TUBERCULOSIS Flashcards

1
Q

Phases of treatment

A

Treatment is split into 2 phases:
Initial phase
- 2 months
- 4 drugs

Continuation phase (4 months)
- 4 months
- 2 drugs

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2
Q

Initial phase

A
  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
    2 months
    RIPE
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3
Q

Continuation phase

A
  • Rifampicin
  • Isoniazid
    4 months
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4
Q

Latent TB

A

3 months of rifampicin + isoniazid or 6 months of isoniazid

Vitamin B6 pyridoxine in conjunction – for peripheral nephropathy

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5
Q

who would you give unsupervised regimen to

A

people who are likely to take anti-TB drugs reliably and willingly without supervision

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6
Q

who would you give supervised regimen (aka directly observed therapy DOT) to

A
  • non-adherence
  • previous treatment for TB
  • homelessness, drug or alcohol misuse
  • in prison or young offender, or have been in past 5 yrs
  • major psychiatric, cognitive or memory disorder
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7
Q

a 23 year old man has tuberculosis and you are in charge of his regimen. you are looking into whether you should give supervised DOT or unsupervised. he seems adherent, is not in denial of his diagnosis, and has no psychiatric, cognitive or memory disorder. he is not in prison, however he was in a young offender institution 3 years ago for 12 months. what do you offer him

A

offer DOT because he was in a prison in the past 5 years

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8
Q

with supervised treatment, the preferred option is ….. but a …….. schedule can be considered in individuals with TB if they require enhances case management and daily DOT therapy is not available

A

Daily supervised treatment is the preferred option wherever feasible.
A 3 times weekly dosing schedule can be considered in individuals with TB if they require enhanced case management and daily directly observed therapy is not available.

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9
Q

Vitamin B6 pyridoxine

A

peripheral nephropathy

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10
Q

Hepatotoxicity

A

Patients with latent TB aged 35 - 65 years should be cleared of hepatotoxicity

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11
Q

Rifampicin side effects

A

Common SE:
- N + V
- Thrombocytopenia

Specific:
- Psychosis
- Flu like symptoms with intermittent therapy
- Colours soft contact lenses AND urine red/orange

Enzyme Inducer - CYP450 INTERACTION!!!!

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12
Q

rifampicin is an enzyme… which means

A

inducer
so it can decrease the exposure of other drugs that are metabolised by CYP enzymes

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13
Q

a patient who takes rifampicin comes to the pharmacy and complains of persistent nausea, vomiting, malaise and jaundice. what do you do

A

stop treatment and seek immediate medical attention
hepatic disorder

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14
Q

rifampicin - 3 labels

A

do not stop taking unless dr says
may colour urine, harmless
take on empty stomach - 1 hour before or 2 hours after food

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15
Q

Rifampicin - hepatic impairment

A

Caution
Dose reduction - max 8 mg/kg/day
Monitor weekly for 2 weeks, then fornightly for 6 weeks
Counsel pt to report signs of hepatotoxicty

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16
Q

Rifampicin - Pregnancy + BF

A

Rifampicin = enzyme inducer = reduced efficacy of oral contraceptives (recommend IUD)
Pregnancy = high doses are teratogenic in 1st trimester, increased risk of neonatal bleeding in 3rd trimester.
BF = safe (amount too small to be harmful)

17
Q

Isoniazid

A
  • Contraindicated in drug induced liver disease
  • Enzyme Inhibitor - CYP450 INTERACTION!!!!
  • Avoid tyramine rich food or histamine- rich food
  • Monitor liver function
18
Q

Isoniazid - peripheral neuropathy

A

Pyridoxine given to prevent this SE.
More likely to occur with risk factors:
- Diabetes
- Alcohol dependance
- Renal failure
- Pregnancy
- HIV

19
Q

hepatitis with isoniazid is more common in

A

pt ages over 35 and those with daily alcohol intake

20
Q

isoniazid instructions - with food or before food or after food

A

30-60 mins before food

21
Q

Risk of peripheral neuropathy

A
  • Diabetes
  • Alcohol dependance
  • Renal failure
  • Pregnancy
  • HIV
22
Q

Isoniazid - pregnancy + BF

A

Pregnancy = not known to be harmful
BF = risk of convulsions and neuropathy, monitor infant for toxicity

23
Q

Pyrazinamide

A
  • Contraindicated in acute attacks of gout
  • Hepatotoxic
  • Monitor renal and hepatic function
24
Q

Pyrazinamide - contraindications

25
Pyrazinamide - Pregnancy + BF
Pregnancy = only use if risk outweighs benefit BF = amount too small to be harmful
26
Ethambutol
* Visual Impairment + Ocular Toxicity * Contraindicated in optic neuritis and poor vision * Avoid in children as they cannot report signs of visual impairment * TDM peak 2-6mg/L and trough less than 1mg/L
27
Ethambutol - contraindications
Optic neuritis Poor vision
28
Ethambutol - ocular toxicity
Counsel patient to report visual changes. More common in high doses or renal impairment Early discontinuation = recovery of eyesight
29
will early discontinuation of ethambutol recover eyesight
Early discontinuation of the drug is almost always followed by recovery of eyesight.
30
Side effects - GENERAL
Liver toxicity = rifampicin, isoniazid + pyrazinamide Peripheral neuropathy = isoniazid Ocular toxicity = ethambutol Orange/red secretions = Rifampicin
31
RIPE - with ones are hepatotoxic and which one is oculotoxic
RIP - hepatotoxic E - oculotoxic