TB - Drugs Flashcards

1
Q

TB Skin Test (TST) (PPD)

  • Give
  • Read
A
  • Give intra-dermal

- Read 48-72H after it’s given

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2
Q

CXR

A
  • Assisted with locating infected areas of lungs in active TB or to rule out active TB if PPD+
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3
Q

TB Blood tests

A
  • QuantiFERON-TB Gold in Tube test (GFT-GIT)
  • T-SPOT TB test

=> Expensive & only if pt can’t come back in 2 days

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4
Q

Acid Fast Bacilli (AFB)

A
  • To test for TB

- AFB + means active TB

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5
Q

S/S of TB

A
  • Chronic cough
  • Fever
  • Weight loss
  • Night sweats
  • Fatigue
  • Hemolysis: cough up blood
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6
Q

5mm = + for

10mm

15mm

A

5mm

  • Low immunity: HIV & steroid therapy
  • High risk for TB infection: close contact w/ a TB person

10mm

  • DM
  • CKD
  • Health care workers

15mm
- Everyone else

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7
Q

BCG

A
  • Bacillus of Calmette and Guerin (BCG) is a vaccine against TB given in countries with high prevalence of TB

=> make the pt has PPD+ but may wear off after years

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8
Q

What is?

  • Thiamine
  • Ravin
  • Niacin
  • Pyridoxine
  • Folic
  • Cyanabolic
A
  • *The Rabi Need Prayer for Comfort**
  • Thiamine: B1
  • Ravin: B2
  • Niacin: B3
  • Pyridoxine: B6
  • Folic: B9
  • Cyanabolic: B12
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9
Q
Isoniazid (INH)
- SEs
 => D/C when?
- DDI
- Dose
A

SEs
- Hepatotoxicity => check LFT periodically
=> D/C if AST > 3x UL w/ s/s of toxicity
=> D/C if AST > 5x UL w/ no s/s
- Peripherally neuropathy
=> prevent by take B6 10-50mg QD

DDI

  • 1A2, 2C9 inhibitors
  • Theophylline, warfarin, phenytoin

Dose
- 5mg/kg up to 300mg PO QD

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10
Q

Empty stomach

Take with food

A

Empty stomach:
- Rifampin
=> Rifamate & Rifater => b/c contain rifampin

Take with Food
- Bedaquiline - Sirturo

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11
Q

Color body red/orange

A

Rifampin

Rifapentine - Priftin

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12
Q
Rifampin (Rifadin)
- SEs
- DDI
  => Never give with
- Dose
A

SEs

  • Hepatotoxicity
  • Fever, rash, flu-like illness, GI upset
  • Thrombocytopenia
  • Change body fluid red/orange

DDI

  • Strong inducer of 1A2, 2C9, ad 3A4
  • NEVER give w/ PI = hepatotoxicity

Dose
- 10mg/kg up to 600 mg PO/IV QD

Take on empty stomach

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13
Q

All TB drugs are bactericidal except

A

Ethambutol

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14
Q

Hyperuricemia

A
  • Rifapentine - Priftin
  • Pyrazinamide
  • Ethambutol - Myambutol
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15
Q

Rifapentine - Priftin

- SEs

A
  • Hepatotoxicity
  • Thrombocytopenia
  • Hyperuricemia
  • Orange/red body fluid
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16
Q

Pyrizinamide

  • SE
  • Avoid in
A

SEs

  • Hepatoxocity
  • Hyperuricemia

Avoid in renal dysfxn

17
Q

Cause optic neuritis

A

Ethambutol - Myambutol

18
Q

CI in pregnancy

  • SE
A

StreptOmyciN

=> SE: Nephrotoxicity, ototoxicity

19
Q

Streptomycin

  • Monitoring monthly
  • Forms
  • SEs
A

Monitor monthly

  • Auditory
  • Renal function
  • Electrolytes

Forms
- IV/IM

SEs

  • Nephrotoxicity
  • Ototoxicity
20
Q

QT

A
  • Bedaquiline - Sirturo
21
Q

Bedaquiline - Sirturo

  • Indication
  • Administer by
  • SEs
  • DDI
A

Indication:

  • Part of combo therapy w/ 3 other drugs for >/= 18 y.o w/ multiple drug resistant
  • Adm by directly observed therapy (DOT)

SEs

  • QT
  • Hepatotoxicity

DDI
- CYP 3A4 inducers/inhibitors

22
Q

Referred regimen to treat TB

A

Take for the 1st 8 weeks

  • Isoniazid
  • Rifampin
  • Pyrazinamide
  • Ethambutol

Then for 18 weeks (4.5 mo)

  • INH
  • Rifampin
23
Q

Rec tx for LTBI

ALT

A

Rec
- Isoniazid 300 mg PO QD x 9 mo

ALT

  • Rifampin 600 mg PO QD x 4 months
  • INH + rifapentine (Priftin) QW x 3 months
24
Q

TB Drugs - RIPES

A

All bactericidal except ethambutol

  • Isoniazid (INH)
  • Rifampin (Rifadin) - Empty stomach
  • Pyrazinamide
  • Ethambutol (Myambutol): use to prevent resistant
  • Streptomycin
  • Bendaquiline (Sirturo)
  • Rifamate = INH + Rifampin- Empty stomach
  • Rifater = INH + Rifampin + pyrazinamide- Empty stomach
25
Q

Ethambutol (Myambutol)

  • SEs
  • Direction to take
A
  • SEs: E = Eye = Optic neuritis: test color vision and visual acuity monthly if > 15mg/kg/d
  • Increase uric acid
  • Give 4H before Al containing antacids, sucralfate, buffered didanosine.