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Therapeutics IV > TB - Block 3 > Flashcards

TB - Block 3 Flashcards

1
Q

How is TB transmitted?

A

Aerosilized particles from infected person when they cough, speak, or sing
* Particles remain in air for hours

Ingestion of unpasteurized milk

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2
Q

What ways does TB NOT spread?

A
  1. Shaking someone’s hand
  2. Sharing food or drink
  3. Touching clothing and toilet seats
  4. Sharing toothbrushes
  5. Kissing
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3
Q

What are the risk facotrs for infection?

A
  1. Large urban areas
  2. Foreign birth
  3. Close contact with thos infected
  4. Non-white
  5. Male
  6. Low SE status
  7. Coinfection with HIV
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4
Q

What are the RF for development of the disease?

A
  1. Weakened immune system
  2. Recent TB infection
  3. Drug abuse, alcohol, smoking
  4. Low body weight
  5. Children <5YO who test positive
  6. Elderly
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5
Q

What is the cause of primary infection?

A

M. tuberculosis

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6
Q

What is latent TB infection?

A

Unhibited growth of TB due to immune system suppression -> without tx it may develop to disease

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7
Q

What is active TB infection?

A

Reactivation or reinfection can lead to infectiousness and symptomatic

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8
Q

What is miliary TB? Who are more likely to be infected?

A

Common severe, disseminated form of extrapulmonary TB -> occurs when bacteria spreads in blood stream affecting multiple organs
* Children <4YO
* Immunocompromised
* Elderly

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9
Q

Clincial presentations of TB?

A
  1. Coughing blood or mucus
  2. Chest pain
  3. Loss of appetite
  4. Chills
  5. Night sweats
  6. Fever
  7. Weight loss
  8. Fatigue
  9. Cough more than 2 weeks
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10
Q

Vaccine used for TB? CI?

A

BCG vaccine
CI: pregnant women and immunocompromised

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11
Q

What are the diagnostic tests for LTBI?

A
  1. Tuberculin skin test
  2. Interferon-y release assay (IGRA)
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12
Q

What is the purpose for TST?

A

Mantoux technique: intradermal injection of tuberculin units of purified protein derivative (PPD)
* Delayed types hypersensitivity with 48-72 hrs

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13
Q

What is IGRA?

A

Measure the release of INF-y in blood in response to TB antigens
* Results available within 24 hrs

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14
Q

When would IGRA be recommended over TST?

A

>5YO:
1. Likely infected
2. Low-intermediate risk
3. Testing for latent
4. Hx of BCG vaccine
5. Unlikely to return to have their PPD read

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15
Q

RF if TST is positive and ≥5mm?

A
  1. HIV
  2. Recent TB contact
  3. Nodular or fibroticchanges on chest X-ray
  4. Organ transplant
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16
Q

RF if TST is positive and ≥10mm?

A
  1. Immigrant
  2. IVDU
  3. High risk settings
  4. Mycobacterial lab personnel
  5. High-risk comorbidities
  6. Children <4, any child exposed to high-risk adults
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17
Q

RF if TST is positive and ≥15mm?

A

No known RF

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18
Q

Diagnostic tests for TB?

A
  1. Chest X ray: patchy, nodular infiltrates, cavitation
  2. Sputum exam, culture, testing through acid fast bacilli (AFB) smear
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19
Q

Methods of AFB smear sample collection?

A
  1. Sputum volume of at least 3 mL, but the optimal volume is 5–10 mL
  2. Aerosolized hypertonic saline to induce sputum production
  3. Flexible bronchoscopic sampling
  4. Daily sputum collection over three consecutive days is recommended
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20
Q

For suspected extrapulmonary TB, where are samples collected from?

A

Draining fluid, biopsies of site, blood

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21
Q

Resistant to any one TB tx drug?

A

Mono-resistant

22
Q

Resistant to at least any 2 TB drugs (not both isoniazid and rifampin)

A

Poly-resistant

23
Q

Resistant to at least isoniazid and rifampin?

24
Q

Resistant to isoniazid and rifampin plus any FQ and at least 1 of the second line drugs?

25
Q

Who are at risk for MDR-TB?

A
  1. Previous TB tx
  2. Failed TB tx
  3. Areas with a high prevalence of resistance
  4. HIV infection
  5. AFB-positive sputum
  6. Positive cultures
  7. MDR-TB exposure
26
Q

Chracterisitcs of LTBI and Active TB tx?

