tuberculosis part 1 Flashcards
what is the first line of treatment for TB ?
isoniazid pyrazinamide ethambutol rifampicin streptomycin
what is the mechanism of action of rifampicin ?
inhibition RNA synthesis
what is the mechanism of action of isoniazid and ethambutol ?
they both inhibit cell wall synthesis
isoniazid- lipid aspect
ethambutol- protein aspect
what is the mechanism of action of streptomycin ?
inhibition of protein synthesis
what is the standard treatment regimen ?
through the intensive phase
continuation phase
continuous phase
what is the purpose of the intensive phase ?
rapidly kill of the dividing organisms
What is the purpose of the continuation phase ?
to sterilize the lungs by killing dormant and semidormant organsims to prevent relapse
what medications are taken in the intensive phase ?
2 months of all 4
2 months of rifampcin and isoniazid
what medications are taken in the continuation phase
4 months of isoniazid and rifampicin
how often should the drugs be administered ?
3 times per week
how is the monitoring of the TB case done ?
clinical
microbiological response
lab response
what does the clinical monitoring include?
general condition
fever
appetite
screening for common side effects
how is the microbiological response monitored ?
sputum at 2 months
sputum at completion of therapy
sputum at completion of therapy
how is the lab response monitored ?
first 2 weeks; twice weekly (( 4 total ))
at 1 month then monthly
AST ,ALT, bilirubin and CBC
if there are skin rashes what should be stopped ?
stop anti-tb drugs
if there is deafness or dizziness what should be stopped ?
streptomycin
if there is jaundice and or confusion what should be stopped ?
all anti TB drugs
if there is visual impairment what drug should be stopped ?
ethambutol
if there is shock purpura or renal failure what drug should be stopped ?
Rifampicin
if there is decreased urine output what should be stopped ?
streptomycin
what are the minor side effects of the TB drugs ?
anorexia joint pain drowsiness orange/red urine flu syndrome
if there is a burning, numbness or tingling sensation in the hands or feet what should be done and what is the causative agent ?
causative agent is isoniazid give pyridoxine
when are steroids used in TB?
in TB meningitis and pericarditis,peritonitis and pleuritis
in tuberculous meningitis what replacements should be made
ethambutol should be replaced by streptomycin
in multidrug resistant TB , what are the resistant drugs ?
rifampicin and isoniazid
isoniazid
why is it difficult to diagnose TB in HIV patients ?
because of the limitations of current TB tests
what are the problems with the administration of ART and anti-TB drugs at the same time ?
- cumulative drug toxicities
- drug-drug interactions
- high pill burden
- immune reconstitution inflammatory syndrome (IRIS)
what are the guidelines for adults that need ART and TB?
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
how does infection of the fetus occur and where are thee primary complexes ?
- hematogenous dissemination through the placenta
- aspiration of infected amniotic fluid lung or GIT tract
- aspiration or ingestion of infected amniotic fluid
which of the TB drugs is ototoxic to the fetus ?
streptomycin
what is the primary disease in each of the congenital tuberculosis ?
hematogenous dissemination- liver or lungs
aspiration or ingestion of infected amniotic fluid - lung or GIT tract
aspiration- lungs or GIT
which of the TB drugs should be avoided in renal disease ?
ethambutol
cycloserine
para amino-salicylic acid
streptomycin should be avoided if the clearance is less than 50ml
what is rifampicin toxicity dependant on ?
concurrent administration of isoniazid
what is the causative agent responsible for joint pain during the treatment of TB ?
pyrazinamide
what is the cause of flu like syndrome ?
intermittent rifampcin usage
change to daily dosing
what is the classic treatment regimens for TB in HIV positive patients ?
strptomycin, thiacetazone and isoniazid
what is the management if cutaneous reaction occurs in the treatment of a patient with both TB and HIV ?
thioacetazone is drug implicated
what TB drugs cause hepatotoxicity ?
isoniazid
pyrazinamide
rifampcin
if ethambutol is necessary in renal disease what precautions must be taken ?
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
what is the management in drug induced hepatitis ?
once it resolves the drugs can be re introduced back one at a time
