Test 3 - TB Medications (Josh) Flashcards
Tuberculosis is a specials of which bacteria?
Mycobacterium tuberculosis
What is unique about TB?
- slow growing
- lives and replicates inside a phagocyte
- long time to cure (6mo to 2yrs w/ meds)
TB primarily effects which organ?
Lungs
Spreads through coughing/sneezing
What percentage of TB infected clients are latent?
90%
An individual can harbor the bacteria they’re whole life if not given medication to kill it
Challenges facing the treatment of TB?
- ADHERENCE (have to take the drugs for a LONG TIME)
- RESISTENCE (bacteria can develop resistance to drug; so usually given two diff drugs at same time)
- TOXICITY (esp. hepatotoxicity b/c you have to take drug for so long
- COST (non-resistant TB = $12,000, resistant TB + $180,000)
Positive reaction to TB skin test is determined by region the client lives in?
High Risk - treatment recommended if induration is 5mm
Moderate Risk - treatment recommended if induration is 10mm
Low Risk - treatment recommended if induration is 15mm
What is DOT in relation to TB treatment?
Directly Observed Therapy
It is the standard of care for TB b/c patient adherence is most common cause of treatment failure administration of each dose is observed in clinic by rep from Health Depth.
Why must TB treatment be monitored?
- Promote Adherence
- Provide opportunity for ongoing evaluation of effectiveness of treatment regimen
When taking rifampin (TB drug) what happens to urine?
Urine (and other secretions) will turn red-orange color
Harmless, but don’t wear contacts or they will be permanently stained
Why give pyridoxine (Vitamin B6) to client taking isoniazid (TB drug)?
Vitamin B6 deficiency causes peripheral neuropathy
Also give Vitamin B6 to clients at Rick for this adverse effect (alcoholics, diabetics)
What will need to happen if someone taking phenytoin needs to take isoniazid?
Monitor the phenytoin levels b/c isoniazid is a CYP inhibitor
If client is taking oral contraceptives, what should they do if they are prescribed rifampin (TB Drug)?
Rifampin is a potent CYP inducer
- use another method
What types of meds does rifampin (TB drug) affect?
Rifampin is a CYP inducer
- Anti-seizure meds
- Anti-rejection meds
- Oral contraceptives
- HIV meds
- Warfarin
Why is TB being a slow-growing bacteria a problem?
It’s hard to kill bacteria that aren’t very metabolically active. We want them to be active, absorbing our antibiotics but if they aren’t very active, it’s hard to attack them
What percentage of TB cases are in developing nations?
95%
- second only to HIV/AIDS
- 1/3 of humans have TB
Which mask would you wear to treat a TB patient?
N95
Latent Infection
Most people (90%) who have TB don’t know it b/c they have a healthy immune system that can keep the microbes in check. They can still spread it
Clinical Manifestations of TB infection
- low grade fever
- dry cough that could progress to mucopurulent cough w/ hemoptysis
- night sweats
- fatigue
- weight loss
Two major TB drugs
- isoniazid
- rifampin
The primary TB drug is —–
Isoniazid
only for TB, no other uses for it
A client could possibly only have to take one drug if they have which type of TB? Which drug?
If latent infection, they could take isoniazid by itself
The most common adverse effect of isoniazid is —-
Peripheral neuropathy
- symmetric (both sides) numbness/tingling
- issues w/ balance/clumsiness
What causes the issue of peripheral neuropathy w/ isoniazid?
Deficiency of vitamin B6
- give vita. B6 prophylactically to clients at risk like alcoholics and diabetics
Second most common adverse effect of isoniazid is —
Hepatotoxicity
- watch AST level
- watch JAUNDICE s/s
- usually only affects older clients
When should you hold off giving isoniazid?
AST level 3-5x’s original value
—- is a broad-spectrum antibiotic used to treat TB.
Rifampin (Protein Synthesis Inhibitor)
- take it on an empty stomach
Of the TB drugs, —– has many uses while —- is only used for TB.
Rifampin
isoniazid
—- can be taken with or without food.
—- can be taken only without food.
Isoniazid
Rifampin (food decreases absorption)
Common side effect of rifampin is —-
Hepatitis (only problematic for ~ 1%)
- JAUNDICE s/s
—– can cause your secretions to turn red-orange.
rifampin
Why would you need to check a client’s current meds if starting them on isoniazid or rifampin?
Both have lots of CYP interactions
—— is a CYP inhibitor which leads to — —
—– is a CYP inducer which leads to —- —-
Isoniazid –> drug toxity
Rifampin –> sub-therapeutic drug levels
Biggest drug to be concerned about w/ isoniazid?
Phenytoin
Has a narrow therapeutic range and isoniazid is a CYP inhibitor which leads to increased levels of the drug
