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Infectious Disease > TB management > Flashcards

TB management Flashcards

1
Q

How is TB diagnosed

A
  1. induration 48-72 hours after PPD
  2. sputum smear
  3. culture
  4. PCR for acid fast bacillus
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2
Q

What is a considered a positive PPD test in HIV patients or those that had recent contact with TB

A

induration of >/= 5mm

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3
Q

What is a considered a positive PPD test in immigrants, IV drug users, healthcare worker, inmates or moderate immunosuppression?

A

> /= 10 mm induration

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4
Q

What is a considered a positive PPD test in patients with no risk factors?

A

> /= 15mm induration

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5
Q

What is the typical treatment of latent TB?

A

isoniazid (INH) 300mg daily or twice a week for 9 months

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6
Q

What are secondary treatment options for latent TB?

A

Rifadin-rifampin(RIF) 600mg daily for 4 months
or
INH+ Priftin (rifapentin) weekly for 3 months

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7
Q

In what patient population is the INH + rifapentin not used?

A

HIV+ patients or children

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8
Q

What is the alternative to rifampin in patients with unacceptable drug-drug interactions?

A

rifabutin

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9
Q

A patient is diagnosed with latent TB which of the following combinations is NOT a correct choice and why?

a. INH 300mg QD or BIW x 9 months
b. RIF + pyrazinamide
c. Rifadine 600mg QD x 4 months
d. INH + rifapentine QW x 3 months

A

B. Rifadine + pyrazinamide. This combination is no longer used due to hepatotoxicity

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10
Q

A patient is diagnosed with latent TB and has been taking Rifadine for the past 2 months. Recently some additions were made to their medication list, which of the following may pose a problem and why?

a. Norvir
b. Motrin
c. psudaphed
d. Lasix

A

A. Norvir because the use of a PI with rifampin (Rifadine) is contraindicated.

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11
Q

A patient comes to the counter to pick up their prescription for Rifadine. They ask you what are the important things to know about this medication?

a. Wait about 1 hour after taking it or 2 hours after eating before taking it, so the medication is on an empty stomach
b. You may experience flu like symptoms or an upset stomach after taking this
c. contact your doctor if you start to see changes in your urine, spit or other body fluids
d. It is okay to keep taking this medication if your doctor tells your liver is okay

A

A,B, & D: These are all correct.
C is incorrect because changes in body secretions are normal side effects to this medication and the doctor does not need to be contacted.

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12
Q

What is the mechanism of action of rifampin?

A

Blocks RNA transcription which inhibits RNA synthesis

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13
Q

what parameters should be monitored when Rifadin is being used?

A

LFTs
mental status
CBC

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14
Q

This medication inhibits cell wall synthesis and is used in TB

A

INH

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15
Q

What is the weekly and daily dose of INH

A

900mg/week

300mg/day

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16
Q

In the RIPE combination for the treatment of active TB which medication should be taken with regard to food wand which should not

A

Empty stomach: Rifidin & INH

No regard to food: Pyrazinamide & ethambutol

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17
Q

When using INH, what BBW should be reviewed?

A

Severe and fatal hepatitis within the first 3 months.

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18
Q

A patient is diagnosed with TB. What in their medical history would prevent the use of INH

A

Active liver disease or if they had any severe reaction to INH in the past as these are contraindications.

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19
Q

When counseling a patient about INH, what are the key side effects to tell them?

A

INH may cause HA, GI upset, peripheral neuropathy, increases in LFT and lupus like syndrome.

20
Q

What type of blood component changes are caused by INH

A

agranuloctosis
thrombocytopenia
hemolytic & aplastic anemia

21
Q

How is peripheral neuropathy managed in TB & what causes it?

A

tx neuropathy with pyridoxine 25-50mg/day

INH causes neruopathy

22
Q

Rifamate is the brand name for

A

rifampin + INH

23
Q

Rifadine + INH + pyrazinamide are generics for

A

Rifater

24
Q

Rifadine + INH are generics for

A

Rifamate

25
Q

Rifater is the brand for

A

Rifadine + INH + pyrazinamide

26
Q

Myambutol is the brand for

A

ethambutol

27
Q

what is the brand name of ethambutol

A

Myambutol

28
Q

Pyrazinamide converts _______ ______ in mycobacterium with leads to ____ in ______?

A

PYRAZONIC ACID
DECREASE
pH

29
Q

What is the max daily dose of pyrazinamide that can be given

A

2g/d

30
Q

what is the weekly dose of pyrazinamide?

A

3-4g 2-3x a week

31
Q

What is the typical mg/kg/day dosing of pyrazinamide?

A

20-25mg/k/day

32
Q

A patient presents to the ER and is diagnosed with TB. A dose of 1g/day is given to the patient. This patient most likely weighs:

a. 30-39kg
b. 56-75kg
c. 76-90kg
d. 40-55kg

A

D. 40-55kg

33
Q

A patient presents to the ER and is diagnosed with TB. A dose of 1.5g/day is given to the patient. This patient most likely weighs:

a. 30-39kg
b. 56-75kg
c. 76-90kg
d. 40-55kg

A

B. 56-75kg

34
Q

A patient presents to the ER and is diagnosed with TB. A dose of 2g/day is given to the patient. This patient most likely weighs:

a. 30-39kg
b. 56-75kg
c. 76-90kg
d. 40-55kg

A

C. 76-90kg

35
Q

A patient presents to the ER and is diagnosed with TB. A dose of <1g/day is given to the patient. This patient most likely weighs:

a. 30-39kg
b. 56-75kg
c. 76-90kg
d. 40-55kg

A

A. 30-39kg

36
Q

If a patient complains of GI upset, malaise, muscle/bone pain and labs indicate hyperuracemia and elevations in LFTs, which medication is most likely the cause?

a. Pyrazinamide
b. Streptomycin
c. Sirtuto
d. Rifater

A

A & D due to the pyrazinamide

37
Q

The use of what is contraindicated in patients with acute gout or severe hepatic damage

A

pyrazinamide

38
Q

What labs need to be monitored when using pyrazinamide

A

LFTs, SCr, uric acid

39
Q

What suppresses mycobacteria replication by interfering with RNA synthesis

A

Myabutol (ethambutol)

40
Q

What is the max daily dose of Myambutol

A

1.6g daily

41
Q

What is the max twice weekly dose of Myambutol

A

2.4g 2x week

42
Q

What is the max three times weekly dose of Myambutol

A

4g 3x week

43
Q

When is extended dosing interval used for Myabutol?

A

CrCl <50mL/min

44
Q

When is extended dosing interval used for pyrazinamide?

A

CrCl<30mL/min

45
Q

Which of the following are side effects of Myambutol:

a. scotoma, decreased visual acuity, color blindness, hallucinations, confusions, N/V, stomach pain
b. Neuropathy, ototoxicity
c. GI upset, hyperuricemia, malaise, rash
d. HA, GI upset, Increased LFT, nerupathy, lupus like syndrome

A

A. scotoma, decreased visual acuity, color blindness, hallucinations, confusions, N/V, stomach pain

Infectious Disease (7 decks)

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