Test 3 - TB Medications (Josh)

Question 1

Tuberculosis is a specials of which bacteria?

Answer 1

Mycobacterium tuberculosis

Question 2

What is unique about TB?

Answer 2

• slow growing
• lives and replicates inside a phagocyte
• long time to cure (6mo to 2yrs w/ meds)

Question 3

TB primarily effects which organ?

Answer 3

Lungs

Spreads through coughing/sneezing

Question 4

What percentage of TB infected clients are latent?

Answer 4

90%

An individual can harbor the bacteria they’re whole life if not given medication to kill it

Question 5

Challenges facing the treatment of TB?

Answer 5

• ADHERENCE (have to take the drugs for a LONG TIME)
• RESISTENCE (bacteria can develop resistance to drug; so usually given two diff drugs at same time)
• TOXICITY (esp. hepatotoxicity b/c you have to take drug for so long
• COST (non-resistant TB = $12,000, resistant TB + $180,000)

Question 6

Positive reaction to TB skin test is determined by region the client lives in?

Answer 6

High Risk - treatment recommended if induration is 5mm
Moderate Risk - treatment recommended if induration is 10mm
Low Risk - treatment recommended if induration is 15mm

Question 7

What is DOT in relation to TB treatment?

Answer 7

Directly Observed Therapy

It is the standard of care for TB b/c patient adherence is most common cause of treatment failure administration of each dose is observed in clinic by rep from Health Depth.

Question 8

Why must TB treatment be monitored?

Answer 8

• Promote Adherence

- Provide opportunity for ongoing evaluation of effectiveness of treatment regimen

Question 9

When taking rifampin (TB drug) what happens to urine?

Answer 9

Urine (and other secretions) will turn red-orange color

Harmless, but don’t wear contacts or they will be permanently stained

Question 10

Why give pyridoxine (Vitamin B6) to client taking isoniazid (TB drug)?

Answer 10

Vitamin B6 deficiency causes peripheral neuropathy

Also give Vitamin B6 to clients at Rick for this adverse effect (alcoholics, diabetics)

Question 11

What will need to happen if someone taking phenytoin needs to take isoniazid?

Answer 11

Monitor the phenytoin levels b/c isoniazid is a CYP inhibitor

Question 12

If client is taking oral contraceptives, what should they do if they are prescribed rifampin (TB Drug)?

Answer 12

Rifampin is a potent CYP inducer

• use another method

Question 13

What types of meds does rifampin (TB drug) affect?

Answer 13

Rifampin is a CYP inducer

• Anti-seizure meds
• Anti-rejection meds
• Oral contraceptives
• HIV meds
• Warfarin

Question 14

Why is TB being a slow-growing bacteria a problem?

Answer 14

It’s hard to kill bacteria that aren’t very metabolically active. We want them to be active, absorbing our antibiotics but if they aren’t very active, it’s hard to attack them

Question 15

What percentage of TB cases are in developing nations?

Answer 15

95%

• second only to HIV/AIDS
• 1/3 of humans have TB

Question 16

Which mask would you wear to treat a TB patient?

Answer 16

N95

Question 17

Latent Infection

Answer 17

Most people (90%) who have TB don’t know it b/c they have a healthy immune system that can keep the microbes in check. They can still spread it

Question 18

Clinical Manifestations of TB infection

Answer 18

• low grade fever
• dry cough that could progress to mucopurulent cough w/ hemoptysis
• night sweats
• fatigue
• weight loss

Question 19

Two major TB drugs

Answer 19

• isoniazid

- rifampin

Question 20

The primary TB drug is —–

Answer 20

Isoniazid

only for TB, no other uses for it

Question 21

A client could possibly only have to take one drug if they have which type of TB? Which drug?

Answer 21

If latent infection, they could take isoniazid by itself

Question 22

The most common adverse effect of isoniazid is —-

Answer 22

Peripheral neuropathy

• symmetric (both sides) numbness/tingling
• issues w/ balance/clumsiness

Question 23

What causes the issue of peripheral neuropathy w/ isoniazid?

Answer 23

Deficiency of vitamin B6

• give vita. B6 prophylactically to clients at risk like alcoholics and diabetics

Question 24

Second most common adverse effect of isoniazid is —

Answer 24

Hepatotoxicity

• watch AST level
• watch JAUNDICE s/s
• usually only affects older clients

Question 25

When should you hold off giving isoniazid?

Answer 25

AST level 3-5x’s original value

Question 26

—- is a broad-spectrum antibiotic used to treat TB.

Answer 26

Rifampin (Protein Synthesis Inhibitor)

• take it on an empty stomach

Question 27

Of the TB drugs, —– has many uses while —- is only used for TB.

Answer 27

Rifampin

isoniazid

Question 28

—- can be taken with or without food.

—- can be taken only without food.

Answer 28

Isoniazid

Rifampin (food decreases absorption)

Question 29

Common side effect of rifampin is —-

Answer 29

Hepatitis (only problematic for ~ 1%)

• JAUNDICE s/s

Question 30

—– can cause your secretions to turn red-orange.

Answer 30

rifampin

Question 31

Why would you need to check a client’s current meds if starting them on isoniazid or rifampin?

Answer 31

Both have lots of CYP interactions

Question 32

—— is a CYP inhibitor which leads to — —

—– is a CYP inducer which leads to —- —-

Answer 32

Isoniazid –> drug toxity

Rifampin –> sub-therapeutic drug levels

Question 33

Biggest drug to be concerned about w/ isoniazid?

Answer 33

Phenytoin

Has a narrow therapeutic range and isoniazid is a CYP inhibitor which leads to increased levels of the drug