A

LTBI: tx is <6 months, 1 medication, outpatient
Active: Longer duration of tx, 2-4 medications, may require hospitalization

27
Q

Non pharm for TB?

A
  1. Nutrition support
  2. Surgical removal of destroyed tissue or lesions
  3. Counseling on substance abuse
  4. Infection control in hospitals
  5. Notification of public health departments
28
Q

What is DOT?

A

Supervision by public health personnel of the ingestion of every dose of drug:
* Children
* HIV infection
* Tx failure and resistance

29
Q

What is SAT (selective self-administered tx)?

A
  1. Patients committed to tx
  2. Often with combo
  3. Home visits used to:
    * Evaluate potential barriers
    * Check for other active cases
    * Assess close contact
30
Q

What are the first lines for TB?

A
  1. Rifamycins (Rifampin, rifapentine, rifabutin)
  2. Isoniazid
  3. Pyrazinamide
  4. Ethambutol
31
Q

Rifampin

Counseling, DDI, ADR

A

Counseling: Give on an empty stomach
DDI: CYP450 induction, interactions with PIs (HIV and oral contraceptives)
ADR: Orange-red body secretions that can stain contact lenses

32
Q

Rifabutin

Indication, Counseling, DDI, ADR

A

Indication: MAC
Counseling: w/ meals to minimize N/V
DDI: less induction can be used with PIs
ADR: Uveitis

33
Q

Rifapentine

Indication, Counseling, ADR

A

Indication: Not for paitents with HIV
Counseling: Take with food (fat increases AUC)
ADR: Joint pain

34
Q

Isoniazid

Counseling, DDI, ADR, BBW

A

Counseling: Take on empty stomach (food and antacids decrease absorption)
* Administer with pyridoxine

DDI: Inhibit metabolism of phenytoin, carbamazepine, primidone, warfarin
ADR: peripheral neuropathy (pyridoxine deficiecy)
BBW: hepatitis

35
Q

Pyrazinamide

Indication, ADR

A

Indication: initial2 month tx
ADR: Dose-related hepatotox with given QD

36
Q

Ethambutol

Indication, DDI, ADR

A

Indication: If organsim is susceptible to isoniazid, rifampin, and pyrazinamide, ethambutol can be stopped
DDI: antacids (drug requires an acidic environment)
ADR: Retrobulbar neuritis (inability to see red and green)

37
Q

When do you initiate LTBI therapy?

A

Monotherpy with lower bacteria load:
* Initiate after active TB has been excluded

38
Q

Drugs for latent TB?

A

Isoniazid and Rifapentine: I is QD, R is QW for 3 months
Rifampin: QD for 4 months
Isoniazid and Rifampin: QD for 3 months

39
Q

What is the alternative for LTBI?

A

Isoniazid QD for 6 months

40
Q

Tx for active TB?

A
  1. Rifampin
  2. Isoniazid
  3. Pyrazinamide
  4. Ethambutol
41
Q

What are the components of intensive Active TB tx?

A

Rifampin, Isoniazind, Pyrazinamide, and Ethambutol for 8 wks

42
Q

What are the components of continuation active TB tx?

A

Rifampin and Isoniazid for 18 wks

43
Q

What makes an active TB regimen more effective?

A

More frequent dosing

44
Q

Difference between Latent and Active TB tx?

A

Latent: RI or R
Active: RIPE then RI

45
Q

What should be avoided in MDR-TB?

A
  1. Monotherapy
  2. Never add a single drug to a failing regimen
46
Q

What are the components of MDR-TB tx?

A

Using 5 or more drugs:
1. Choose one FQ (Levofloxacin or Moxifloxacin)
2. Add Bedaquiline and Linezolid
3. Add Clofazimine and Cycloserine/terizidone

47
Q

When can you initiate CS for TB?

A

Only added when inflammation is a cause of morbidity and ARDs, minigitis, pericaditis is present

48
Q

What is used for CS adjunt?

A

Dexamethasone 12 mg PO or IV Q6H in patients >25kg for 2-3 wk

49
Q

What is the most important counseling point for TB?

A

Adherence is key

50
Q

When do you follow up for tb?

A

Sputum: Smear and culture monthly until 2 consecutive specimens are negative
Chest radiograph: Q3-6H during and at the end of tx
General follow up at 6 months after tx completion
SX and vision assessment: monthly

51
Q

Labs associated with TB followup?

A
  1. LFTs
  2. Platelet count
  3. Cr
  4. HIV
  5. Hep B and C screening
  6. Diabetes screening

Therapeutics IV (39 decks)

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