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PHA 550 > TB > Flashcards

TB Flashcards

1
Q

What is the pathogen causing tuberculosis?

A

Mycobacterium tuberculosis (acid fast staining bacillus)

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2
Q

What are the different types of TB infections?

A

silent
latent
progressive,active

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3
Q

What groups are most at risk for active disease TB?

A

children under 2yrs

adults over 65 yrs

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4
Q

What are the 2 most important drugs in the treatment of TB?

A

isoniazid
rifampin

multidrug resistant TB is resistant to both :o

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5
Q

Why do we use Directly Observed Treatment?

A

to reduce treatment failures and the selection of drug resistant isolates

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6
Q

What are the diagnostic tests for TB? (2)

A 
Mantoux test (tuberculin unit PPD dose)
- read w/in48-72 hrs

Interferon y release assays

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7
Q

**What are the first line agents in the treatment of TB?

A

(in approx order of preference)

isoniazid
rifampin
pyrazinamide
ethambutol

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8
Q

**Rifampin: MOI

A

inhibits RNA synthesis (inhibits RNA polymerase –> blocks RNA production)

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9
Q

**Isoniazid: MOI

A

inhibits cell wall synthesis (inhibits synthesis of mycolic acid)

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10
Q

**Pyrazinamide: MOI

A

exact target unclear

disrupts plasma membrane

disrupts energy metabolism (ATP synthesis)

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11
Q

**Ethambutol: MOI

A

inhibits cell wall synthesis (inhibits formation of arabinogalactan)

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12
Q

**What is an appropriate therapeutic plan for latent TB? (drug, duration, dosing)

A 
ISONIAZID:
-9mo
daily: 270 doses
twice/wk: 76 dose
-6mo 
daily: 180
twice/wk: 52

ISONIAZID + RIFAPENTINE

  • 3mo
    weekly: 12

RIFAMPIN

  • 4mo
    daily: 120
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13
Q

**What is an appropriate therapeutic plan for active TB? (How many drugs do we use? Which drugs?)

A

combination chemotherapy is required

use at least 2 drugs to which the isolate is susceptible

outset of tx: all 4 drugs

rifampin
isoniazid
pyrazinamide
ethambutol

“trying to use some synergism putting these 4 drugs together”

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14
Q

**Rifampin: ADEs

A 
turns bodily fluids orange 
cholestasis (hepatitis)
rash
flu like syndrome (with intermittent dosing)
thrombocytopenia
nephritis

cutaneous reactions, GI reactions (nausea, anorexia, abdominal pain), flu-like syndrome, hepatotoxicity, severe immunologic reactions, orange discoloration of bodily fluids (sputum, urine, sweat, tears), drug interactions due to induction of hepatic microsomal enzymes

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15
Q

**Isoniazid: ADEs

A

hepatic toxicity
peripheral neuropathy: vitamin B6 deficiency

asymptomatic elevation of aminotransferases, clinical hepatitis, fatal hepatitis, peripheral neurotoxicity, CNS effects, lupus-like syndrome, hypersensitivity, monoamine poisoning, diarrhea

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16
Q

**Pyrazinamide: ADEs

A 
hepatotoxicity
hyperuricemia
rash
GI disturbance
arthralgias

hepatotoxicity, GI symptoms (nausea, vomiting), nongouty polyarthralgia, asymptomatic hyperuricemia, acute gouty arthritis, transient morbilliform rash, dermatitis

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17
Q

**Ethambutol: ADEs

A 
retrobulbar neuritis (sudden loss of vision)
-reversible if drug is stopped

retrobulbar neuritis, peripheral neuritis, cutaneous reactions

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18
Q

**What is multiple drug resistant TB (MDR-TB)?

A

TB caused by organisms that are resistant to isoniazid and rifampin

19
Q

**What is the treatment for MDR-TB?

A

Bedaquiline
First: once daily for 2 wks
Then: 3x/wk for 22 weeks

combination w/ at least 3-4 other antibiotics

can take up to 24 months to cure

20
Q

Is a patient with latent TB able to transmit the disease to others?

A

no

21
Q

In what type of patient does latent TB become active?

A

immunocompromised

22
Q

*What is the preferred treatment regimen for patients with drug susceptible TB?

