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PHRM 840 > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

In mycobacteria the cell wall is composed of

A

mycolic acids

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2
Q

The mycolic acids in mycobacteria are targets for what

A

drug targets

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3
Q

What do you use to stain mycolic acids

A

acid-fast bacilli

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4
Q

What two bacteria are responsible for TB?

A

M. tuberculosis

M. bovis

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5
Q

What two bacteria are responsible for mycobacterium avium complex (MAC)?

A

M. avium

M. intracellulare

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6
Q

How is TB transmitted?

A

coughing or sneezing from droplet nuclei

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7
Q

3 phases of infection of TB

A
  • primary
  • latent tuberculosis infection
  • active (re-activation) tb disease
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8
Q

In LTBI, what is the evidence of infection?

A
  • positive TST

- reactive IFN-gamma release assay

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9
Q

Are patient contagious with LTBI?

A

no, not contagious

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10
Q

What is active reactivation TB?

A

When LTBI becomes active (10%)

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11
Q

Active TB onset and symptoms

A

productive cough lasting >3 weeks,
chills, fever, night sweats, fatigue
and weight loss, hemoptysis

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12
Q

Is active TB contagious?

A

Yes, it is contagious

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13
Q

How to diagnose active TB?

A
  • positive TST
  • positive blood test
  • abnormal chest radiograph
  • positive sputum smear or culture
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14
Q

Treatment for TB?

A 
Rifamycins:
◦ Rifampin (RIF)
◦ Rifabutin
◦ Rifapentine 
Isoniazid (INH) 
Pyrazinamide (PZA)
Ethambutol (EMB)
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15
Q

Downside of RIPE therapy?

A

high pill burden (9 pills)

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16
Q

Treatment principles for LTBI

A
  1. Active disease should be ruled out before
    starting LTBI treatment
  2. Monotherapy may be used (ONLY for LTBI)
  3. Delay treatment during pregnancy
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17
Q

First line therapy for LTBI?

A

Isoniazid 900mg & Rifapentine 900mg (3HP) once weekly for 3 months

18
Q

LTBI Second line therapy and used with pts with ioniazid resistance

A

Rifampin 600mg (RIF) daily for 4 months

19
Q

LTBI second line therapy

A

Isoniazid (INH) 300mg

daily for 6 or 9 months

20
Q

LTBI treatment with INH

A

Only 40-60% of those who initiate treatment for
LTBI with isoniazid (INH) for 9 months complete
therapy due to poor adherence, long treatment duration, and toxicity

21
Q

Advantages of 3HP + DOT?

A
  • higher completion rates
  • shorter duration
  • less hepatotoxicity
  • given once weekly
22
Q

Directly Observed Therapy (DOT)

A

-Health care worker watches patient swallow each
dose of medication
-can lead to reductions in relapse and drug
resistance
-use with other measures to promote adherence

23
Q

Treatment principles for active disease

A
  1. patients should be isolated until no longer infectious
  2. empiric therapy consists of multiple drugs
  3. duration is dependent upon host factors, extent of disease, presence of resistance
  4. never add a single drug to a failing regimen
24
Q

For RIPE therapy, rifampin and isoniazid is dosed on?

A

TBW

25
Q

For RIPE therapy, pyrazinamide and ethanbutol is dosed on

A

IBW

26
Q

Renal adjustments needed for which RIPE medications

A

PZA and EMB: Renal adjustment: CrCl < 30mL/min = dose 3x/wk

27
Q

Pyridoxine (vitamin B6) dose

A

25-50 mg daily

28
Q

Pyridoxine (vitamin B6) therapy needed in which pts

A
  • alcoholsim
  • advanced age 65 or older
  • pregnancy
  • diabetes
  • CKD
  • autoimmune disease
29
Q

When TB is susceptible start on what therapy?

A

RIPE

30
Q

Initiation phase of TB

A

RIPE for two months

31
Q

Continuation phase of TB

A

INH and RIF for 4-9 months

32
Q

When do you extend continuation phase?

A

pts who are culture positive at 2 mo and immune suppressed pts (HIV, cavitary or extrapulmonary dx)

33
Q

Treatment adherence issues of TB

A
  • long treatment duration
  • non-adherence
  • leads to resistance
34
Q

Because of drug-drug interactions when do you adjust dosings while taking with rifamycin

A

Adjust when rifamycin is started and ended

35
Q

Rifamycins are common CYP450 Inducers (increases

metabolism of other drugs to subtherapeutic levels) of what meds

A

Most HIV protease inhibitors
Oral contraceptives
Antifungals
Methadone

36
Q

Isoniazid is an inhibitor (inhibits the metabolism of other drugs
to toxic levels) which drugs

A

Phenytoin
Carbamazepine
Warfarin
Benzodiazepine

37
Q

Mono-resistant

A

resistant to any one TB treatment drug

38
Q

Poly-resistant

A

resistant to at least any 2 TB drugs but not both INH and RIF

39
Q

Multidrug resistant MDR-TB

A

resistant to at least INH and RIF

40
Q

Extensively drug resistant XDR TB

A

resistant to INH and RIF plus to any fluoroquinolone and at least 1 of 3 injectable second line drugs (amikacin, kanamycin, or capreomycin)

41
Q

Preventing resistance

A
  • use multi-drug regimens
  • promote medication adherence
  • monitor for intolerance or toxicities

PHRM 840 (9 decks)

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