Tuberculosis

Question 1

what are the 4 TB drugs

Answer 1

1. isoniazid
2. rifampin
3. ethambutol
4. pyrazinamide

Question 2

___ is clearly associated w. TB reactivation

Answer 2

immunosuppression

Question 3

what 7 conditions are associated w. TB reactivation

Answer 3

1. HIV/AIDS
2. end stage renal dz
3. DM
4. malignant lymphoma
5. corticosteroid use
6. inhibitors of TNF-a → etanercept, infliximab, adalimumab
7. decreased cell-mediated immunity w. aging

Question 4

what other pt populations (besides immunocompromised) are at risk for active TB

Answer 4

1. young children
2. close contact of pt w. recent pulmonary infxn

Question 5

TB organisms grow ___

so symptoms are ___

with a __ incubation period

Answer 5

slowly

insidious

3-8 week

Question 6

TB symptoms are __ and include (8)

Answer 6

nonspecific

malaise, anorexia, wt loss, f/c, night sweats, cough, increased sputum

Question 7

TB infxns are exceedingly ___

but complications can be acutely ___

Answer 7

chronic

lethal

Question 8

what are the 3 subpopulations of TB organisms

Answer 8

1. intracellularly in caseating granulomas
2. extracellularly → rapidly dividing
3. intracellular in macrophages

Question 9

which drug targets intracellularly caseating granulomas

Answer 9

rifampin, INH

Question 10

which drugs treat extracellular organisms

Answer 10

INH

streptomycin

rifampin

Question 11

which drugs target intracellular macrophages

Answer 11

pyrazinamide

INH

rifampin

Question 12

resistance to any one TB drug is

Answer 12

extremely high

Question 13

what is the goal of active TB therapy

Answer 13

1. eliminate as many organisms as possible
2. prevent development of resistance
3. minimize cost and toxicity → increase compliance

Question 14

the induction phase of tb tx targets

Answer 14

rapid elimination of extracellular organisms → more bugs more drugs

Question 15

active TB pt’s are no longer contagious w.in __

of __

Answer 15

2-4

induction tx

Question 16

the continuation phase of TB tx targets

Answer 16

intracellular organisms → weaker regimen, longer duration

Question 17

active pulmonary tb w.o complications is cured w.in __

of tx

Answer 17

6-9 months

Question 18

initial tb tx is __ weeks of

(4)

Answer 18

8 weeks

rifampin/INH/PZA/ethambutol

Question 19

during initial therapy, what is the drug regimen after susceptibility is established (3)

Answer 19

1. INH
2. rifampin
3. PZA

Question 20

what drug should be used after susceptibility has been established if PZA is not tolerated (liver dz or gout)

Answer 20

ethambutol

Question 21

after initial therapy, continuation therapy lasts __ weeks

and includes (2)

Answer 21

18 weeks

Isoniazid

Rifampin

Question 22

what is the alternative initial 4 month tx for tb

Answer 22

8 weeks →

rifapentine

INH

moxifloxacin

PZA

Question 23

what is the alternative 4 month continuation tx for tb

Answer 23

9 weeks →

rifapentine

isoniazid

moxi

Question 24

tx of latent tb is recommended for

Answer 24

1. co infected w. HIV
2. children <5yo
3. DM or CKD on dialysis
4. close contacts of pt w. recent pulmonary infxn
5. recent conversion from (-) to (+) ppd test

Question 25

latent tb tx should be

Answer 25

shortest regimen appropriate

consider comorbidities

Question 26

latent tb tx includes (2)

Answer 26

isoniazid

rifapentine

Question 27

if a pt is intolerant to isoniazid, what drug should be used for latent tb tx

Answer 27

rifampin

Question 28

what is the tx for pregnant women for latent tb

Answer 28

isoniazid

Question 29

what is the tx for multi drug resistant latent tb

Answer 29

PZA

plus

fluroquinolones

OR

ethambutol

Question 30

in pregnant women, tx for latent tb is __

until __

unless __

Answer 30

delayed

2-3 months after delivery

HIV (+)

Question 31

for active tb in pregnant women you should __

with

Answer 31

treat!

INH

rifampin

ethambutol

Question 32

what drug should be added to active tb for pregnant women if co-infected w. HIV

Answer 32

pyrazinamide

Question 33

isoniazid is ___

and activated to ___

by ___

Answer 33

bactericidal

toxic form

catalase-peroxidase enzyme

Question 34

isoniazid has decreased absorption if

Answer 34

food or antacids are present

Question 35

dosage of isoniazid should be reduced if

Answer 35

severe hepatic insufficiency

Question 36

isoniazid can cause __,

which can be prevented with __

Answer 36

neuritis

pyridoxine (B6)

Question 37

increase for hepatotoxicity with isoniazid is increased if

Answer 37

35-50 yo plus rifampin

pre-existing dysfxn, etoh

Question 38

allergic rxns and DDIs w. isoniazid can occur dt __

of __

Answer 38

inhibition → think I for inhibit

CYP450

Question 39

rifampin binds strongly to __

and inhibits __

Answer 39

RNA polymerase

RNA synthesis