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967 Block 3 - Pulmonary > TB > Flashcards

TB Flashcards

1
Q

What is the staining results of mycobacterium tuberculosis?

A

acid fast

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2
Q

Mycobacterium tuberculosis is very slow growing (T/F)

A

True

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3
Q

What species are reservoirs for mycobacterium tuberculosis?

A

only humans

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4
Q

How is TB transmitted?

A

horizontal transmission via respiratory droplets

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5
Q

Patients must be kept in what type of isolation?

A

respiratory

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6
Q

What factors affect the transmission of TB?

A
  • infectiousness of patient
  • environmental conditions
  • duration of exposure
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7
Q

Most exposed persons become infected with TB. (T/F)

A

False, most do not

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8
Q

Define LTBI.

A
  • Once inhaled, bacteria travel to lung alveoli and establish infection.
  • 2-12 weeks after infection, immune response limits activity; infection is detectable.
  • Bacteria are potentially viable for years
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9
Q

LTBI patients are asymptomatic and non-infectious. (T/F)

A

True

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10
Q

What factors increase the risk for infectiousness?

A
  • coughing
  • cavitation on X-ray
    • acid-fast bacilli sputum smear result
  • inadequate TB treatment
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11
Q

What is a cavitation?

A

TB gets walled off by immune system in the lung

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12
Q

When do you test for TB?

A
  • HIV
  • IV drug use
  • homeless
  • incarcerated
  • contact with persons with TB
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13
Q

When should you treat a patient with LTBI?

A

always

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14
Q

When is a PPD of ≥ 5mm a positive test?

A
  • recent close contact
  • HIV+
  • chest X-ray shows healed TB
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15
Q

When is a PPD of ≥ 10 mm a positive test?

A
  • IV drug users
  • homeless shelter
  • arrived within 5 years from country with high prevalence
  • low income
  • children < 4
  • minors exposed to high risk adults
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16
Q

When is a PPD of ≥ 15 mm a positive test?

A

always

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17
Q

What are the signs/symptoms of active TB?

A
  • weight loss
  • fatigue
  • productive cough
  • fever
  • night sweats
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18
Q

What are the lab results of active TB?

A
  • moderate WBC elevation

- lymphocyte predominance

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19
Q

What does the chest radiograph of active TB look like?

A
  • patchy or nodular infiltrates in upper lobes

- cavitation

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20
Q

If you suspect your patient has active TB, what tests should you run?

A
  • AFB stain
  • culture
  • susceptibility testing
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21
Q

When should a patient be placed in respiratory isolation?

A
  • suspected or confirmed smear-positive
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22
Q

When is a patient considered noninfectious?

A
  • effective therapy
  • clinical improvement
  • negative results for 3 consecutive sputum AFB on different days
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23
Q

What are the first line drugs?

A
  • Isoniazid (INH)
  • Rifampin (RIF)
  • Pyrazinamide (PZA)
  • Ethambutol (EMB)
  • Rifapentine (RPT)
24
Q

What are the 2 phases of drug therapy?

A
  • initial

- continuation

25
Q

What is the duration of the initial phase?

A

2 months

26
Q

What is the main regimen for the initial phase?

A

INH + RIF + PZA + EMB

27
Q

When can EMB be dropped from regimen?

A

When bacteria is susceptible to INH, RIF, PZA.

28
Q

What is the duration of the continuation phase?

A

4 months

29
Q

What are the 2 main continuation regimens?

A
  • INH + RIF

- INH + RPT

30
Q

How frequently is RPT administered?

A

weekly

31
Q

When might the continuation phase be extended to 7 mo?

A
  1. initial chest X-ray shows cavitation and culture + at 2 months
  2. used only INH/RIF/EMB in initial phase
  3. Culture + at 2 mo and want to use 1x/week INH and RPT
32
Q

Why might someone choose 1x/week INH/RPT?

A

Otherwise, you may be required to take dose in front of healthcare worker - directly observed therapy

33
Q

When might you treat a culture negative patient?

A
  • abnormal chest X-ray
  • clinical symptoms
  • no other diagnosis
    • TB skin test
34
Q

What should patients with negative culture but high suspicion of TB be treated with?

A

placed on initial phase regimen: INH/RIF/EMB/PZA for 2 months

35
Q

In patients with active TB, when should we do sputum collection for AFB and culture?

A
  • AFB smear daily until out of isolation
  • AFB smear q 1-2 weeks to assess early response
  • culture initially and at 2 mo, then monthly until negative
36
Q

When should a second drug-suseptability test be conducted?

A

culture positive after 3 mo of treatment

37
Q

What needs to be tested if on EMB for > 2 mo?

A

visual acuity and color vision monthly

38
Q

When should a chest X-ray be repeated?

A
  • culture negative: at completion of initial treatment phase and at the end of treatment
  • culture positive: none
39
Q

What is the treatment of choice for LTBI?

A

INH x 6 – 9 mo

40
Q

What is the new recommendation of LTBI treatment?

A

INH weekly + RPT weekly with DOT for 12 mo

41
Q

What are risk factors for drug resistant TB?

A
  • prior TB therapy
  • from high resistance area
  • homeless/institutionalized/ IV drug use/ HIV infection
  • failed or relapsed treatment
  • known MDR-TB exposure
42
Q

What is done if pt is resistant to INH?

A
  • RIF + PZA + EMB for 6 – 9 mo
  • can sub SM for EMB
  • RIF + EMB + ( optional 2nd line) for 12 mo
43
Q

How is MDR-TB defined?

A

resistant to INH + RIF

44
Q

How is MDR-TB treated?

A
  • consult specialist

- ≥ 4 susceptible drugs

45
Q

How is XDR-TB defined?

A
  • resistant to INH and RIF and FQ plus one injectable drug
46
Q

How is “treatment failure” defined?

A

positive cultures after 4 months of treatment and ensured compliance

47
Q

How is a treatment failure resolved?

A
  • Add at least 3 new drugs to existing regimen
  • retest for drug resistance
  • no single drug should ever be added
48
Q

What are ADRs associated with isoniazid?

A
  • hepatitis

- peripheral neuropathy

49
Q

What is a major counseling point for patients taking isoniazid?

A

NO alcohol

50
Q

What are ADRs associated with Rifampin?

A
  • GI
  • skin rash
  • hepatitis
  • thrombocytopenia
51
Q

What is a major counseling point for Rifampin?

A

colors all body fluids red/orange and can stain clothing and contacts

52
Q

What are ADRs associated with Pyrazinamide?

A
  • hepatic injury
  • hyperuricemia
  • rash
  • GI upset
53
Q

Which 2 drugs when used in combination are linked to severe liver toxicity?

A

Pyrazinamide and Rifampin

54
Q

What are ADRs associated with Ethambutol?

A
  • retrobulbar neuritis (monitor visual acuity)
55
Q

In what cases can you use rifampentine?

A
  • used once weekly with INH in continuation
  • HIV negative
  • negative sputum smears following initial phase
56
Q

In what patient population is Rifabutin used commonly in?

A

HIV+

57
Q

What drug is newly approved for drug-resistant TB?

A

Bedaquiline (Sirturo)

967 Block 3 - Pulmonary (3 decks)

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