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Karboski's Pharmacology - UT AEMSN > TB and UTIs > Flashcards

TB and UTIs Flashcards

1
Q

What factors are necessary for a ≥ 5 mm induration to be positive on a PPD skin test?

A
  • HIV co-infxn
  • recent TB contact
  • classic x-ray Δ’s
  • organ transplant
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2
Q

Treatment for cath-associated UTI?

A
  • D/C or change cath
  • Get UA w/ C/S first
    • Then 7-14 days of ABX therapy
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3
Q

What should initially be done for acute pyelonephritis?

A
  • UA w/ C/S and Gm stains
  • Initiate empiric therapy
    • f/u w/ directed therapy on basis of infecting pathogen
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4
Q

What factors are necessary for a ≥ 10mm induration to be positive on a PPD skin test?

A
  • immigration from endemic area w/in 5 yrs
  • IVDU
  • high-risk congregate setting
  • microbio lab workers
  • CKD/DM/cancer
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5
Q

What are some common risk factors for developing UTIs?

A
  • Female gender
  • ↑ age
  • obstruction
    • calculi, BPH
  • ↓ flow
    • Anti-Ach Rx, neuro Dz
  • Catheters/Instruments
  • Diaphrams
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6
Q

What is the initial Rx therapy for active TB infxn?

A

Intensive phase (all 4 Rx, no abbrev.)

  • rifampin + isoniazid + pyranizamide + ethambutol
    • for 2 months
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7
Q

What Sx do we look for when hepatotoxicity is a concern on TB agents?

A
  • anorexia
  • fatigue
  • jaundice
    • scleral icterus
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8
Q

How do we administer the “rif” 1st line TB agents?

A
  • Must take it on an empty stomach (food ↓ absorption)
  • take 1 hr before or 2 hrs after meals
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9
Q

What are the risk factors for contracting/communicating TB

A
  • Foreign travel/residence
  • Immune weakness
  • IVDU
  • Close contact
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10
Q

What is a clinical pearl associated with moxifloxacin?

A

will cover E. coli, Ø concentrated in urine

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11
Q

Why are there a lot of Rx interactions w/ 1st line TB agents, and what are some interaction examples?

A
  • Potent inducer of CYP-450
    • oral contraceptives
    • anti-retrovirals
    • anticonvulsants
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12
Q

Why is latent TB treated w/ Rx therapy?

A
  • to reduced lifetime risk of reactivation from 10% to 1% for non-HIV+ patients
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13
Q

Which asymptomatic patients should you NOT screen for UTI and why?

A
  • Groups Ø to screen:
    • DM
    • elderly
    • spinal cord injuries
    • indwelling catheters
  • Likelihood of finding MO’s high but risk of complication extremely low
    • want to avoid unnecessary treatment
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14
Q

What is a clinical pearl associated with Sulfonamides?

A

Avoid after 32 wks of pregnancy if possible

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15
Q

What is the treatment for culture positive, pan-susceptible TB during the contiuation phase?

A
  • rifampin + isoniazid for 4 additional mo
    • q day, q 5x/wk, or q 3x/wk
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16
Q

What are things that need to be considered when treating UTIs?

A
  • Regional ABX resistance (antibiogram)
  • Uncomplicated vs Complicated
  • That drugs make it to kidneys
    • excretion, urine [Rx], molecular size/protein binding
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17
Q

What are the latent TB infxn treatment options?

A
  • isoniazid 300mg q day for 9 mo
    • typically Ø done b/c it’s 9 months
  • isoniazid 900mg + rifapentine 900mg q weekly for 3 mo
    • most common and DOT
  • rifampin q day for 4 mo
    • Ø tolerate INH, or…
    • exposed to INH resistant TB
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18
Q

What Rx treatment approach is taken for TB relapse?

A
  • six agent minimum for re-treatment
    • RIPE + fluoroquinolone + aminoglycoside
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19
Q
  1. Why is asymptomatic bacteriuria in pregnancy treated differently?
  2. How is it treated?
A
  1. b/c likelihood of developing pyelonephritis with bacteriuria during pregnancy is significantly higher
  2. treat like symptomatic bacteriuria
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20
Q

What is unique about the SE profile of Ethambutol?

A
  • can cause retrobulbar neurtitis
  • least hepatotoxic of 1st line agents
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21
Q

What are the two primary reasons why TB relapse occurs?

A
  • Self admin therapy
  • non-rifampin containing regimen
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22
Q

What are the greatest risks for reactivation of TB?

A
  • HIV coinfection
  • Infected contact
  • Corticosteroid use
  • CKD/DM
  • Smokers
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23
Q

What is the treatment process for uncomplicated UTI?

A
  • Get a UA
  • Get antibiogram
  • Treat
    • Nitrofurantoin monohydrate
    • Trimethoprim-Sulfamethoxazole
    • Fosfomycin tromethamine
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24
Q

What is multi-drug resistant TB?

A

resistant to isoniazid and rifampin

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25
Q

What is a clinical pearl associated with Nitrofurantoin?

