TB

Question 1

What is the general duration for TB tx? (short or long)

Why is this?

Answer 1

• long tx

- they. are a slow growing bacteria

Question 2

Does a positive acid fast smear = positive for TB

Answer 2

no this only indicated the presence of mycobacterium

Question 3

What is the difference in the diagnostic criteria for active vs latent TB?

Answer 3

I really don’t know what mare bare is looking for here considering the self study quiz answer….

Question 4

What are the 3 different tx options for latent TB according to the CDC?

Answer 4

1. NIH alone daily for 6-9 mo (9 mo preferred, 6 mo not for kids)
2. NIH + rifapentine taken weekly for 12 wks
3. rifampin daily for 4 mo –> NIH resistant TB, or cannot take NIH

Question 5

Why should we tx TB with at least 2 drugs?

Answer 5

decreases the change of the bacteria developing resistance –> it would have to undergo 2 subsequent mutations specific to the treatment which is unlikely

Question 6

Which 4 drugs are typically given as induction therapy for active TB?

Answer 6

• NIH
• rifampin
• pyrazinamide
• ethambutol

Question 7

What is the minimal treatment time for active TB

What about MDR TB

Answer 7

• minimal : 6 mo

- MRD-TB : up to 24 mo or until sputum cultures become negative

Question 8

When is second line drug theory used?

Answer 8

• resistance occurs to first line agents

- severe pulmonary and disseminated TB infections

Question 9

MDR-TB is resistant to what 2 medications?

Answer 9

• NIH

- rifampin

Question 10

XDR-TB is resistance to which drugs (2 specific, 2 categories)

Answer 10

• NIH
• rifampin
• all fluoroquinolone
• at least 1 of the injectable 2nd line anti TB drugs

Question 11

What is directly observed therapy? How does it and intermittent dosing impact TB tx?

Answer 11

• DOT : pt is observed while taking their meds
• intermittent dose : dosing is 2-3 times / wk
• this is very important in promoting adherence

Question 12

How are the drugs used to treat TB selected for the pt?

Answer 12

• ideally : from culture and sensitivity tests –> take a LONG time
• until then –> empirically based on : patterns of drug resistance in the community, and the immunocompetence of the pt

Question 13

In which phase of TB tx are we working to actively eliminate dividing extracellular TB?
This phase is over when we achieve what?

Answer 13

• induction phase

- non-infectious sputum sample

Question 14

In which phase of TB tx does elimination of intracellular bacteria occur?

Answer 14

• continuation

Question 15

Which drug can cause a deficiency in Vit B6?

How would a pt with this deficiency present?

Answer 15

• NIH

- peripheral neuropathy

Question 16

Which drug would be most appropriate for a pt with severe liver cirrhosis?

Answer 16

• ethambutol

Question 17

NIH is a CYP inhibitor, what 3 drugs are of concern for a drug drug interaction?

Answer 17

• phenytoin
• diazepam
• carbamazepine

Question 18

Which drug should be given on an empty stomach?

Answer 18

rifampin

Question 19

Which drug can potentially interaction with OCP, warfarin, protease inhibitors, and NNRTIs?

Answer 19

rifampin

Question 20

What is the most common SE associated with NIH?
rifampin?
pyrazinamide?

Answer 20

• NIH : peripheral neuropathy
• Rif : red/orange discoloration of body fluids
• pry : pain in multiple joints

Question 21

What drug can cause optic neuritis? What problem can this cause?

Answer 21

• ethambutol

- blurred vision, constricted field of vision, color discrimination problems