Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulmonary Unit > TB Pharm > Flashcards

TB Pharm Flashcards

1
Q

What populations are at an increased risk of active disease?

A

HIV and children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is TB diagnosed based on initial suspicion?

A

Respiratory symptoms
abnormal CXR (upper lobe infiltrates & cavities)
Positive acid-fast bacilli-stained smear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the definitive diagnosis for TB?

A

Isolation of M tub from clinical specimen

May take 3-8 weeks for clinical report to come back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the general treatment regimen for TB?

A

Intensive phase - 4 drug regimen
Continuation phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the first line agents for active tuberculosis treatment?

A

Isoniazid - tabs/IV/IM
Rifampin - capsule/IV
Rifapentine - tab
Rifabutin - cap
Ethambutol - tab
Pyrazinamide - tab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the second like agents for active TB treatment?

A

Streptomycin
Amikacin
Capreomycin
Ethionamide
Cycloserine
p-aminosalicylic acid
levofloxacin
moxifloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the initial vs continuation phase?

A

initial - bactericidal phase
-eliminates majority of bacteria
-resolves symptoms and infectiousness

Continuation phase - sterilization phase
-phase that kills persisting mycobacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the duration of treatment of drug susceptible TB

A

minimum 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the traditional regimen of TB treatment?

A

Intensive phase - 2 months
-Isoniazid
-Rifampin
-Ethambutol
-Pyrazinamide

Continuation phase - at least 4 months
-Isoniazid
-Rifampin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should guide the approach to management for treating active disease?

A

Sputum acid fast bacilli culture results at 2 months AND presence or absence of cavitary disease on CXR at initiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the required doses of the intensive phase to ensure treatment completion?

A

60 doses with daily therapy administered in 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the required doses of the continuation phase to ensure treatment completion?

A

All doses for 4 month phase should be delivered in 6 months
All doses for 6 month phase should be completed in 9 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should be done after the continuation phase?

A

CXR comparison

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is considered interrupted treatment and what should be done?

A

Number of doses unable to be administered in the targeted time period

Determine whether to extend duration of treatment or restart treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is continuous treatment more important? Why?

A

The intensive phase
-organ burden highest
-drug resistance greatest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the relationship between rifampin and hepatotoxicity?

A

Cholestatic pattern - increased bilirubin and alkaline phosphatase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which drugs will cause elevated serum transaminase concentrations?

A

Isoniazid, rifampin, pyrazinamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What should be included in patient education if meds cause GI upset

A

common in first few weeks

take meds with food

DO not discontinue unless absolutely necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which med can cause peripheral neuropathy?

A

isoniazid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which meds can cause urine discoloration?

A

rifampin and rifabutin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which med can cause elevated serum uric acid concentrations (gout)?

A

pyrazinamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which med can cause vision disturbances?

A

Ethambutol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What should be included in monitoring for meds?

A

Baseline LFTs
-bilirubin
-alk phos
-ALT/AST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What liver manifestations indicate discontinuation of meds?

A
  1. serum bilirubin >3mg/dL or ALT/AST >5x ULN
  2. Symptoms of hepatitis present ALT/AST >3x UNL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

If a med must be discontinued due to hepatotoxicity, what should be used until LFTs <2-3x the UNL

A

Ethambutol
Fluoroquinolone
Injectable agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How should hepatotoxic meds be reintroduced if needed discontinued?

A

one at a time with monitoring between starts of each agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What approach should be taken to restarting HTX meds if the issue had a cholestatic pattern?

A

This is more often seen with rifampin, so start with isoniazid or pyrazinamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What approach should be taken to restarting HTX meds if there was no increase in hepatic transaminase after 1-2 weeks?

A

start rifampin first, the isoniazid after 1-2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What should be done when restarting HTX meds if the symptoms reoccur or hepatic transaminases increase?

A

the last drug added should be stopped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What should be done if a patient is tolerating rifampin and isoniazid but having prolonged or severe HTX?

A

do not rechallenge pyrazinamide
extend treatment to 9 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What should be done if a patient is tolerating rifampin and isoniazid and having milder HTX?

A

pyrazinamide may be rechallenged
Rifampin + pyrazinamide + ethambutol can be given for 6 months

32
Q

Which drug has the most D/D interaction and what is it?

A

Rifamycins (rifampin most potent)
CYP450 inducers
decrease levels of protease inhibitors and selected nonnucleoside reverse transcriptase inhibitors (HIV tx)

33
Q

What are two important pt ed points?

A
  1. compliance is critical to treatment
  2. take all meds at the same time to reduce risk of drug resistance
34
Q

What are the two fixed dose combination products and their benefits?

A
  1. INH/RIF (rifamate)
  2. INH/RIF/PZA (Rifater)
    easier administration
    less pill burden
    reduce dosing errors
35
Q

Isoniazid MOA?

A

inhibits synthesis of mycolic acids (cell wall component)
Bactericidal at therapeutic levels

36
Q

Rifampin MOA?

A

inhibit bacterial DNA-dependent RNA polymerase
Concentration dependent

37
Q

Ethambutol MOA?

A

inhibits arabinosyl transferase resulting in impaired mycobacterial cell wall synthesis

38
Q

Pyrazinamide MOA?

A

converted to pyrazinoic acid in susceptible strains which lowers the pH of the environment
exact mechanism unclear

39
Q

What is the treatment duration for latent TB?

A

9 month daily isoniazid regiment

40
Q

What is the completion rate of self-administered plans with latent TB?

