Tuberculosis

Question 1

what is tuberculosis?

Answer 1

any infection caused by Mycobacterium

Question 2

MTB microbe specifics

Answer 2

–aerobic (needs lots of O2)
–bacillus (rod-shaped)

Question 3

why does TB affect the lungs the most?

Answer 3

super aerobic bacteria–needs lots of oxygen!

Question 4

TB specifics

Answer 4

–granulomas in lungs
–transmitted via humans, cattle, or birds
–AIRBORNE
–slow growing (harder to treat)

Question 5

common reactivators of TB

Answer 5

–HIV
–immunosuppressive meds
–poor nutritional status
–renal failure

Question 6

symptoms of active TB

Answer 6

–fatigue
–weight loss
–lethargy
–anorexia
–low-grade fever
–productive cough
–night sweats
–anxiety

Question 7

symptoms occurring later in TB’s disease process

Answer 7

–dyspnea
–chest pain
–hemoptysis

Question 8

signs of extrapulmonary TB

Answer 8

–neuro deficits
–meningitis symptoms
–bone pain
–urinary problems

Question 9

what is the symptom most indicative of TB?

Answer 9

night sweats

Question 10

diagnosis of TB

Answer 10

–interferon-gamma release assay (high risk)
–TB skin test (non-high risk)
–sputum stain and culture (confirm)
–granulomas on CXR (confirm)

Question 11

antitubercular drug categories

Answer 11

–first line = primary used first
–second line = more complicated, resistant to primary

Question 12

MOA of isoniazid (INH)

Answer 12

disrupts cell wall synthesis and essential functions of mycobacteria

Question 13

Route of INH

Answer 13

PO

Question 14

side effects of INH

Answer 14

–peripheral neuropathy
–hepatotoxicity
–optic neuritis/visual disturbances
–hyperglycemia

Question 15

what should be avoided with INH?

Answer 15

antacids (reduces drug absorption)

Question 16

what happens if INH is given with rifampin?

Answer 16

increase CNS and hepatotoxicity

Question 17

what happens if INH is given with phenytoin?

Answer 17

increase effects of phenytoin

Question 18

black box warning for INH

Answer 18

increased risk of hepatitis = give with pyridoxine (vit. B6)

Question 19

MOA of rifampin

Answer 19

inhibits protein synthesis by attacking the hydrocarbon ring structure

Question 20

side effects of rifampin

Answer 20

–hepatitis
–hematologic disorders
–red-brown discoloration of urine and other body fluids

Question 21

what does rifampin decrease effects of?

Answer 21

–beta blockers
–benzos
–cyclosporins
–anticoags
–antidiabetics
–phenytoin
–theophylline

Question 22

route for rifampin

Answer 22

PO or IV

Question 23

MOA of ethambutol

Answer 23

diffusing into the mycobacteria and suppresses RNA synthesis, inhibiting protein synthesis

Question 24

side effects of ethambutol

Answer 24

–retrobulbar neuritis
–blindness

Question 25

route of ethambutol

Answer 25

PO

Question 26

age restriction for ethambutol

Answer 26

not for patients under 13

Question 27

MOA of pyrazinamide

Answer 27

unknown; thought to inhibit lipid and nucleic acid synthesis

Question 28

specifics of pyrazinamide

Answer 28

--bacteriostatic or bactericidal depending on concentration --used in combo with other meds

Question 29

side effects of pyrazinamide

Answer 29

--hepatotoxicity --hyperuricemia

Question 30

route for pyrazinamide

Answer 30

PO

Question 31

contraindications for pyrazinamide

Answer 31

--severe hepatic disease --acute gout --pregnancy

Question 32

first ever drug available for TB

Answer 32

streptomycin

Question 33

MOA for streptomycin

Answer 33

aminoglycoside --interferes with normal protein synthesis causing production of faulty proteins within the bacteria

Question 34

side effects of streptomycin

Answer 34

--ototoxicity --nephrotoxicity --blood dyscrasias

Question 35

route for streptomycin

Answer 35

IM

Question 36

alert for streptomycin

Answer 36

careful with people on anticoags = increase bleeding

Question 37

who does drug-resistant TB affect most?

Answer 37

--HIV/AIDS community --homeless --undernourished/malnourished --substance users --cancer patients --immunosuppressed --people who live in crowded/poor sanitation housing