TB Self Study Flashcards
Unique qualities about mycobacterium is that they are ____ growing microbes, making it necessary for ____ drug therapy.
slow, long
Which two methods are used to determine if a patient has latent tuberculosis?
1) PPD skin test
2) Interferon gamma release assay, blood test
Why are mycobacterium often referred to as “acid fast bacilli”?
Because mycobacterium resists discoloration when exposed to acid/ethanol in staining procedures.
What drugs are used to treat latent TB?
Isoniazid and Rifapentine
What is the minimum number of drugs used to treat TB?
The minimum number of drugs used to treat TB is two. Active TB infections are treated using 4-7 drugs.
Why is TB always treated with two or more drugs?
Since treatment takes a long time, spontaneous mutations conferring drug resistance are probable. By always using two or more drugs, the chances of two mutations in the same bacteria conferring resistance to both drugs in nil.
What are the first line drugs? (6)
Isoniazid Rifampin Rifapentine Rifabutin Pyrazinamide Ethambutol
Isoniazid
MOA
Inhibits mycobacterial cell wall synthesis and interferes with metabolism.
Rifampin
MOA
Inhibits RNA synthysis
Ethambutol
MOA
Obstructs formation of the cell wall.
Pyrazinamide
MOA
Unknown
Isoniazid
Side Effects
- Peripheral neuropathy, pyridoxine (B6) can be given to prevent PN
- Liver toxicity
Isoniazid
Interactions
CYP450 Inhibitor: Phenytoin, diazepam, carbamazepine
Isoniazid
Patient Teaching/Testing
Report symptoms of hepatitis.
Encourage alcohol abstinence.
Monitor liver enzymes
Rifampin
Side Effects
- Red/orange discoloration of body fluids
- Liver toxicity
Rifampin
Interactions
CYP450 Inducer: Oral contraception, warfarin, protease inhibitors and NNRTI’s for HIV
Rifampin
Patient Teaching/Testing
Take on an empty stomach.
Report symptoms of hepatitis.
Encourage alcohol abstinence.
Monitor liver enzymes.
Ethambutol
Side Effects
Optic Neuritis
Ethambutol
Interactions
Aluminum containing antacids
Ethambutol
Patient Teaching/Testing
Educate patient to report alteration to vision (Blurred vision, constriction of the visual field, color discrimination problems).
Test for color discrimination and visual acuity before and during treatment.
Stop drug if optic neuritis occurs.
Pyrazinamide
Side Effects
- Polyarthralgia: pain in multiple joints; treat with NSAIDS
- Liver toxicity
Pyrazinamide
Interactions
A lot.
Pyrazinamide
Patient Teaching/Testing
Report symptoms of hepatitis.
Encourage alcohol abstinence.
Monitor liver enzymes.
What is DOT?
DOT = Directly Observed Therapy, each dose of medication is taken in the presence of an observer
What is intermittent dosing?
Intermittent Dosing = Dosing 2 or 3 times per week, rather than daily
What is the benefit of DOT and intermittent dosing?
DOT and intermittent dosing are considered the standard of care for TB and helps ensure adherence to drug therapy.
Drug selection for active TB is based upon which two factors?
Drug sensitivity and HIV co-infection
What is the difference between the induction phase and the continuation phase?
Induction phase – Eliminate actively dividing extracellular tubercle bacilli, renders sputum non-infectious
Continuation Phase – Elimination of persistent intracellular bacteria.
These TB medications can cause liver toxicity.
Isoniazid, Rifampin, Pyrazinamide
A major side effect of this medication is optic neuritis
Ethambutol
This medication can turn urine orange-reddish color or stain contact lenses:
Rifampin
Pyridoxine (vit B6) is given to prevent peripheral neuropathy caused by this drug:
Isoniazid
Patients on these medications should have their liver enzymes (AST, ALT) checked:
Isoniazid, Rifampin, Pyrazinamide
This medication should NOT be given with food as it decreases absorption:
Rifampin
Significant drug-drug interactions occur with the HIV medications (certain protease inhibitors and NNRTIs):
Rifampin
Routine eye exams should be done to assess for color discrimination and visual acuity:
Ethambutol
This drug may be given alone for treatment of latent TB infection:
Isoniazid
Patients on oral contraceptives should use another form of birth control with this medication:
Rifampin
What is a typical drug regimen for someone with active TB infection?
Isoniazid, rifampin, pyrazinamide, ethambutol for 8 weeks, then isoniazid and rifapentine for 18 weeks.
