Tuberculosis (Exam 1b)

Question 1

Tuberculosis

Answer 1

-Any infection caused by bacteria mycobacterium

-MTB is aerobic bacillus - rod - shaped and need lots of O2 to grow and proliferates –> why it is most common in the lungs

Question 2

Tuberculosis: Characterized by

Answer 2

• granulomas in the lungs –> nodular accumulations of inflammatory cells

Transmitted via humans, cattle or birds

Question 3

Tubercle bacilli are transmitted in

Answer 3

AIRBORNE Droplets expelled by infected people or animals

Question 4

Tuberculosis is slow or fast growing organisms

Answer 4

very slow making it harder to treat

Question 5

Infectious TB

Answer 5

-For those with normal immune system exposed to TB, the bacteria is usually contained by the immune/inflammatory system called LATENT TB infection –> not clinical evidence of disease

-Sometimes even when a person becomes infected the bacilli are isolated in those granulomas (Tubercles) and it remains dormant for life

If persons immune system is impaired, reactivation of the bacteria can occur and can spread throughout the body HIV, immunosuppressive mediations, poor nutritional status, and renal failure are common reactivators

Question 6

Active TB Symptoms

Answer 6

Fatigue
Weight loss
Lethargy
Low-grade fever (Afternoon)
Nigh sweats (more addictive)
Anxiety
Productive cough

Later in the disease dyspnea, chest pain and hemoptysis can occur

Question 7

Extrapulmonary TB

Answer 7

Neurologic deficits, meningitis symptoms, bone pain, urinary problems

Question 8

Screening and Diagnosis

Answer 8

High risk populations

Interferon gamma release assay (blood draw)

Non high risk –> TB skin test

Confirm through a sputum stain and culture and look for the granulomas on CXR

Question 9

Pharmacology for TB

Answer 9

Isoniazid
Rifampin
Ethambutol
Pyrazinamide
Streptomycin

Question 10

Antitubercular Drugs

Answer 10

Treat all infections caused by the mycobacterium organism

FIrst (what we learn) and Second line categories

Question 11

Isoniazid (INH)

Answer 11

Most widely used TB medications (First line)

Question 12

isoniazid: MOA

Answer 12

Disrupts cell wall synthesis essential functions of mycobacteria given PO

Question 13

isoniazid: SE

Answer 13

-Peripheral neuropathy

-hepatotoxicity

-optic neuritis/visual disturbances

Question 14

Isoniazid: NSG consideration

Answer 14

Do not give in patients with liver failure

Avoid antacids — Reduces drug absorption

Given with rifampin (can increase CNA and hepatotoxicity symptoms)

Given with phenytoin, can increase the effects

Question 15

Isoniazid: BBW

Answer 15

Increase risk of hepatitis –> often given with pyridoxine (vitamine B6)

Question 16

Rifampin

Answer 16

First line used for lost of mycobacterial infections and other clinical uses

Question 17

Rifampin: MOA

Answer 17

Inhibits protein synthesis via attacking the hydrocarbon ring structure of mycobacteria

Question 18

Rifampin: SE

Answer 18

Hepatitis

RED BROWN discoloration of the urine and other body fluids

Question 19

Rifampin: NSG consideration

Answer 19

CYP inducer

Decrease the effects

Question 20

Ethambutol

Answer 20

First line basteriostatic

Question 21

Ethambutol: MOA

Answer 21

Diffusing into the mycobacteria and suppresses RNA synthesis, which inhibits protein synthesis

Question 22

Ethambutol: SE

Answer 22

Retrobulbar neuritis and blindness

Question 23

Ethambutol: NSG considerations

Answer 23

Give in combo with INH and rifampin (one in three pill)

Not for children less than 13

Question 24

Pyrazinamide (PZA)

Answer 24

Bacteriostatic or bactericidal depending on drug concentration

Question 25

PZA: MOA

Answer 25

Unknown: thought to inhibit lipid and nucleic acid synthesis

Question 26

PZA: SE

Answer 26

Hepatotoxicity and Hyperuricemia

Question 27

PZA: Contraindicated

Answer 27

in severe hepatic disease or acute gout (high uricemia levels)

not for pregnant people in US

Question 28

Streptomycin

Answer 28

First ever drug for TB

Question 29

Streptomycin: TB

Answer 29

aminoglycoside –> interfering with normal protein synthesis causing production of faulty proteins within the bacteria

Question 30

Streptomycin: SE

Answer 30

Ototoxicity

Nephrotoxicity

Blood Dyscrasias (bleeding times increase)

Question 31

Streptomycin is

Answer 31

IM only and daily

Question 32

Drug Resistant TB

Answer 32

-More of issue with HIV and AIDS community. Affects high risk community (PPS)

-MDR-TB

-Asian and Hispanic immigrants i the US are high risk