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Pharmacy CPS Flashcards > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Are local health authorities required to report TB cases?

A

Yes!

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2
Q

What happens when you report TB to local health authority

A

Then it can be VOLUNTARLY reported to the national reporting level if they meet the case definition

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3
Q

Which location in canada has the highest RATES of TB?

A

The northern territories-> massively highe rrate per 100,000

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4
Q

is a vaccine avaliable for TB?

A

Yes! but not commonly recommended, Canada reccomends BCG (TB vaccine) for individuals at high risk coming from TB endemic areas or infants in high-incidenece settings.

NOT recommended for prophylaxis for HCW travelling to endemic areas

Recomended for infants born in canada who are traveling to endemic areas short after ARRIVAL in that high incidence country

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5
Q

Do you do a skin test before vaccine?

A

For infants >6months of age, do a skin test prior to vaccination and DOCUMENT

2-6 month olds should assess risk of skin test before doing

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6
Q

Who is BSG reserved for in Canada for now?

A

Inuit and on reserve fist nations children born to mothers who tested negative for HIV prenatally

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7
Q

Classic symptoms of pulmonary TB disease

A

chronic cough of at least 2-3 weeks in duration -> Initially dry cough but afer several weeks to months will become productive

Fever and night sweats are common but may be abscent in very young and old

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8
Q

What would indicate advanced pulmonary TB?

A

Hemoptysis, anorexia, weight loss, chest pain and other symptoms are generally manifestations of more advanced disease

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9
Q

Usual first line diagnostic test for suspected TB?

A

Chest radiography
Typically se a triad of classic signs
Infiltrates in upper lobels or superior egment of lower lobes
Volume loss - TB is destructive and fibrotic in nature
Cavitation - Seen at a later stage depending on immune response

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10
Q

Is chest Xray definitive?

A

No need microbiology reports after

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11
Q

Gold standard TB lab test?

A

Microbology

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12
Q

how many sputum cultures are recommended?

A

at least 3 should be collected

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13
Q

Can TST find active TB?

A

not really, it cant differentiate between latent and active. You might just have a chest cold but latent TB infection

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14
Q

Why do you test for latent TB?

A

So that you can identify people at risk of developing ACTIVE TB. Dont test everybody, only those who would benefit from treatment

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15
Q

Name the two tests acceptable for latent TB identification?

A

TST (Tuberculosis skin test)

IGRA (interferon gamma release assay)

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16
Q

Which is more specific TST or IGRA?

(in regards to individuals with BCG vaccine history

A

IGRA

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17
Q

When do you do both a TST and IGRA?

A

> 18YOs where you suspect TB, but IGRA should not be used in place of microbiology

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18
Q

Standard treatment regiment for ACTIVE TB in canada?

A

Isoniazid, rifampin, pyrazinamide and ethambutol

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19
Q

When can you change therapy from first line?

A

When drug susceptibilities come back you can stop ethambutol if all other drugs work

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20
Q

How long to use pyrazinamide?

A

First two months of treatment

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21
Q

Standard therapy duration

A

6 months

22
Q

when to increase duration to 9 months of treatment?

A

risk factors for relapse such as persistent presence of cavity on the chest x-ray after 2 months, if culture comes back +ve after standard duration

23
Q

When to use DOT therapy? (directly observed treatment)

A

When risk of non-adherence is high or population group being treated has historically increased risk so of treatment failure

24
Q

Does pregnancy drug regiment differ?

A

No same standard tetrad

25
Q

Dosing changes in renal impariment?

A

No DOSE changes but frequency changes to ethambutal and pyrazinamide, change from DAILY to three times per week

26
Q

Second line drugs for TB?

A

Fluroquin (moxi +levo) (400mg, 750-1000mg)

Amikacin (15mg/kg single dose daily)

27
Q

What happens if you dont use isoniazide?

A

You must prolong to at least 12 months

28
Q

What is pyridoxine?

A

B6! routine addition for patients with diabetes, renal failure, malnutrition, substance abuse or seizure disorders

Women who are pregnant or breastfeeding also get this
(added to isoniazide therapy for both situations)

29
Q

pyridoxine dosage?

