Tuberculosis Flashcards
mycobacterium are ___ (slow/fast) growing microbes
slow
mycobacterium require ____ (short/long) therapy
long
2 methods for determining if pt has latent TB
- TST (intradermal injection of PPD)
2. IGRA (blood test, WBC will release interferon gamma if latent TB)
what does “acid fast bacilli” mean
mycobacterium resist decolorizing by dilute acid used in staining protocols (high content of mycolic acid in cell wall)
treatment for latent TB (3 different treatments)
- isoniazid alone taken daily for 6 or 9 months
- isoniazid plus rifapentine taken weekly for 12 wks
- can’t take isoniazid? take rifampin daily for 4 months
risk of treating pt with active TB with isoniazid only
would promote emergence of resistant bacilli
1st line therapy meds to treat active TB infections
isoniazid rifampin pyrazinamide ethambutol rifamycin rifapentine
2nd line therapy meds to treat active TB infections
cycloserine
ethionamide
capreomycin
para-amino salicylic acid (PAS)
the aminoglycosides (streptomycin, amikacin, kanamycin)
the quinolones (levofloxacin, moxifloxacin)
TB drugs only available in IM or IV route
capreomycin
streptomycin
amikacin
kanamycin
4 drugs given as induction therapy for active TB
isoniazid
rifampin
pyrazinamide
ethambutol
minimum length of therapy for active TB infection
6 months
when is 2nd line drug therapy used for active TB
TB is MDR or XDR (extensively drug resistant)
MDR-TB is defined as a strain resistant to which drugs?
isoniazid
rifampin
XDR-TB is defined as a strain resistant to which drugs?
isoniazid
rifampin
all fluroquinolones
at least one of the injectable second-line anti-TB drugs (amikacin or capreomycin)
what is DOT?
daily observed therapy
what is intermittent dosing?
dosing 2 or 3 times a week rather than every day
drug selection for active TB based upon which 2 factors?
- patterns of drug resistance in the community
2. the immunocompetence of the patient
difference between induction phase and continuation phase
induction: initially tx, eliminate actively dividing tubercle bacilli
continuation: eliminate persistent intracellular bacteria
5 main meds for active TB
isoniazid (INH) rifampin ethambutol pyrazinamide (PZA) pyridoxine
TB meds that cause liver toxicity (3)
INH
rifampin
PZA
a major SE of this TB med id optic neuritis
ethambutol
this TB med can turn urine an orange-reddish color or stain contact lenses
rifampin
pyridoxine (vit B6) is given to prevent peripheral neuropathy caused by this TB drug
INH
pt with ETOH use disorder or with liver disease should not take these TB meds (3)
INH
rifampin
pyrazinamide
pt on oral contraceptive should use another form of BC with this TB med
rifampin
pt on these TB meds should have their liver enzymes (AST, ALT) checked
INH, rifampin, pyrazinamide
this TB med should NOT be given with food as it decreases absorption
rifampin
significant drug-drug interactions occur with the HIV meds and this TB drug (certain protease inhibitors and NNRTIs)
rifampin
routine eye exams should be done to assess for color discrimination and visual acuity when taking this TB drug
ethambutol
this TB drug may be given alone for tx of latent TB infection
INH
typical drug regimen for someone with active TB
usually initiated with a 4-drug regimen; INH and rifampin are almost always included
what would indicate that a TB drug should be discontinued because of hepatotoxicity
signs of hepatitis (jaundice, anorexia, malaise, fatigue, nausea) abnormal AST (3-5x tx baseline levels)
pt being treated for active TB should see improvements:
clinical manifestations decrease within ______
CXR manifestations show improvement within ______
sputum culture become negative in over 90% of pt after ______
2 weeks
3 months
3 months
