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Infectious Disease > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What is the name of the bacterial organism that causes tuberculosis (TB)?

A

Mycobacterium tuberculosis

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2
Q

Define mycobacterium tuberculosis

A

An aerobic, non-spore forming bacillus that thrives in environments where the oxygen tension is relatively high

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3
Q

Mycobacterium tuberculosis is often referred as:

A

Acid-fast bacillus (AFB) because it resists decolorization by acid alcohol after staining with basic fuschin

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4
Q

Is replication of mycobacterium tuberculosis fast or slow?

A

Slow (very slow)

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5
Q

How is mycobacterium tuberculosis transmitted?

A

Through the air by aerosolized drop nuclei

  • Cough
  • Sneeze
  • Speak
  • Sing
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6
Q

(T/F) - Transmission of mycobacterium tuberculosis occurs through inanimate objects too

A

FASLE - does not occur

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7
Q

Who are most at risk for tuberculosis?

A
  • Family household contacts
  • Persons living or working in enclosed environments
  • People with impaired immune systems
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8
Q

(T/F) - During latent infection of TB, patients are infectious

A

FALSE - not infectious

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9
Q

(T/F) - During latent infection of TB, patients are positive from the tuberculin skin test (PPD)

A

TRUE

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10
Q

(T/F) - During latent infection of TB, patients are asymptomatic without radiographic evidence of infection

A

TRUE

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11
Q

(T/F) - Patient who do not receive treatment during latent TB will develop active TB

A

TRUE

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12
Q

(T/F) - High risk of active TB is in the first 5 years

A

FALSE - first 2 years

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13
Q

What are the subjective findings of TB in a patient?

A
  • Cough
  • Fatigue
  • Fever
  • Night sweats
  • Anorexia/weight loss
  • Pleuritic pain
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14
Q

Is the cough productive or not productive in subjective findings?

A

Non-productive at first then becomes productive

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15
Q

What are the objective findings of TB in a patient?

A
  • Nodular infiltrates
  • Positive sputum smear of AFB
  • Positive PPD skin test
  • Anemia
  • Leukocytosis
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16
Q

What could cause a PPD skin test to be a false positive?

A

Pts with hx of bacillus of Calmette-Guerin vaccine (BCG)

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17
Q

What is a definitive diagnosis of TB?

A
  • Isolate M. tuberculosis from the site of the infection
  • AFB smear are best obtained in the morning
  • PPD test
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18
Q

At least how long should AFB smear tests should be taken?

A

At least 3 consecutive days

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19
Q

(T/F) - A negative AFB smear test rules out TB

A

FALSE - it does not rule out TB

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20
Q

(T/F) - PPDs have a false negative rate of 25%

A

TRUE

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21
Q

What is the cause of false negatives in PPDs?

A

Anergy

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22
Q

Define anergy

A

Decreased ability to respond to antigens

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23
Q

If anergy is suspected in a PPD skin test, what should be done furthermore?

A

Control skin tests should also be placed in contralateral arm

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24
Q

What treatment should be given in a patient who is suspected to have high clinical suspicion of active TB?

A

Rifampin (RIF), Isoniazid (INH), Ethambutol (EMB), and Pyrazinamide (PZA) for 8 weeks

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25
Q

Which of the 4 medications that are given initially would be given for an extra 18 weeks?

A

RIF and INH

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26
Q

What is the role in therapy of INH?

A

Potent ability to kill rapidly multiplying organisms during the initial phase of treatment

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27
Q

What is the MOA of INH?

A

Unknown; may affect cell wall

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28
Q

What are some main AEs of INH?

A
  • Hepatitis
  • GI Sx of hepatitis
  • Peripheral neuropathy
  • CNS reactions
  • Allergic reactions
  • Arthritic symptoms/SLE
  • Dry mouth
  • Psychoses
  • Hemolytic anemia
  • Agranulocytosis
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29
Q

Who are at risk of gaining hepatitis with the use of INH?

A
  • EtOH consumption
  • > 35 yo
  • IVDU
  • Using other hepatoxic drugs
  • Black and Hispanic women
  • Postpartum women
  • Liver disease
30
Q

INH is a potent inhibitor of:

A
  • CYP2C9
  • CYP2C19
  • CYP2E1
31
Q

INH is a minimal inhibitor of:

A

CYP3A4

32
Q

What is the role in therapy of RIF?

A

Activity against intracellular organisms that are usually dormant; inhibits RNA synthesis to inhibit RNA transcriptase

33
Q

What are some main AEs of RIF?

A
  • Flu-like Sx
  • Elevated LFTs
  • Thrombocytopenia
  • Drug-induced SLE
  • Fever, N/V, rash
  • Acute renal failure
  • Orange-red colorization
34
Q

What should be avoided during the use of RIF?

