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Pharm I ( Melicia) > Tuberculosis - EG > Flashcards

Tuberculosis - EG Flashcards

1
Q

Which bacteria causes TB?

A

mycobacterium tuberculosis

silent, latent, progressive/active disease

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2
Q

What ages have 2-5x greater risk for active dz compared with other age groups?

A

kids younger than 2y/o and adults older than 65y/o

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3
Q

what are the 2 most important drugs in the tx of TB?

A

Isoniazid and rifampin

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4
Q

directly observed treatment (DOT) should be used…

A

whenever possible to reduce tx failures and the selection of drug-resistant isolates

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5
Q

What are 2 ways to test for TB?

A

Mantoux test –> tuberculin PPD skin test read in 48-72 hrs

IGRA –> measures release of INF-y in blood in response to TB antigens

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6
Q

What factors contribute to the new epidemic of TB?

A 
increased incidence among prison inmates
IV drug abusers
immigrants
HIV pts
increasing numbers of young minority adults
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7
Q

TB symptoms…

A

fatigue, weight loss, fever, night sweats, and productive cough

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8
Q

What is required for treating active TB disease?

A

combination chemotherapy
at least two drugs to which the isolate is susceptible
generally, 4 drugs given at the onset of tx

(isoniazid, rifampin, pyrazinamide, ethambutol)

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9
Q

What are the best drugs for preventing drug resistance?

A

rifampin and isoniazid followed by

ethambutol, treptomycin, & pyrazinamide

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10
Q

Monotherapy can be used only for…

A

infected pt’s who do not have active TB (aka Latent infx)

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11
Q

What are the dosing recommendations for adults w/ reduced renal function and for receiving hemodialysis?

A

Pyrazinamide, ethambutol, and levofloxacin require a change in frequency — 3x per wk not daily

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12
Q

Pt’s with proved or strongly suspected active TB should get tx’d w/ isoniazide, Rifampin, pyrazinamide, and ethambutol for…

A

2 months

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13
Q

Patients w/active TB re-evaluated after 2 months of tx should have…

A

a repeat smear and culture

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14
Q

What drugs are the treatment options for latent TB?

A

isoniazid and rifampin

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15
Q

What is the first line tx for active and latent TB?

A

Isoniazid (INH)

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16
Q

Isoniazid (INH) MOA?

A

inhibits synthesis of mycobacterial cell walls

17
Q

Isoniazid (INH) ADE’s?

A

peripheral neuropathy: vitamin B6-pyridoxine

& hepatoxicity

18
Q

Rifampin will turn…

A

body fluids orange

19
Q

Rifampin MOA

A

inhibits DNA-dep RNA polymerase –> blocking production of RNA

20
Q

What parameters would you monitor for a pt on isoniazid?

A

LFT monthly if preexisting liver dz or abnormal fx

dosage adjustments for pt’s on anticonvulsants or warfarin

21
Q

Rifampin ADE’s

A

turns body fluids orange color
cholestasis (hepatitis)
flu-like syndrome w/intermittent dosing
nephritis

22
Q

What are 2 other rifamycins?

A

rifabutin –> fewer drug interactions

rifapentine –> long acting, given once weekly

23
Q

What lab tests should you order to monitor pt on Rifampin?

A

liver enzymes and interacting drugs (ie warfarin)

24
Q

Pyrazinamide ADE’s

A 
*hyperuricemia
hepatotoxicity
rash
GI disturbance
arthralgias
25
Q

Ethambutol is given until…

A

drug sensitivities are known

26
Q

Ethambutol MOA

A

inhibits mycobacterial cell wall

27
Q

What labs would you order to monitor pt on pyrazinamide?

A

serum uric acid for adherence monitoring

LFTs in pt’s w/ liver dz

28
Q

MDR-TB caused by…

A

organisms resistant to at least 2 of the best anti-TB drugs: isoniazid and rifampin

29
Q

Bedaquiline box warning:

A

increased mortality

QT prolongation >500ms

30
Q

MDR-TB can take up ___ months to cure

A

24

31
Q

What parameters would you monitor for pt on ethambutol?

A

baseline visual acuity testing and color discrimination; monthly if taking >15-20mg/kg, renal insufficiency, or taking longer than 2 mo’s

32
Q

What are the 2nd line TB meds?

A

streptomycin, amikacin/kanamycin, capreomycin, p-aminosalicylic acid, moxifloxacin

33
Q

What 2nd line TB drugs have ADE’s for ototoxicity and nephrotoxicity?

A

streptomycin
amikacin/kanamycin
capreomycin

34
Q

Ethambutol ADE

A

Retrobulbar neuritis

Think “eye-butol”

35
Q

MOA of bedaquiline

A

Inhibits proton transfer of ATP synthase

*Used in MDR

Pharm I ( Melicia) (18 decks)

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