Tuberculosis Flashcards
What are the 4 recommended first-line anti-TB medications?
Isoniazid, Rifampin, Pyrazinamide, Ethambutol
Why is a multi drug regimen approach used to treat TB?
to delay or prevent resistant strains
True/False: Anti-TB meds can be discontinued as soon as symptoms subside
False. They are continued for at least 6 months to make sure all persistent organisms are eradicated.
What is the most serious side effect of the anti-TB meds?
Liver dysfunction/hepatitis
Because of their potential liver harming effects, which labs should be performed on patients on these meds?
ALT/ASTs for a baseline and then while taking as well
What is the most serious side effect of Ethambutol? How do we monitor for it?
Loss of visual acuity as well as loss of ability to tell the difference between green and red. Need to perform vision tests monthly.
What is the most common side effect of Isoniazid? How do we treat it?
Peripheral neuritis/neuropathy. Will feel paresthesias in their hands and feet. Can supplement with Vitamin B6.
If a patient is on a Cytochrome P450 med (warfarin, oral contraceptives, prednisone, etc), would you need to adjust their dose if starting a anti-TB regimen?
Yes. Rifampin decreases the half-life of these meds and might need to increase dose.
What other baseline labs should be performed on patient before starting a anti-TB drug regimen?
CBC (including platelets), creatinine, serum bilirubin, and urate level
What is the preferred method of TB testing for patients who have received the BCG shot?
Interferon gold blood test
After how many hours after placement does a skin PPD test need to be read?
48-72 hours.
Can PPD skin testing be used to test for active TB in persons with symptoms?
Yes, but a positive test does not differentiate between active and latent infection
True/False: If a patient has a negative Interferon gold (IGRA) negative blood test, active or latent TB is highly unlikely.
True
True/False: A patient with a latent TB infection is symptomatic.
False
What drug do you give for Latent TB infection prophylaxis?
Isoniazid
How long is the prophylaxis for Latent TB infection?
at least 9 months
Common SX of someone with active TB?
Chronic dry cough that progresses to productive then may have hemoptysis PLUS malaise, loss of some lbs, fever, night sweats (appears chronically ill and malnourished)
What is a good lab test you could do to detect M. Tuberculosis?
Acid fast! But definitive diagnosis requires culture.
How long is the typical tx for someone with active TB?
6-9 months of the 4 drug regimen
In which populations is the highest incidence of TB recorded?
malnourished, homeless, living in overcrowded and substandard housing, and HIV-positive.
What conditions can re-activate a latent TB infection?
gastrectomy, silicosis, DM, therapy with steroids, HIV infection
What are risk factors for TB-drug resistance?
Immigration from countries with prevalence of drug-resistant TB, close and prolonged contact with individuals with drug-resistant TB, unsuccessful therapy, and non adherence to treatment
What are diagnostic physical exam findings for TB?
none specific. Exam may be normal.
How do you collect a culture on a patient that cannot produce enough sputum or acid-fast was negative?
Sputum induction with 3% hypertonic saline
True/False. Current corticosteroid use can result in a false negative TB skin test
True.
True/False. Patients with latent TB who test negative on a skin test, proves that the infection is gone.
False. May be negative many years after exposure but not gone.
Can an interferon gamma test tell the difference between active and latent TB?
No, should not be used to exclude active TB
Which TB test is preferred in patients < 5 years old?
TB skin test
Is TB a reportable disease?
YES, ACTIVE ONLY
What are ways to improve adherence with TB meds?
provide detailed patient education about TB, assign a case manager. Directly observed therapy (DOT) physically observes them taking meds.
Who does the CDC recommend Direct observed therapy (DOT) for?
all patients with drug-resistant TB and for those receiving intermittent therapy.
What is extra pulmonary TB?
TB spreads across body and can affect any organ system - bone, brain, liver, GI, GU, kidneys, etc
How is treatment of extra pulmonary TB different to regular TB?
It’s not, in most cases the same regimens are effective. 9 months of therapy may be needed if bone, joint, or meningeal disease is present. May need early surgery and debridement of necrotic bone.
Which TB med can precipitate a gout attack?
Ethambutol
T/F: you have to report latent TB to health department
FALSE
Which race has the highest incidence of TB?
Asian Americans