A

Ø concentrates in urine adequately if CrCl <60mL/min

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26
Q

How can hyperuricemia be distinguished from non-gout polyarthralgia w/ pyrazinamide use? What does this mean for SE treatment?

A
  • hyperuricemia typically in one joint, polyarthralgia in many joints
  • anti-gout Rx for one and anti-inflammatory Rx for the other
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27
Q

What are the SE of the rifampin 1st line TB agents?

A
  • rash/mild GI discomfort
  • discoloration of all bodily fluids
  • hepatotoxicity
  • pseudomenbranous colitis
28
Q

What is the purpose of RNA amplification?

A
  • rapid TB detection
  • diff btw TB and non-TB mycobacterium
  • can detect rifampin-resistant genes
29
Q

What 3 factors does duration of therapy of the intensive phase depend on?

A
  1. culture results
    • 6 to 8 wks to finalize
    • 90-95% should be neg at 3 mo
  2. Cavitary dz (abscess)
  3. Resistance profile
    • rifampin resistance or detection of other resistance
30
Q

Why do we use the TB two-step (TST) process?

A
  • to identify anyone with a booster phenomena and avoid falsely labeling TB conversion (from - to +)
    • initial test stim body to react → (+) rxn to subsequent TST
31
Q

How are severely ill acute pyelonephritis patients treated?

A
  1. Go to the hospital
  2. IV antimicrobal agents for first 48-72 hr then 7 days oral therapy
  3. Use C/S results to tailor therapy once received
32
Q

What are the additional symptoms that can help differentiate upper UTI (pyelo) from lower UTI (cystitis)?

A
  • flank pain
  • fever, malaise
  • N/V
33
Q
  1. What initial steps are taken to treat symptomatic abacteriuria?
  2. What is done if Pt reports recent sexual activity?
A
  1. Treat with 3 day course of TMP-SMX
    • if ineffective, get culture
  2. Recent sexual activity possible Chlamydia trachomatis
    • Ø see Clap on UA
    • Azithromycin 1 gram x 1 day + Doxycycline 100 mg BID x 7 days
34
Q

How are recurrent UTI infxns treated?

A
  • < 3 episodes/yr
    • short course therapy
  • ≥ 3 episodes/yr
    • suppressive at home/PPX therapy
      • TMP-SMX 160mg/800mg PO q day 1/2 DS tab x 6 mo
      • Levofloxacin 500 mg PO q day x 6 mo
      • Nitrofurantoin 50-100 mg PO q day x 6 mo
  • Indefinite cont therapy available if needed
35
Q
  1. What two criteria would extend the continuation phase to 7 mo+?
  2. How many total months would treatment be?
A
  1. Two Criteria
    • initial CXR shows cavitary dz
    • cultures drawn at 2 mo are positive
  2. 9 months
36
Q

What are the general ADRs with isoniazid?

A
  • peripheral neuropathy
    • results from ↓ B6
  • hepatotoxicity
  • hyperglycemia
37
Q

What are the ADRs associated with pyrazinamide?

A
  • hepatotoxicity
  • GI
  • hyperuricemia/gout
  • non-gout polyartheralgia
38
Q

What are the different types of cystitis?

A
  • uncomplicated
  • complicated
  • recurrent
  • relapse
39
Q
  1. What is asymptomatic bacteriuria defined as?
  2. What does this typically mean?
A
  1. Consecutive UA w/ > 105 CFUs/mL of same organism w/ Ø Sx
  2. Usually represents COLONIZATION, not infxn
    • Can attempt to eradicate once
40
Q

What 3 different patient presentations occur with UTIs?

A
  1. asymptomatic bacteriuria
    • technically Ø an infxn
  2. symptomatic abacteriuria
  3. symptomatic bacteriuria
41
Q

How are complicated UTIs treated?

A
  • treat as mild-moderate pyelonephritis
42
Q

What are the elderly Sx associated with UTIs?

A
  • AMS
  • GI symptoms
  • Δ eating patterns
43
Q

What is a clinical pearl associated with Trimethoprim?

A

Should be avoided in 1st trimester or pregnancy

44
Q

What are the 3 types of TB?

A
  • Latent TB
  • Active pulmonary TB
  • Extra-pulmonary TB
45
Q

What are the Sx of active TB

A
  • fever
  • weight loss
  • night sweats
  • productive cough
  • hemoptysis
  • fatigue
46
Q

What is the treatment for chronic bacterial prostatitis?

A
  • Initial Therapy
    • TMP-SMX for 4-12 wks
    • Quinolone for 4-12 wks
  • Suppressive therapy
    • 3/wk dosing
      • Ciprofloxacin
      • TMP-SMX reg str
    • Nitrofurantoin 100 mg q day
47
Q

What are the Rx, doses, and admin instructions for the 3 Rx’s used to treat uncomplicated UTIs?