A

intensive phase: 2 months
continuation phase: 4-7 months
total: 6-9months for treatment

Regimen 1: 
INTENSIVE PHASE:
(inh, rif, pza, emb)
7 d/wk for 56 doses (8wks)
OR
5 d/wk for 40 doses (8wks)
CONTINUOUS PHASE:
(inh, rif)
7 d/wk for 126 doses (18wks)
OR
5 d/wk for 90 doses (18wks)
23
Q

What treatment regimen that has an A rating/evidence for LATENT TB in adults?

A

isoniazid

daily for 9 months

24
Q

What other infections can be treated with Rifampin?

A

atypical mycobacterial infections
eradication of meningococcal colonization
staphylococcal infections (including MRSA)

25
Q

How are pyrazinamide metabolites cleared from the body?

What indicates an adjustment of the dose?

A

renally cleared

reduce dose if <30mlmin clearance

26
Q

How is ethambutol cleared from the body?

When would you consider adjusting the dose?

A

hepatic and renal clearance

dose reduction in renal failure

27
Q

**Bedaquiline: MOI

A

inhibits ATP synthase required for energy generation

28
Q

**Bedaquiline: box warning

A

increased mortality

QT prolongation

29
Q

What are the second line TB medications?

A 
streptomycin
amikacin/kanamycin
capreomycin
p-aminosalicyclic acid
moxifloxacin

consider for MDR TB
significant ADEs

30
Q

Capreomycin: ADEs, max dose in elderly

A

ototoxicity, nephrotoxicity

dose in older pts should not exceed 750

31
Q

Clofazimine: active against, ADEs

A

Active against leprosy, M avium complex, TB

ADEs:
N/V, abdominal pain, skin discoloration

32
Q

Cycloserine: MOI, when is it used, ADEs

A

MOI: bacteriostatic

used in TB re-treatment and MDR TB

ADEs:
CNS dysfunctions
psychotic reactions

33
Q

How is ethambutol cleared from the body?

When would you consider adjusting the dose?

A

hepatic and renal clearance

reduce dose in renal failure

34
Q

Fluoroquinolones: Moxifloxacin

A

active against TB

efficacious in patients unable to take inh, rif, pza

rapid emergence of resistance in some series

6mo of long acting rifamycin, rifapentine w/ moxifloxacin = effective as standard therapy

35
Q

Linezolid

A

effective in achieving culture conversion in pts w/ tx refractory highly resistant pulmonary TB

significant side effects

36
Q

Linezolid

A

effective in achieving culture conversion in pts w/ tx refractory highly resistant pulmonary TB

significant side effects

37
Q

Capreomycin:
ADEs
what is the max dose in the elderly?

A

ototoxicity, nephrotoxicity

dose in older pts should not exceed 750

38
Q

Clofazimine:
what is it active against?
ADEs

A

Active against leprosy, M avium complex, TB

ADEs:
N/V, abdominal pain, skin discoloration

39
Q

Cycloserine:
MOI
when is it used?
ADEs

A

MOI: bacteriostatic

used in TB re-treatment and MDR TB

ADEs:
CNS dysfunctions
psychotic reactions

40
Q

Ethionamide:
MOI
when is it used?
ADEs

A

MOI: bacteriostatic

used in combination therapy

ADE:
marked gastric irritaiton

41
Q

Fluoroquinolones: Moxifloxacin
what is it active against?
when would we consider using it?

A

active against TB

efficacious in patients unable to take inh, rif, pza

rapid emergence of resistance in some series

6mo of long acting rifamycin, rifapentine w/ moxifloxacin = effective as standard TB therapy

42
Q

How many drugs do we use to treat LATENT TB?

Which drugs do we use to treat LATENT TB?

A

MONOTHERAPY can be used only for infected patients who do NOT have active TB

rifampin, isoniazid

43
Q

Rifamycin: Rifabutin:

what is it used for?

A

disseminated Mavium infection in AIDs patients
TB
pts receiving protease inhibitors

44
Q

Rifamycin: Rifapentine:
what is it?
when do we use it?

A

long acting rifamycin

used once weekly in continuation phase in HIV- pts

PHA 550 (26 decks)

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