)
- Can remain in the air for hrs
- Multiply in alveoli
- Mostly lung disease, but can become systemic (miliary)
3
Q
TB RF
A
- Sick contact w/ TB
- Foreign born
- Recent travel to endemic area (esp. Mexico, Phillipines)
- Immunocompromised
- Healthcare worker
- Peds
4
Q
TB Stages
A
- Latent: immune system is working (not infectious)
- Active: bacilli are able to multiply, can happen quickly or take yrs (infectious)
5
Q
TB Sx
A
- Key sx: cough >3 wks, hemoptysis, weight loss
- Other sx: fever, chills, night sweats
6
Q
TB Systemic Sx
A
- Blood in urine –> TB of kidney
- HA/confusion –> TB meningitis
- Back pain –> TB of spine
- Hoarseness –> TB of larynx
7
Q
TB Dx
A
- CXR: most commonly in upper lobe, caseating granulomas
- Miliary–millet seed appearance
- HIV might appear differently (neg CXR does not r/o TB)
- Skin test (TST)
- IGRA (no differentiation bt latent and active)
- Sputum culture (takes 2-3 wks)
- Acid fast smear
- NAA test (rapid results)
- Drug sensitivity test
- *Culture is gold standard
8
Q
Reading TB Skin Test
A
- Measure diameter of raised area
- High risk pop: >5 mm is +
- Low risk pop: >10 mm is +
- Avg pop: >15 mm is +
9
Q
TB Tx: things to consider
A
- Have they been treated before?
- Current meds?
- HIV testing
10
Q
TB Drugs
A
- Not used monotherapy
- Compliance is very important (often directly observed therapy)
RIPE: - Rifampin / Rifapentine
- Isoniazid
- Pyrazinamide
- Ethambutol
11
Q
Treating Active TB
A
2RIPE/4IR
- Initial Phase: 1st 2 months–RIPE
- Continuation Phase: at least 2 drugs for 4 months (IR)
- Relapse: occurs when tx is not continued long enough, surviving bacilli may cause TB again
12
Q
Isoniazid (INH)
A
- Inhibits cell wall synthesis (cidal)
- Used for adults and peds
- Tx and prevention
- P450 2C9 inhibitor
- ADR: I=intestinal upset, N=neuropathy, H=hepatotox
- Take on empty stomach
13
Q
Rifampin
A
- Inhibits DNA dependent RNA polymerase (cidal)
- Used for meningococcal carriers
- Used if pt cannot tolerate INH
- STRONG P450 3A4 inducer (loss of efficacy)
- Interactions w/ oral contraceptives and warfarin
- ADR: turns all body fluids red, GI, thrombocytopenia, HA, fever, fatigue, visual disturb, pruritus, rash
14
Q
Rifapentine
A
- Inhibits DNA dependent RNA polymerase (cidal)
- Used w/ INH
- Not for <12 y/o, preg, HIV
- ADR: hepatotox, hyperbilirubinemia, colored body fluids, CDAD
15
Q
Pyrazinamide
A
- Vit B3 analog
- Used for adults and peds
- Not used in severe liver disease and gout pts
- ADR: GI, hyperuricemia, increased LFTs, rash, arthralgias, myalgias