What would indicate that a drug should be discontinued because of hepatotoxicity?
Right upper quadrant pain, nausea, jaundice, anorexia, malaise, fatigue, increased liver enzymes
Patients treated for active TB infection should see the following improvements in what time frame?
Clinical manifestations (fever, malaise, weight loss, and cough) should decrease markedly within ________.
2 weeks
Patients treated for active TB infection should see the following improvements in what time frame?
The CXR should show improvement within ________.
3 months
Patients treated for active TB infection should see the following improvements in what time frame?
Sputum cultures become negative in over 90% of patients after ________ of treatment.
3 months
The nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin (Rifadin). Which of the following would be an expected finding?
a) peripheral neuropathy
b) myopathy
c) cystalluria
d) red-orange tinged urine
red-orange tinged urine
A patient is beginning therapy for active tuberculosis (TB). The patient asks, “Why do I have to take so many drugs?” What is the nurse’s best response?
a) “When a case is severe, multiple drugs are required.”
b) “The more agents used, the shorter the duration of therapy.”
c) “Multiple agents prevent the emergence of resistant organisms.”
d) “It is assumed that patients take about 50% of the prescribed drug.”
“Multiple agents prevent the emergence of resistant organisms.”
The nurse is caring for a patient with HIV/AIDS who has taken protease inhibitors for 18 months. The patient has been diagnosed with active tuberculosis. The nurse would expect the provider to AVOID which TB drug for this patient’s medication regimen because of the risk of drug-drug interactions?
a) isoniazid (INH)
b) rifampin (Rifadin)
c) pyrazinamide (PZA)
d) kanamycin (Kantrex)
rifampin (Rifadin)
An adult has active tuberculosis, as diagnosed by sputum examination and culture. In evaluating the patient’s response to therapy, the nurse would expect to see which finding?
a) improved X ray report within 3 months
b) absence of symptoms by 8 weeks
c) return of a negative skin test within one week.
d) negative computed tomography (CT) scan by 2 weeks.
improved X ray report within 3 months
The nurse describes a typical treatment course of therapy to a patient newly diagnosed with active tuberculosis. Which description is the most accurate?
a) “The course of therapy generally lasts 1 year with 4 drugs.”
b) “Most patients require 4 full months of therapy, followed by 1 year of weekly tuberculin skin tests.”
c) “The four-regimen should last for 4 weeks. If the radiograph is normal, the medications are discontinued. “
d) “The entire course should take 6 months; the first 2 months with four drugs, and the last 4 months with two drugs.”
“The entire course should take 6 months; the first 2 months with four drugs, and the last 4 months with two drugs.”
The nurse is caring for a patient taking INH for latent tuberculosis. Which clinical manifestation would most concern the nurse related to INH therapy?
a) cramps in the back when walking up steps
b) headaches and lightheadedness on awakening
c) dry mouth and difficulty swallowing solids
d) numbness in fingers and difficulty buttoning shirts
numbness in fingers and difficulty buttoning shirts
The nurse is providing care to a patient with tuberculosis who is taking ethambutol. Which statement by the patient indicates a correct understanding of the effects of ethambutol?
a) “Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time. “
b) “Constipation will be a problem, so I will increase the fiber in my diet. “
c) “I will let someone know if I am having any vision changes while I am taking this drug.”
d) “This medication may cause my bodily secretions to turn reddish-orange.”
“I will let someone know if I am having any vision changes while I am taking this drug.”
A patient is taking pyrazinamide (PZA) as a component of a multidrug regimen for tuberculosis. Which co-morbid condition in the patient’s health history would most concern the nurse?
a) cirrhosis
b) migraine headaches
c) diabetes mellitus
d) osteoarthritis
cirrhosis
When assessing a patient for adverse reactions to the combination of isoniazid (INH) and rifampin (Rifadin), the nurse would monitor which laboratory results?
a) liver function tests (LFTs)
b) complete blood count (CBC)
c) uric acid levels
d) calcium levels
liver function tests (LFTs)
A patient is newly diagnosed with a positive PPD. Does this patient need drug therapy?
a) Yes, the patient has latent TB and should be treated with isoniazid (INH).
b) Drug therapy will be started if the patient develops any symptoms of tuberculosis.
c) If the patient’s CXR is suspicious of TB, then drug therapy will be initiated.
d) Drug therapy with a three drug regimen will be started immediately.
Yes, the patient has latent TB and should be treated with isoniazid (INH).