A

Contact-lenses due to the colorization

35
Q

RIF is an inducer of:

A

CYP3A4 and glucoronidation

36
Q

What is the role in therapy of PZA?

A

Most effective against organisms in the acidic environment within the macrophages or areas of tissue necrosis; most effective within the first 2 months of treatment

37
Q

What is the MOA of PZA?

A

Converted to pyrazinoic acid in MTB to lower the pH of the environment

38
Q

What are some main AEs of PZA?

A
  • Hepatitis
  • Arthralgias
  • Malaise
  • N/V
39
Q

What is the role in therapy of EMB?

A

Bacteriostatic at low doses; bactericidal at high doses; moderately effective against the fast-growing bacilli with little sterilizing activity.
Used mainly to prevent resistance

40
Q

What is the MOA of EMB?

A

RNA synthesis

41
Q

What are some main AEs of EMB?

A
  • Optic neuritis

- Renal adjust

42
Q

EMBs absorption is decreased when?

A

Aluminum salts are taken concomitantly

43
Q

Which of the 4 medications does not have any CYP450 enzyme interactions?

A

PZA

44
Q

What is the name and dose of the medication that should be administered with INH?

A

Pyridoxine 25 mg/day

45
Q

Why does INH need to be taken with another medication?

A

To prevent peripheral neuropathy

46
Q

What two ways can TB medications be administered?

A
  • Directly observed therapy (DOT)

- Fixed dose combinations

47
Q

Which administered method is preferred?

A

DOT

48
Q

Which administered method reduces pill burden and risks of monotherapy?

A

Fixed dose combinations

49
Q

What should be monitored during therapy?

A
  • CBC
  • LFTs
  • Visual examination
  • Sputum cultures and AFB smears
  • Adherence
  • Chest X-ray
50
Q

How often should sputum cultures and AFB smears be monitored?

A

Initially q 2-4 weeks THEN
monthly once sputum cultures are negative THEN
one more smear and culture at the completion of therapy.

51
Q

Who are candidates for latent TB treatment?

A
  • Positive PPD skin test and/or

- Risk for reactivation of active TB

52
Q

What are the preferred treatment options of TB?

A
  • INH QD x 6 months - no DOT
    OR
  • INH and rifapentin qweek x 3 months - DOT
53
Q

Which patients should not use INH and rifapentin as a treatment option for latent TB?

A
  • < 2 yo
  • Pregnant or becoming pregnant during treatment
  • HIV pts receiving antiretroviral
  • Patients with latent TB with presumed resistance to INH or RIF
54
Q

In elderly patients, active TB is treated how?

A

The same as the general population; use with caution due to AEs

55
Q

In elderly patients, latent TB is treated how?

A

The same as the general population; but should cutoff if 15 mm or more in > 35 yo

56
Q

Define MDR-TB

A

Resistant to RIF and INH

57
Q

Define primary resistance

A

Patient harbors a resistant strain PRIOR to any treatment

58
Q

Define acquired resistance

A

Gaining resistance due to:

  • Noncompliance
  • Inappropriate therapy
  • Inadequate dosage
  • Malabsorption issues
59
Q

What are the treatment options for MDR-TB?

A
  • Bedaquiline
  • Fluoroquinolones
  • Para-aminosalicylic acid
  • Cycloserine
  • Ethionamide
  • Injectible agents
60
Q

In HIV-patients, latent TB is treated how?

A
  • INH QD
    OR
  • INH and RIF
    Depends on ARV therapy
61
Q

In HIV-patients, active TB is treated how?

A

INH/RIF/PZA/EMB

62
Q

If HIV-patient is on PI, how is active TB treated then?

A

Replace RIF to rifabutin to avoid DDIs

- INH/PZA/EMB and rifabutin

63
Q

(T/F) - Fixed dose combinations is recommended for active TB in HIV-patients

A

FALSE - DOT is preferred

64
Q

In pregnant patients, TB is treated how?

A

INH/RIF/EMB

65
Q

(T/F) - Streptomycin should not be used in pregnant patients for TB treatment, unless no other alternative

A

TRUE

66
Q

(T/F) -TB is an indication for terminating pregnancy

A

FALSE - it’s not

67
Q

(T/F) - EMB should only be used in pediatrics if resistance is suspected

A

TRUE - it’s not used routinely b/c it’s difficult to assess visual acuity in children

68
Q

(T/F) - Extrapulmonary TB or TB meningitis have a longer duration of treatment of at least 12 months

A

TRUE

69
Q

(T/F) - Corticosteroids are prohibited for adjunctive treatment in extrapulmonary TB or TB meningitis

A

FASLE - it can be used

70
Q

Solid organ transplant patients are treated how in latent and active TB?

A

Standard treatment from general population

Infectious Disease (41 decks)

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