A
  • Nitrofurantoin monohydrate 100mg PO BID x 5 days
    • Ø if early pyelon is suspected
  • Trimethoprim-Sulfamethoxazole 160mg/800mg (DS) PO BID x 3 days
    • Ø if resistance > 20%
    • Ø if used to treat UTI in last 3 mo
  • Fosfomycin tromethamine 3 gram powder PO x once
    • ↓ efficacy
    • Ø if early pyelo suspected
48
Q
  • What should never be done to a failing TB regimen and why?
  • What should be generally done?
A
  • Never add a single Rx to a failing regimen b/c all TB considered resistant
  • Always add 2 Rx to a regimen
49
Q

What is extensively drug-resistant TB?

A

resistant to isoniazid + rifampin + at least 2 other Rx

50
Q

What defines a TB regimen failure?

A
  • positive cultures after 4 mo of treatment
    • never got negative result
51
Q

What minimum regimen must HIV+ Pts be on during continuation phase?

A

≥ 3x/wk or more

52
Q

What is the UA gold standards for C/S?

A
  • > 105 CFU/mL → reasonably assume infectious
    • can still have cystitis w/ < 105 CFU/mL
      • just can’t say 100% positive UTI
53
Q

What factors make Mycobacterium tuberculosis (MTB) unique?

A
  • aerobic bacilli w/ thick, waxy cell wall
  • very slow growing
    • > 15 hr generation time
54
Q

What are important things we should be doing and/or monitoring for while on TB therapies?

A
  • HIV test (if status unknown)
  • Pregnancy test
  • LFTs
    • initial and q month if baseline abnml
  • visual acuity if on ethambutol
    • initial and q month
  • culture results every 2 mo
    • positive at 4 mo = failure
55
Q

What steps are taken if high suspicion of TB but all diag tests are negative?

A
  1. Initiate RIPE (must spell out) therapy
  2. Assess response and culture results at 2 months
56
Q

Following treatment of highly suspicious TB for 2 months, what criteria is needed to:

  1. d/c therapy
  2. cont therapy (how long?)
A
  1. neg culture and no change in CXR/clinical picture
    • then → d/c therapy
  2. neg culture and positive response to therapy
    • then → cont for 4 additional mo
57
Q

Why do we treat UTIs?

A
  • Treat symptoms - don’t like Sx and want them to go away
  • Don’t want infxn to travel
    • to blood → urosepsis
    • to kidney → pyelonephritis
58
Q

What’s the difference btw each of the “rif” 1st line TB agents?

A
  • rifampin = most common in US
  • rifabutin = ↓ Rx interactions (common in HIV+ Pts)
  • rifapentine = longer DoA (weekly regimens)
59
Q

What is the first-line rifampin Rx therapy choice for TB?

A
  • rifampin
  • rifabutin
  • rifapentine
60
Q

What are some Rx alternatives to uncomplicated UTIs?

A
  • Urinary fluoroquinolones x 3 days
    • cipro-, o-, levofloxacin
    • ↑ resistance d/t overuse, so need good reason to use
  • β-Lactams
    • amoxicillin-CA, cefdinir, ceflacor, cefpodoximine x 3-7 days
      • used when others can’t
61
Q
  1. What is the recommended treatment for mild-to-moderate symptomatic acute pyelonephritis?
  2. What are alternative Rx options?
A
  1. Treat as outpatient
    • Recommended therapy
      • ciprofloxacin 500 mg PO BID x 7 days
        • ok if resistance < 10%
      • TMP-SMX 160 mg/800 mg BID x 14 days
  2. Alternative Rx’s = q day
    • Ciprofloxacin 1000 mg x 7 days
    • Levofloxacin 750 mg x 5 days
62
Q

Why is the first-line therapy Rx considered 1st line?

A

Because all other Rx therapies for TB take longer to work

63
Q

What is the treatment for acute bacterial prostatitis?

A
  • Oral
    • TMP-SMX or quinolones for 4-6 wks
  • IV
    • rarely needed
    • IV → PO
      • if afebrile for 48hr, or
      • after 3-5 days of IV ABX
64
Q

What are some additional clues to help validate a UA sample?

A
  • Non-specific findings:
    • pyuria, hematuria, proteinuria
  • Specific findings:
    • nitrite from Gm (-) organisms
    • leukocyte esterase (WBCs present)
65
Q

What are the Sx we are monitoring for when looking for hepatoxicity?

A
  • jaundice
  • scleral icterus
  • ABD pain
  • nausea
  • fatigue
  • ↓ appetite (mentioned in lecture)
66
Q
  • What LFT results would lead to d/c’ing therapy?
  • How is therapy then restarted?
A
  • D/C all agents if LFTs
    • >5x ULN or
    • >3x ULN w/ Sx
  • then restart agents one at a time
    • rifampin +/- ethambutol 1st
    • add isoniazid if LFTs remain nml x1 wk
67
Q

What steps are taken to distinguish btw active vs latent TB?

A
  • good history
  • CXR
  • 3 AFB smears/cultures taken ≥ 8 hrs apart
    • RNA amplification and C/S

Karboski's Pharmacology - UT AEMSN (11 decks)

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