TB: Antimycobacterial Agents Flashcards
- Aerobic, non-spore forming, non-motile bacillus
- Slow growing, acid fast
Mycobacterium Tuberculosis (M. tuberculosis)
S/S of TB
night sweats
prolonged cough
fever
loss of appetite
Person to person through the ____.
_____ can get into alveoli and replicate.
Produced by cough, _____, sings, or speaks.
(make sure to cover mouth/wear mask)
- air
- droplets
- sneezing
can’t spread through clothing, drinking glass, silverware, handshakes, or surfaces*
Testing for TB can include what ways?
PPD (takes 48 hours)
Chest x-ray
Blood test (24-48hrs)
Sputum culture
What provides definitive diagnosis that takes 2-6 weeks long?
Sputum CULTURE
Who is tested for TB?
HIGH RISK patients DM CKD Leukemia Recent Infection
____ can give a false positive for PPD
BCG
Treatment Goals
- cure patient
- prevent transmission to others
- use 2 or more active drugs (to reduce resistance)
- increase changes of successful treatment
- administration in presence of an observer
- continuous evaluation of response and ADR
DOT
directly observed therapy
- 2-3 times/week dosing
OR - larger doses but less frequently
effective as daily dosing
Intermittent Dosing
Latent TB treatment:
Standard –> ______ daily for __ months (self-administered)
OR
_____ and _____ once weekly for _____ months (DOT need to go to clinic)
Standard :
- Isoniazid daily for 9 months
OR
- Isoniazid and Rifapentine; weekly 3 months
Active TB Treatment:
________ and _________ phase
Induction and Continuation phases
- eliminate actively dividing extracellular tubercle bacilli
- Rifampin, isoniazid, pyrazinamide, ethabutol for 2 months
Induction Phase (initial trx)
- eliminate intracellular “persisters” (bacilli still there)
- Rifampin + Isoniazid x 4.5 months (18 weeks)
- May last longer
Continuation phase
If after the _____ phase the patient is still (+) for TB, the ______ phase will last longer!
induction; continuation
If culture is resistant , use ____
Isoniazid (INH)
- used for Latent TB
- 1st line drug for Active TB
- Bactericidal against active TB
- Bacteriostatic against dormant TB
ADR
- HEPATOTOXICITY
- Peripheral Neuropathy (watch out for patients who already have == consider taken with Vit B6 (pyriodoxine))
Education:
- limit/avoid alcohol
- can develop resistance
isoniazid (INH)
Isoniazid (INH) CNS manifestations :
- optic neuritis
- seizures
- ataxia
- dizziness
- memory impairment
- potential depression
- hallucinations
- toxic psychosis
- 1st line drug in active TB
- Kills active and semi-dormant TB
Drx INT:
- warfarin
- PO contraceptive
- PI (Protease inhibitors)
- NNRTIs
ADR:
- HEPATOTOXICITY
- RED ORANGE BODILY FLUIDS
- GI (nausea)
- FLU-LIKE symp
- PRURITUS
Yellowing of skin and eyes – make contacts stained
Rifampin
- 1st line drug for active TB
ADR:
- Hepatotoxicity
- Nongouty polyarthralgias (take NSAID - aspirin)
- N/V/D
- Rash
- photosensitive dermatitis
CONTRA:
- Liver disease
Monitor:
- ALT/AST
Education
- limit alcohol
- use NSAID for polyarthralgia
Pyrainamide (PZA)
- 1st line drug in active TB
- Bacteriostatic
ADR
- optic neuritis (blurred vision)
- dermatitis itching
- peripheral neuritis
- GI upset (take with food)
- confusion
** dont give to children <8 years old
Monitor monthly
- COLOR discrimination
- Visual field constriction
- changes in vision
Ethambutol
Before giving to HIV patients, what is needed to be done?
- evaluate treatment
- sputum check 4-6 weeks
- if (-) move to monthly sputum checks
(usually negative within 3 months of treatment)
Considerations in HIV Patients
- may require longer durations of trx
- at risk for IRIS (immune reconstitution syndrome)
- freeze-dried prepariation of M. bovis
- used in countries with high TB
- for protection of infants
- PRODUCE FALSE POSITIVE OF TB TEST
- Bacille Calmette-Geurin (BCG) vaccine
