Wk 1 TB Flashcards
TB is any infection caused by the bacteria
mycobacterium
The most common mycobacterium is
Mycobacterium tuberculosis
What is the etiology of leprosy?
Mycobacterium leprae
Mycobacterium tuberculosis is __-shaped
rod
Mycobacterium tuberculosis is also __
aerobic
Why does mycobacterium tuberculosis most commonly affect the lungs?
It needs tons of oxygen to grow and proliferate
Where else in the body can mycobacterium tuberculosis grow?
end of the bone and the brain
What is tuberculosis characterized by?
Granulomas in the lungs
What are granulomas?
nodular accumulations of inflammatory cells
What types of inflammatory cells are in granulomas?
macrophages and lymphocytes
What is the consistency of a granuloma in the lung?
They are hard on the outside and the inside is cheesy or lacerated
What is a granuloma in the lung filled with?
Caseous necrosis
What is caseous necrosis?
Broken down tissue from the macrophages in the granuloma
What are granulomas also called?
tubercles
Tuberculosis can be transmitted by which type of animals?
birds and cattle, also humans
What are the infectious particles of tuberculosis called?
Tubercle bacilli
How is tuberculosis transmitted from person to person?
Via airborne droplets
Mycobacterium tuberculosis is a very __ growing organism
slow
Because mycobacterium tuberculosis grows slow, this makes it difficult to treat. Why?
We typically treat infections by inhibiting cell growth and proliferation
In latent TB, where is the bacteria located?
They remain in the tubercles/granulomas and remain dormant for life
A person with latent TB is __
asymptomatic
What are common reactivators of TB?
HIV, immunosuppressive drugs, poor nutrition status, renal failure
Symptoms of active TB develop very __
gradually
When in the disease process do symptoms of TB typically occur?
Very late in the disease
5 symptoms of active TB
Fatigue/Lethargy Low grade-fever/Night sweats Weight loss/anorexia Productive cough Anxiety
What happens as the disease progresses and is not treated?
Dyspnea
Chest pain
Hemoptysis
What is it called if the TB spread to other parts of the body?
Extrapulmonary TB
What are symptoms of extrapulmonary TB? (4)
Neurologic deficits, meningitis symptoms, bone pain, urinary problems
How are high risk populations tested for TB?
interferon-gamma release assay (blood draw)
How are non-high risk population tested for TB?
skin test
How is TB infection confirmed?
Sputum culture and granulomas on chest x-ray
Second line antitubercular drugs are reserved for
complicated cases of TB resistant to primary antitubercular drugs
When treating a patient with suspected TB, it’s important to consider what?
That the patient may have contracted a TB strain that is resistant to antibiotics
The CDC always recommends using more than one drug-susceptibility test because of?
The increasing presence of resistance
What is the most widely used TB medication?
Isoniazid
What is the MOA of Isoniazid?
Disrupts cell wall synthesis essential functions
What routes is isoniazid given?
PO
What are side effects of isoniazid?
Peripheral neuropathy
hepatotoxicity
optic neuritis /visual disturbances
hyperglycemia
What is optic neuritis?
Inflammation of the optic nerve
What is peripheral neuropathy?
Peripheral neuropathy, a result of damage to the nerves located outside of the brain and spinal cord (peripheral nerves), often causes weakness, numbness and pain, usually in the hands and feet.
Where is isoniazid metabolized?
the liver
What should be monitored on a patient taking isoniazid?
liver enzymes
Why should you teach patients taking isoniazid to avoid antacids?
It reduces the absorption of INH
When isoniazid is given in conjunction with rifampin, what can happen?
Increase CNS side effects and hepatotoxicity
If isoniazid is given in conjunction with phenytoin, what can happen?
It will increase the effects of phenytoin
What is phenytoin used for?
Seizures
Isoniazid has a __ __ __
black box warning
Why does Isoniazid have a black box warning?
Increased risk of hepatitis
What is isoniazid often given with because of the increased risk of hepatitis?
Vitamin b6
What is the scientific name of vitamin b6?
pyridoxine
Rifampin is used __-line for treatment of TB
first
What is the MOA of rifampin?
Inhibits protein synthesis via attacking the hydrocarbon ring structure
Where is rifampin metabolized?
the liver
If giving rifampin and INH together, if can cause
hepatitis
What is a unique, notable side effect of rifampin?
red-brown discoloration of the urine and other bodily fluids
Rifampin has a ton of drug interaction because it is a
CYP inducer
Rifampin decreases the side effects of which drugs?
beta blockers benzos anticoags diabetic medications phenytoin cyclosporins theophylline
If a patient is taking rifampin, they need to tell their HCP because…
they may need much higher doses of other medications
What routes is rifampin given?
PO or IV
What is the MOA of ethambutol?
Diffuses into the mycobacteria and suppresses RNA synthesis, which inhibits protein synthesis
Ethambutol is a first-line __
bacteriostatic
What are two notable side effects of ethambutol?
retrobulbar neuritis
blindness
A patient taking ethambutol may need to be seen frequently by a __
ophthalmologist
What route is ethambutol given?
PO
Ethambutol is used in combination with __ and __
INH and rifampin (there is a pill that contains all 3)
You can’t give ethambutol to children less than…
13 years old
Pyrazinamide is __ or __ depending on the concentration
bacteriostatic or bacteriocidal
Pyrazinamide is __ used in combination with other medications
always
What is the MOA of pyrazinamide?
Unknown but thought to inhibit lipid and nucleic acid synthesis
What are two notable side effects of pyrazinamide?
hepatotoxicity and hyperuricemia
What is hyperuricemia?
elevated uric acid level in the blood
Which two conditions is pyrazinamide contraindicated for?
Severe hepatic disease and acute gout
What routes if pyrazinamide given?
PO
Pyrazinamide is not for __ people in the US, but may see it used in other countries
pregnant
What was the first drug ever available to treat TB?
Steptomycin
What is the MOA of streptomycin?
Aminoglycoside – interfering with normal protein synthesis causing production of faulty proteins within the bacteria
3 notable side effects of steptomycin
ototoxicity, nephrotoxicity, blood dyscrasias
What is ototoxicity?
Ototoxicity is when a person develops hearing or balance problems due to a medicine.
What are blood dyscrasias?
Dyscrasia is a nonspecific term that refers to a disease or disorder, especially of the blood
What routes is streptomycin given?
IM injection
How frequently is streptomycin given?
Daily
Be careful giving streptomycin to people on __ because?
Anticoagulants; because streptomycin can increase bleeding
What special groups are at highest risk to have TB?
Asian and hispanic immigrants
