Tuberculosis

Question 1

Latent TB infection is (symptomatic/asymptomatic) and (is/isn’t) contagious

Answer 1

Asymptomatic. Isn’t

Question 2

True or false: Latent TB infection does not require treatment

Answer 2

False

Question 3

What is secondary TB?

Answer 3

Reactivation of latent TB

Question 4

What is miliary TB?

Answer 4

Disseminated. Hematogenous spread

Question 5

True or false: TB can virtually affect all organ systems

Answer 5

True

Question 6

Length of intensive phase of TB treatment

Answer 6

2 months

Question 7

Agents used in intensive phase of TB treatment

Answer 7

RIPE: Rifampin, Isoniazid, Pyrazinamide, Ethambutol

Question 8

Usual length of continuation phase of TB treatment

Answer 8

4 months. May be 7 months in certain situations

Question 9

Agents used in continuation phase of TB treatment

Answer 9

Isoniazid + rifampin

Question 10

In what cases would you extend active TB treatment?

Answer 10

1. Pulmonary TB patients: sputum
   culture at time of completion of
   2 months of intensive phase
   treatment is still positive
2. Initial phase of treatment did NOT include PZA
3. HIV patients not on ART during TB treatment

Question 11

Adverse effects and monitoring for isoniazid

Answer 11

Hepatotoxicity and peripheral neuropathy. Monitor LFTs monthly

Question 12

What medication should be added to isoniazid to avoid peripheral neuropathy?

Answer 12

Pyridoxine 25-50mg PO daily

Question 13

High risk patients for peripheral neuropathy while taking isoniazid?

Answer 13

. Alcoholics
. Pregnant
. HIV
. Diabetes
. CKD
. Malnourished

Question 14

Rifampin resistance is often associated with resistance to what other TB agent?

Answer 14

Isoniazid

Question 15

Rifamycins adverse effects

Answer 15

Hepatotoxicity, orange discolouration of bodily fluids

Question 16

Rifamycins are potent inducers of which CYP enzymes?

Answer 16

CYP3A4, CYP2C8 and CYP2C9

Question 17

Pyrazinamide weight based dosing regimen

Answer 17

20-25mg/kg/day dosed on ACTUAL body weight

Question 18

In what case may ethambutol be removed from intensive phase TB treatment?

Answer 18

Susceptibility report comes back prior to two month treatment period showing no rifampin resistance

Question 19

What agents are used in the 4-month TB treatment that has shown similar efficacy to traditional regimens?

Answer 19

4 month RPT/MOX regimen
.Rifampin + MOXifloxacin + Isoniazid (and vit. B6) + Pyrazinamide

Question 20

What is culture conversion in TB?

Answer 20

When cultures/smears of a once positive patient are now negative

Question 21

Pyrazinamide warning

Answer 21

. Hepatotoxicity

Question 22

Which of the following if the least potent CYP inducer
a. Rifapentene
b. Rifabutin
c. Ritonavir
d. Rifampin

Answer 22

b. Rifabutin

Question 23

Ethambutol adverse effects

Answer 23

. Ocular toxicity
. Rash
. Peripheral neuritis

Question 24

What is the preferred regimen for treatment of latent TB infection?

Answer 24

Isoniazid + rifapentine once weekly for 3 months

Question 25

Which of the following is the preferred treatment for TB HIV for most patient on antiretroviral therapy?
a. Rifabutin
b. Rifapentene
c. Rifampin
d. Ritonavir

Answer 25

a. Rifabutin

Question 26

For ART-naive patients receiving TB treatment with a CD4 count of 10, when should ART be initiated after TB treatment initiation?

Answer 26

2 weeks or less (for CD4 count of < 50)

Question 27

For ART-naive patients receiving TB treatment with a CD4 count of 80, when should ART be initiated after TB treatment initiation?

Answer 27

8 weeks or less (for CD4 count of 50 or greater)

Question 28

What is BPaL and duration?

Answer 28

BPaL Regimen: bedaquiline daily for 2 weeks then thrice weekly + pretomanid daily + linezolid daily for 6 months total

Question 29

When is BPaL indicated?

Answer 29

Pulmonary XDR-TB and treatment intolerant/nonresponsive MDR-TB