TB Adverse Drug Reactions Flashcards
Name common side effects of TB drugs
Anorexia, nausea, abdominal pain
Joint pain
Orange urine
Pruritis/rash
Peripheral neuropathy
Which TB drugs are responsible for anorexia, nausea and abdominal pain side effects?
All TB drugs
How do you manage anorexia, nausea and abdominal pain side effects secondary to TB drugs?
- Continue TB drugs
- Give TB drugs at night
- Give anti-emetics
- Exclude liver toxicity
Which TB drug is responsible for joint paint side effects?
Pyrazinamide
How do you manage joint point secondary to pyrazinamide?
Continue TB drugs
NSAIDs if normal eGFR
Which TB drug is responsible for peripheral neuropathy?
INH
How do you manage peripheral neuropathy secondary to INH?
- Continue TB drugs
- Increase pyridoxine to 100mg daily
- Give amitryptiline 25mg note OR gabapentin 300mg tds
- Exclude other causes (DM, renal, B12 deficiency)
Which TB drug is responsible for orange urine?
Rifampicin
How do you manage orange urine secondary to rifampicin?
Reassurance
Which TB drug is responsible for pruritis/rash
All TB drugs
Most common E->P->R->I
Consider ART
Cotrimoxazole
How do you manage pruritis/rash secondary to TB drugs?
Mild - continue therapy, symptomatic treatment
Moderate - rechallenge 1 drug at a time I->R->P->E every 3-5 days
Severe - stop all drugs
What are severe side effects of TB drugs?
Hepatotoxicity
Visual impairment
Thrombocytopenia
Haemolytic anemia
Psychiatric
Seizures
Which TB drugs are responsible for hepatotoxicity?
RIP
What is the management of hepatotoxicity secondary to TB drugs?
- Stop treatment
- LFTs
- Refer
Which TB drugs are responsible for visual impairment?
Ethambutol
Rifabutin
What is the management of visual impairment secondary to TB drugs?
Stop ethambutol
Refer to ophthalmologist
Consider differential (CMV, CCM, toxoplasmosis)
Which TB drugs are responsible for thrombocytopenia or haemolytic anaemia?
Rifampicin
What is the management of thrombocytopenia/hemolytic anaemia secondary to TB drugs?
- Consider differential
- Start rifampicin-sparing regimen
Which TB drugs cause psychiatric side effects?
INH
Terizidone
Ethionamide
Which TB drugs cause seizures?
INH
What is the management of seizures secondary to TB drugs?
Diagnosis of exclusion -> differential diagnosis
Exclude CNS lesion
What is the pattern of injury in pyrazinamide DILI?
Hepatocellular