Tuberculosis

Question 1

ACTIVE VS LATENT TB

Answer 1

Active: symptomatic and contagious

Latent: dormant, asymptomatic and not contagious

Question 2

TEst to diagnose TB

Answer 2

PPD: Intradermal (test is read 48-72 hours after administered)

CXR: assist with locating infected areas of lungs in active TB or rule out active TB if PPD+

TB blood test: QuatniFERON- TB Gold In- Tube test sand T-SPOT TB test

AFB (Acid Fast bacilli): IF active TB suspected, sputum sample can check for active TB under microscope

+AFB mean active TB

Question 3

PPD result

Answer 3

5mm: HIV , steroid therapy or at high risk of TB inf (contact with person with active TB)

10mm: DM, ckd, health care workers

15mm: postive for all

Question 4

BCG vaccine

Answer 4

vaccine given in countries with high prevalence of TB

BCG vaccine can make individual a +Tb skin test but wears off after years

Question 5

Latent TB treatment

Answer 5

**
1. Rifampin QD for 4 months (4R)
2. INH & Rifampin QD for 3 mon (3HR)
3. INH & Rifapentine Qweek for 3 months

For pt. with CI to rifampamycin use
- **INH 300mg QD for 6-9 months **

Question 6

ACTIVE TB DRUGS

Answer 6

**RIPE for first 8 weeks (2 months)

R: Rifampin (Rifadin) empty stomach
I: Isoniazid - empty stomach
P: Pyrazinamide
E: Ethambutol (Myambutol)

then for 18 weeks(4.5 months)
- Isoniazid and Rifampin

COmbO
- Rifamate: INH+ Rifampin- empty stomach
- Rifater: INH+ Rifampin+ Pyrazinamide: empty stomach

Question 7

Isoniazid

Answer 7

HEPATOXICITY ( report fatigue, dark urine)

Peripheral neuropathy
- prevent peripheral neruopathy give with vitB6 (pyridoximine)

Form:Tablet, syrup

Question 8

Rifampin

Answer 8

Rifadin
- Hepatoxicity
- fever , rash, flu elike illness, Gi upset
- Thrombocytopenia (CBC) inc bleeding
- Induce (dec efficacy of COC, warfarin and avoid used with PI increase of hepatoxicity)
- Body red- orange color
- Empty stomach

Question 9

Rifapenitne

Answer 9

• Hepatoxicity
• Thrombocytopenia (CBC) inc bleeding
• orang brown discoloration of urine

Question 10

Pyrazinamide

Answer 10

Hepatotoxicity
Hyperuricemia
avoid in renal dysfunction

Question 11

Ethambutol

Answer 11

optic Neuritis

inc UA

Cauiton with kidney dx

Question 12

Streptomycin

Answer 12

Nephrotoxicity, ototoxicity
just like aminoglycoside

Question 13

counseling pts

Answer 13

1. Hepatoxicity with INH, Rifamycin or pyrazinamide
2. Rifamycin casue orange discoloration
3. Rifamycin are inducer
4. Add vit B6 with INH
5. Hyeruricemia with pyrazinamide