A

25mg

30
Q

Treatment lengths

A

18 months if not using rifampin at all
12 months if no isoniazide
9 months if using rifampin and isonaizide
6 months maybe (depending on if patients are stable and responding to treatment) if using pyrazinamide

31
Q

when to use rifabutin?

A

has less induction w/ CYP450 so used in HIV-infected or tranplant patients

Hematological toxicity common

32
Q

What is pyrazinamide?

A

Bacteriocidal agent that only really works up to first 2 months

33
Q

injectables that are used in canada for TB treatment

A

Amikacin (most common), streptomycin (not really in canada), kanamycin and capreomycin

34
Q

Do you HAVE to do daily administration of drugs?

A

DOT therapy does allow for 5 times/week for first 2 months and 3 times weekly for continuation phase

35
Q

Hepatotoxicity risk changes?

A

No pyrazinamaide and minimum 9 months (since no pyrazinamide is being used)

36
Q

adverse effects of isoniaide?

A

Rash, hepatitis, neuropathy, anemia, CNS toxicities

37
Q

adverse effects of rifampin

A

drug interactions (CYP inducer), hepatitis, flu like illness, thrombocytopenia and neutropenia

38
Q

Pyranizomide adverse effects?

A

hepatitis, rash, arthralgias, GOUT (rare)

39
Q

ethambutal adverse effects?

A

EYE TOXICITY (well known), rash

40
Q

Current treatment for latent TB?

A

Isoniazide for 9 months

41
Q

Alternative options for latent TB?

A

isoniazide for 6 months

Isonizide + rifampin for 3-4 months

42
Q

Should you treated pregnant patients for latent TB?

A

not usually, defer till 3 months post partum

43
Q

any issues treating latent TB in breastfeeding mothers?

A

Nope

44
Q

TST results indicating latent TB

A

> 5mm (if HIV infection, contact w/ TB patient in last 2 years, organ transplant patient, end stage renal disease, on immunosuppresants)

> 10mm (diabetes, malnutrtion, smokers, daily alcohol consumption (>3 drinks per day) solicosis, hematological malignancies such as leukemia and lymphoma)

45
Q

Latent TB who have had contact with cases of resistant TB disease recommendations

A

Contacts of isoniazide resistance should be treated with 4 months of rifampin (if they are not rifampin resistant)

Contacts of rifampin resistant TB but not isoniazide treated with 9 months of isoniazide

Multidrug resistance traet with combo of levo or moxifloxacin and pyranazinamide for 9 months

Pyranazinamide or ethambutol resistance just gets isoniazide for 9 months

46
Q

Latent TB with hepatic dysfunction?

A

Rifampin better choice then isoniazide in mild
severe contraindicates rifampin, rifapentin, and isoniazide

use daily levo or moxifloxacin for 9 months instead

47
Q

when to stop latent TB infection therapy?

A

5x upper limit of normal liver transaminases (or 3x if you start getting symptoms of liver failure ei flu like symptoms, jauncide, labile INR, encephalopathy)

48
Q

I DONT THINK THIS WILL BE ON PEBC BUT HERE IS KIDDO DOSING

A

Past 35kg or older (>12YO) super vague dosing and canada guideline sucks
isoniazide:
<12 YO or <35KG 10-15mg/kg/day (max 300mg) better absorption on empty stomach, avoid sugars as it inactivates isonaizide (good luck getting kids to eat that lul)
rifampin 10-20mg/kg/day (max 600mg)
Pyrazinamide 30-40mg/kg/day max 2000mg
Ethambutal 15-25mg/kg/day max (1600-2500 (differs between guidelines)
pyridoxine 1mg/kg/day max 25mg (as it is in adults to avoid decreasing isozianide therapy effectiveness)

49
Q

Do you use pyridoxine all the time in kiddos?

A

no, indicated for children on meat and or milk deficient diets, breastfed infants and nutrtionally defcient kids or HIV infections

50
Q

Duration in pediatrics

A

same as adults

Pharmacy CPS Flashcards (27 decks)

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