TB medication

Question 1

Side effects Rifampicin

Answer 1

Anorexia, nausea, abdominal
pain

Orange/red urine

Need to exclude DILI/Hepatitis-isolated jaundice

Hypersensitivity

NB: potent liver enzyme inducer-need to dose adjust
eg. Need to increase dose of contraceptive pill

Question 2

side effects pyrazinamide

Answer 2

Joint pains

Question 3

Side effects isoniazid

Answer 3

HEPATOTOXICITY
NEUROTOXICITY; ataxia, seizures, psychosis
peripheral neuropathy

Give pyridoxine (Vit B6). 25mg.

Question 4

Which TB drugs can cause a rash/itching as well as jaundice/hepatotoxicity?

Answer 4

Rifampicin, Isoniazid, Pyrazinamide (RIP)

Question 5

which TB drug causes eye problems (uveitis), rash, gout (hyperuricaemia), peripheral neuropathy (more rare)?

Answer 5

Ethambutol: BACTERIOSTATIC

Question 6

Which TB drug causes thrombocytopaenia/purpura?

Answer 6

Rifampicin

Question 7

What is standard first line TB treatment

Answer 7

Intensive Phase:RHZE. Take dly for 2 mnths
R-rifampicin, H- isoniazid, Z-pyrazinamide, E-ethambutol

Continuation Phase: RH. Take dly for 4 mnths
Rifampicin
Isoniazid

Question 8

What is standard second line TB treatment

Background TB regimen?

Answer 8

to treat drug-resistant TB

Isoniazid resistance: usual regimen but replace Isoniazid with Levofloxacin. 6 mnths.

1. Bedaquiline (QT prolongation)
2. Clofazimine
3. Cycloserine
4. Delamanid
5. Ethiomamide
6. Fluoroquinolone: moxifloxacin or levofloxacin
7. Linezolid

Question 9

Background TB regimen

Answer 9

moxifloxacin/levofloxacin, linezolid, terizidone, amikacin

Question 10

Why is ethionamide and kanamycin no longer indicated?

Answer 10

Kanamycin: fewer side effects, more effective

Ethionamide: Can increase aminotransferase levels, liver injury

Question 11

MDR-TB short course

Answer 11

Start SHORT COURSE
4-6 months (Intensive Phase):
LZD (2 months only) + BDQ (total 6 months) + hdINH (4-6 months) + LFX + CFZ (clofazimine) + PZA + EMB

5 months (Continuation Phase):
LFX + CFZ + PZA +EMB

Note: Give pyridoxine 50 mg/day to adults to prevent peripheral neuropathy while receiving INH

Question 12

Why is LZD only given for 2 mnths in MDR-TB?

Answer 12

Toxicity

Question 13

Antidote for Isoniazid OD

Answer 13

pyridoxine massive dose +-5g

Question 14

which TB drugs need to be dose adjusted in renal impairment

Answer 14

ethambutol and pyrazinamide

Question 15

Biggest problem associated with Rifampicin

Answer 15

potent inducer
results in more rapid metabolism, drug concentration goes down

eg. Dolutegravir, double dose (50 mg morning 50mg night not 100mg one go)

Question 16

Interaction between lopinavir and Ritonavir (PIs)

Answer 16

Ritonavir INHIBITS METABOLISM of Lopinavir
Always given together

Question 17

Effect of rifampicin on Lopinavir and Ritonavir?

Answer 17

Have to double doess Lopinavir and Ritonavir because Rifampicin potent inducer

Question 18

Which TB drugs cause rash

Answer 18

All

Question 19

which TB drugs cause hyperuricaemia

Answer 19

PZA (also arthralgia)
Ethambutol

Question 20

clofazamine side effects

Answer 20

GIT effects

Question 21

Management TB DILI

Question 22

Why do you need to exclude active TB before starting INH preventative therapy

Answer 22

Prevents resistance

Question 23

What is IRIS

Answer 23

immune system is reconstituting and presents as inflammation

paradoxical TB IRIS: Start TB treatment, then start ARVs, within 3 mnths

Question 24

Who should receive INH preventative therapy

Answer 24

All HIV patients no signs or symptoms active TB

all children less than 5 IRRESPECTIVE OF HIV STATUS with POSITIVE TB contact