tuberculosis part 1 Flashcards

1
Q

what is the first line of treatment for TB ?

A
isoniazid 
pyrazinamide 
ethambutol 
rifampicin 
streptomycin
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2
Q

what is the mechanism of action of rifampicin ?

A

inhibition RNA synthesis

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3
Q

what is the mechanism of action of isoniazid and ethambutol ?

A

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

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4
Q

what is the mechanism of action of streptomycin ?

A

inhibition of protein synthesis

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5
Q

what is the standard treatment regimen ?

A

through the intensive phase
continuation phase

continuous phase

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6
Q

what is the purpose of the intensive phase ?

A

rapidly kill of the dividing organisms

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7
Q

What is the purpose of the continuation phase ?

A

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

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8
Q

what medications are taken in the intensive phase ?

A

2 months of all 4

2 months of rifampcin and isoniazid

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9
Q

what medications are taken in the continuation phase

A

4 months of isoniazid and rifampicin

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10
Q

how often should the drugs be administered ?

A

3 times per week

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11
Q

how is the monitoring of the TB case done ?

A

clinical
microbiological response
lab response

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12
Q

what does the clinical monitoring include?

A

general condition
fever
appetite
screening for common side effects

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13
Q

how is the microbiological response monitored ?

A

sputum at 2 months
sputum at completion of therapy

sputum at completion of therapy

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14
Q

how is the lab response monitored ?

A

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

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15
Q

if there are skin rashes what should be stopped ?

A

stop anti-tb drugs

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16
Q

if there is deafness or dizziness what should be stopped ?

A

streptomycin

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17
Q

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

A

all anti TB drugs

18
Q

if there is visual impairment what drug should be stopped ?

A

ethambutol

19
Q

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

A

Rifampicin

20
Q

if there is decreased urine output what should be stopped ?

A

streptomycin

21
Q

what are the minor side effects of the TB drugs ?

A
anorexia 
joint pain 
drowsiness 
orange/red urine 
flu syndrome
22
Q

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

A

causative agent is isoniazid give pyridoxine

23
Q

when are steroids used in TB?

A

in TB meningitis and pericarditis,peritonitis and pleuritis

24
Q

in tuberculous meningitis what replacements should be made

A

ethambutol should be replaced by streptomycin

25
Q

in multidrug resistant TB , what are the resistant drugs ?

A

rifampicin and isoniazid

isoniazid

26
Q

why is it difficult to diagnose TB in HIV patients ?

A

because of the limitations of current TB tests

27
Q

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

A
  • cumulative drug toxicities
  • drug-drug interactions
  • high pill burden
  • immune reconstitution inflammatory syndrome (IRIS)
28
Q

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

A

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

29
Q

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

A
  • hematogenous dissemination through the placenta
  • aspiration of infected amniotic fluid lung or GIT tract

- aspiration or ingestion of infected amniotic fluid

30
Q

which of the TB drugs is ototoxic to the fetus ?

A

streptomycin

31
Q

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

A

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

aspiration- lungs or GIT

32
Q

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

A

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

33
Q

what is rifampicin toxicity dependant on ?

A

concurrent administration of isoniazid

34
Q

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

A

pyrazinamide

35
Q

what is the cause of flu like syndrome ?

A

intermittent rifampcin usage
change to daily dosing

36
Q

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

A

strptomycin, thiacetazone and isoniazid

37
Q

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

A

thioacetazone is drug implicated

38
Q

what TB drugs cause hepatotoxicity ?

A

isoniazid
pyrazinamide
rifampcin

39
Q

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

A

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

40
Q

what is the management in drug induced hepatitis ?

A

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