Tuberculosis

Question 1

what is tuberculosis and state its cause

Answer 1

• Tuberculosis (TB) is an contagious and airborne infectious disease caused by bacteria
• Cause by Mycobacterium tuberculosis

Question 2

Tuberculosis can be pulmonary and non -pulmonary

Answer 2

pulmonary = TB in the lungs
Non pulmonary = TB in other organs such as lymph nodes, abdomen skin

Question 3

Describe the signs and symptoms of Active Pulmonary Tuberculosis

Answer 3

· Cough >3 weeks; productive
· Purulent sputum
· Haemoptysis (coughing of blood that comes from. Respiratory tract)
· Weight loss
· Malaise
· Fever

Question 4

How would diagnose a patient with tuberculosis

Answer 4

Diagnose symptoms
- check for cough and
- Haemoptysis

Diagnose clinical signs
- sputum microscopy (acid -fast staining sputum smears)
- chest radiography

Question 5

Discuss the first line treatment for TB and for each treatment include the MOA and if they are bactericidal or bacteriostatic

Answer 5

· 1st line treatment for Pulmonary TB in UK
Aim: To prevent emergence of drug resistance and determining the ultimate outcome of the regimen

· Isoniazid (H):
- Inhibition biosynthesis of mycolic acids of mycobacterial cell wall.
Effects:
- Bacteriostatic for resting bacilli
- Bactericidal for extracellular diving microorganism
Adverse effects: 5%of patients
- Peripheral neuropathy
- anaemia
- hepatoxicity
·
Rifampicin (R) :
- Inhibition of RNA polymerase of mycobacteria
Effects
- Bactericidal effect on all 3 MTB population
Side effects:
- Causes orange-red coloration of urine
Adverse effect: rare BUT serious:
- Hepatotoxicity
- Toxic syndrome
Drug interactions:
- It increases mechanism of enzymes thereby increasing degradation of warfarin, glucocorticoids, analgesic, oestrogen!
- NOTE: in patient using oral contraceptives, alternative family planning advice should be offered.
- Rapid development of resistance!

· Pyrazinamide (Z):
- Uncertain
Effects:
- Bacteriostatic at acidic pH
new fatty acids, required for growth and replication.
Adverse effects:
- Hepatotoxicity
- Increased plasma urate (gout!)
- Resistance can develop rapidly!

· Ethambutol (E) :
- Impairs biosynthesis of bacterial cell wall
Effects:
- bacteriostatic (selective for mycobacteria)
Adverse effects:
- Uncommon
- Optic neuritis: changes in colour vision or visual field – usually reversible (check visual acuity before treatment and repeat regularly)
- Use with care in children WHY? Because of the concern about risk of ocular toxicity in ocular function in young children. Basically affects eyes in younger children

Question 6

Explain the treatment phase of antibiotic treatment

Answer 6

Initial phase, 2 months treatment with:

	· Isoniazid (H)
	
	· Rifampicin (R)
	
	· Pyrazinamide (Z)
	
	· Ethambutol (E)

Continuation phase, further 4 months treatment with:

	·  Rifampicin
	·  Isoniazid

Question 7

Why are these drug regimens used

Answer 7

→ Isoniazid and Ripamficin allow for short-course regimens with high cure rates.

→ Pyrazinamide has potent sterilizing activity, which allows further shortening of the regimen from 9 to 6 months.

→ Ethambutol helps to prevent the emergence of Rifampicin resistance when primary Isoniazid resistance is present

Question 8

what is latent TB

Answer 8

Is where a person is infected with the Mycobacterium tuberculosis but do not have the TB disease, do not feel sick or have symptoms

Question 9

How can you diagnose Latent TB and explain the interpretation

Answer 9

Diagnosis
Tuberculin Skin Testing
- 0-5 mm: Negative
- 6-14 mm: Positive:
- >15 mm: strongly positive

Question 10

Describe the management of latent TB

Answer 10

• 3 months of isoniazid AND rifampicin OR
• 6 months of isoniazid

Question 11

Explain diagnoses of non-pulmonary TB and treatment

Answer 11

• Symptoms depend on the affected organ

Diagnosis
- Imaging technique, biopsy and needle aspiration
- Site-specific investigations e.g CNS, lymph node

Treatment:
- Similar to pulmonary TB
- Longer antibiotic treatment and use of corticosteroids in CNS TB

Question 12

As a pharmacist how would you continue treatment in a patient with TB having antibiotic resistance

Answer 12

• Combine remaining available 3 drugs
• Extend duration of continuation treatment up to 10 month.

Question 13

Name FIVE major causes affecting adherence in patients and how to improve adherence

Answer 13

• unclear instructions : chose
• adverse effects : conducting medication reviews
• Number of tablets : change dosage regimen
• Treatment frequency : use reminders
• if patient feel symptoms are improving :
• cant open packaging : change prescription packaging
• financial reasons : lower prescription charges

Question 14

State TWO causes of antibiotic resistace

Answer 14

Inadequate dosing
Incomplete treatment regimens