41
Q

What is an alternative to the standard 9 month plan for latent TB treatment

A

Combination of isoniazid and rifapentine administered once weekly for 12 weeks with directly observed therapy
better compliance with = efficacy

42
Q

What do most pregnant patients with latent TB choose to do?

A

Defer treatment until 3 months after delivery

43
Q

Which groups of pregnant women should under treatment for latent TB while pregnant?

A

Recent contact with a patient untreated with active respiratory TB

HIV-infected pt with CD4 count <=350

44
Q

Which treatment regimen is recommended for pregnant patients with latent TB?

A

Rifampin
-effective
-favorable completion rates
-low HTX

45
Q

What regiment for pregnant patients with active TB undergo?

A
  1. Isoniazid + rifampin + ethambutol x 2 months
  2. Then isoniazid + rifampin x 7 months
    -total 9 month treatment
46
Q

What are the risk factors of resistant TB for patients without a history of TB

A
  1. Exposure to drug-resistant TB
  2. travel/living somewhere with high prevalence of DR-TB
  3. work/reside in setting with documented DR-TB
  4. Emigration within previous 2 years from region with known DR-TB
47
Q

What are the risk factors of resistant TB for patients with a history of TB

A
  1. Progressive clinical/radiographic findings while on TB treatment
  2. Lack of conversion of cultures to negative during first 3 months of tx
  3. Noncompliance with TB tx
  4. Documented tx failure or relapse
  5. Inappropriate treatment regimen
48
Q

What is the empiric treatment for drug resistance?

A

Isoniazid + rifampin + pyrazinamide + 2 additional drugs
1. fluoroquinolone (levo or moxi)
2. second line agent

49
Q

What are the steps to treatment of DR-TB

A

Isoniazid + rifampin + pyrazinamide
step 1 - choose levo or moxi
step 2 - bedaquiline + linezolid
step 3 - clofazime + cycloserine/terizidone

50
Q

Define monoresistant TB?

A

TB caused by an isolate of M tub that is resistant to a single antituberculous agent

51
Q

Define polyresistant TB

A

isolate of TB resistant to more than one antituberculous agent
- either isoniazid OR rifampin (not both)

52
Q

Define multidrug resistant TB?

A

TB caused by an isolate of M tub that is resistant to at least both isoniazid AND rifampin

53
Q

Why are second line agents not as effective?

A

-decreased activity against m tub
-unfavorable pharmacokinetic profile
-increased adverse effects

54
Q

Outline capreomycin

A

needs at least 9 months

ADE:
-ototoxic
-vestibular toxicity
-nephrotoxicity
-electrolyte disturbances
-local pain with IM injection

AVOID in pregnancy

55
Q

Outline cycloserine?

A

ADE - CNS toxicity
Monitoring:
-CNS monitoring ideally monthly
-serum concentration levels
-renal dosing requirements

56
Q

Outline Ethionamide

A

ADE:
-GI
-HTX
-neurotoxicity
-endocrine: DM hypothyroid, gynecomastia

Monitor:
-LFTs
-TSH baseline & monthly

Pt ed - take with food

57
Q

Outline fluoroquinolones?

A

ADE:
-GI
-H/A
-dizziness
-QT prolongation
-Achilles tendonitis

needs renally dosed

58
Q

What is pneumocystis jirovecii pneumonia classified as?

A

fungal infection spread through the air and to immunocompromised patients by healthy adult carriers

59
Q

What increases risk of infection for PJP?

A

immunosuppression (diseases and steroids)

60
Q

How is PJP diagnosed?

A

Sputum sample - bronchoalveolar lavage
Lung biopsy
Blood test (B-D-Glucan; part of cell wall)

61
Q

What is the treatment of choice for PJP?

A

Bactrim (T/S)

62
Q

What decides if patient is clinically stable or not with PJP?

A

PaO2 >=60mmHg, RR<25
oral vs IV consideration

63
Q

What should be done if a patient with PJP has a sulfa allergy?

A

consider desensitization

64
Q

What should be done if a patient has a sever allergy to sulfa drugs (like SJS)

A

do not desensitize and avoid sulfa drugs

65
Q

What should be monitor with T/S treatment?

A

hyperkalemia

66
Q

What are the ADEs of T/S?

A

Fever
neutropenia
rash
hyperkalemia

67
Q

What should be given as an alternative treatment for PJP if T/S not an option (mild disease)

A
  1. Atovaquone - preferred
  2. Clindamycin + Primaquine
  3. TMP + Dapsone
68
Q

What should be given as an alternative treatment for PJP if T/S not an option (moderate disease)

A
  1. Clindamycin + Primaquine
  2. TMP + Primaquine
69
Q

What should be given as an alternative treatment for PJP if T/S not an option (severe disease)

A
  1. Clindamycin + Primaquine - preferred
  2. IV Pentamidine - very toxic
70
Q

Outline IV pentamidine

A

often not used due to toxicity but potentially as effective as T/S
ADE:
-hypotension
-hypoglycemia
-nephrotoxicity
-pancreatitis

71
Q

What should be given with atovaquone?

A

high fat meal to help with absorption

72
Q

How long should treatment for PJP be?

73
Q

PJP - When should non HIV patients see improvement and when should it be considered that treatment may have failed?

A

7 days for both

74
Q

What should be done after 21 days of treatment for PJP and why?

A

decrease dose to prophylactic dose to prevent recurrent infection

75
Q

What may be a potential benefit of adjunctive glucocorticoid therapy in the treatment of PJP?

A

potential benefit for lung inflammation

76
Q

What is the mortality rate of PJP in untreated patients?

Pulmonary Unit (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions