TB - Drugs Flashcards
TB Skin Test (TST) (PPD)
- Give
- Read
- Give intra-dermal
- Read 48-72H after it’s given
CXR
- Assisted with locating infected areas of lungs in active TB or to rule out active TB if PPD+
TB Blood tests
- QuantiFERON-TB Gold in Tube test (GFT-GIT)
- T-SPOT TB test
=> Expensive & only if pt can’t come back in 2 days
Acid Fast Bacilli (AFB)
- To test for TB
- AFB + means active TB
S/S of TB
- Chronic cough
- Fever
- Weight loss
- Night sweats
- Fatigue
- Hemolysis: cough up blood
5mm = + for
10mm
15mm
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
BCG
- 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
What is?
- Thiamine
- Ravin
- Niacin
- Pyridoxine
- Folic
- Cyanabolic
- *The Rabi Need Prayer for Comfort**
- Thiamine: B1
- Ravin: B2
- Niacin: B3
- Pyridoxine: B6
- Folic: B9
- Cyanabolic: B12
Isoniazid (INH) - SEs => D/C when? - DDI - Dose
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
Empty stomach
Take with food
Empty stomach:
- Rifampin
=> Rifamate & Rifater => b/c contain rifampin
Take with Food
- Bedaquiline - Sirturo
Color body red/orange
Rifampin
Rifapentine - Priftin
Rifampin (Rifadin) - SEs - DDI => Never give with - Dose
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
All TB drugs are bactericidal except
Ethambutol
Hyperuricemia
- Rifapentine - Priftin
- Pyrazinamide
- Ethambutol - Myambutol
Rifapentine - Priftin
- SEs
- Hepatotoxicity
- Thrombocytopenia
- Hyperuricemia
- Orange/red body fluid
Pyrizinamide
- SE
- Avoid in
SEs
- Hepatoxocity
- Hyperuricemia
Avoid in renal dysfxn
Cause optic neuritis
Ethambutol - Myambutol
CI in pregnancy
- SE
StreptOmyciN
=> SE: Nephrotoxicity, ototoxicity
Streptomycin
- Monitoring monthly
- Forms
- SEs
Monitor monthly
- Auditory
- Renal function
- Electrolytes
Forms
- IV/IM
SEs
- Nephrotoxicity
- Ototoxicity
QT
- Bedaquiline - Sirturo
Bedaquiline - Sirturo
- Indication
- Administer by
- SEs
- DDI
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
Referred regimen to treat TB
Take for the 1st 8 weeks
- Isoniazid
- Rifampin
- Pyrazinamide
- Ethambutol
Then for 18 weeks (4.5 mo)
- INH
- Rifampin
Rec tx for LTBI
ALT
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
TB Drugs - RIPES
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
Ethambutol (Myambutol)
- SEs
- Direction to take
- 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.
