tuberculosis part 1

Question 1

what is the first line of treatment for TB ?

Answer 1

isoniazid 
pyrazinamide 
ethambutol 
rifampicin 
streptomycin

Question 2

what is the mechanism of action of rifampicin ?

Answer 2

inhibition RNA synthesis

Question 3

what is the mechanism of action of isoniazid and ethambutol ?

Answer 3

they both inhibit cell wall synthesis
isoniazid- lipid aspect
ethambutol- protein aspect

Question 4

what is the mechanism of action of streptomycin ?

Answer 4

inhibition of protein synthesis

Question 5

what is the standard treatment regimen ?

Answer 5

through the intensive phase
continuation phase

continuous phase

Question 6

what is the purpose of the intensive phase ?

Answer 6

rapidly kill of the dividing organisms

Question 7

What is the purpose of the continuation phase ?

Answer 7

to sterilize the lungs by killing dormant and semidormant organsims to prevent relapse

Question 8

what medications are taken in the intensive phase ?

Answer 8

2 months of all 4

2 months of rifampcin and isoniazid

Question 9

what medications are taken in the continuation phase

Answer 9

4 months of isoniazid and rifampicin

Question 10

how often should the drugs be administered ?

Answer 10

3 times per week

Question 11

how is the monitoring of the TB case done ?

Answer 11

clinical
microbiological response
lab response

Question 12

what does the clinical monitoring include?

Answer 12

general condition
fever
appetite
screening for common side effects

Question 13

how is the microbiological response monitored ?

Answer 13

sputum at 2 months
sputum at completion of therapy

sputum at completion of therapy

Question 14

how is the lab response monitored ?

Answer 14

first 2 weeks; twice weekly (( 4 total ))
at 1 month then monthly
AST ,ALT, bilirubin and CBC

Question 15

if there are skin rashes what should be stopped ?

Answer 15

stop anti-tb drugs

Question 16

if there is deafness or dizziness what should be stopped ?

Answer 16

streptomycin

Question 17

if there is jaundice and or confusion what should be stopped ?

Answer 17

all anti TB drugs

Question 18

if there is visual impairment what drug should be stopped ?

Answer 18

ethambutol

Question 19

if there is shock purpura or renal failure what drug should be stopped ?

Answer 19

Rifampicin

Question 20

if there is decreased urine output what should be stopped ?

Answer 20

streptomycin

Question 21

what are the minor side effects of the TB drugs ?

Answer 21

anorexia 
joint pain 
drowsiness 
orange/red urine 
flu syndrome

Question 22

if there is a burning, numbness or tingling sensation in the hands or feet what should be done and what is the causative agent ?

Answer 22

causative agent is isoniazid give pyridoxine

Question 23

when are steroids used in TB?

Answer 23

in TB meningitis and pericarditis,peritonitis and pleuritis

Question 24

in tuberculous meningitis what replacements should be made

Answer 24

ethambutol should be replaced by streptomycin

Question 25

in multidrug resistant TB , what are the resistant drugs ?

Answer 25

rifampicin and isoniazid | isoniazid

Question 26

why is it difficult to diagnose TB in HIV patients ?

Answer 26

because of the limitations of current TB tests

Question 27

what are the problems with the administration of ART and anti-TB drugs at the same time ?

Answer 27

- cumulative drug toxicities - drug-drug interactions - high pill burden - immune reconstitution inflammatory syndrome (IRIS)

Question 28

what are the guidelines for adults that need ART and TB?

Answer 28

1- start ART between 2 and 8 weeks after starting TB treatment for those with a CD4 count less than 200 2- for people with both T and HIV it isn't necessary to delay the initiation of ARV therapy

Question 29

how does infection of the fetus occur and where are thee primary complexes ?

Answer 29

- hematogenous dissemination through the placenta - aspiration of infected amniotic fluid lung or GIT tract | - aspiration or ingestion of infected amniotic fluid

Question 30

which of the TB drugs is ototoxic to the fetus ?

Answer 30

streptomycin

Question 31

what is the primary disease in each of the congenital tuberculosis ?

Answer 31

hematogenous dissemination- liver or lungs aspiration or ingestion of infected amniotic fluid - lung or GIT tract | aspiration- lungs or GIT

Question 32

which of the TB drugs should be avoided in renal disease ?

Answer 32

ethambutol cycloserine para amino-salicylic acid streptomycin should be avoided if the clearance is less than 50ml

Question 33

what is rifampicin toxicity dependant on ?

Answer 33

concurrent administration of isoniazid

Question 34

what is the causative agent responsible for joint pain during the treatment of TB ?

Answer 34

pyrazinamide

Question 35

what is the cause of flu like syndrome ?

Answer 35

intermittent rifampcin usage change to daily dosing

Question 36

what is the classic treatment regimens for TB in HIV positive patients ?

Answer 36

strptomycin, thiacetazone and isoniazid

Question 37

what is the management if cutaneous reaction occurs in the treatment of a patient with both TB and HIV ?

Answer 37

thioacetazone is drug implicated

Question 38

what TB drugs cause hepatotoxicity ?

Answer 38

isoniazid pyrazinamide rifampcin

Question 39

if ethambutol is necessary in renal disease what precautions must be taken ?

Answer 39

shouldn't exceed 5 to avoid eye toxicity interval between doses may need to be increased to 48 hrs or a reduced dose of 8-10 mg/kg

Question 40

what is the management in drug induced hepatitis ?

Answer 40

once it resolves the drugs can be re introduced back one at a time