TB 2 Flashcards
who should not use isoniazide
someone with an AST or ALT 6-8 times normal
what should always be given in combination with isoniazide? why
vitamin B6 (pyridoxine) prevent neurotoxic side effects
what does rifampin compete with for uptake by hepatocytes
bilirubin
what are two major adverse effects of pyraxinamide
hepatotoxicity hyperuricemia (avoid with gout)
which TB drug has no risk of hepatotoxicity?
what risk does it have?
ethambutol
optic neuritis
what is the least likely to be resistant of all first line TB agents
ethambutol
what are the non-pharm steps for TB
- respiratory isolation = prevent spread
- contact investigation
- return pt. to state of normal weight
what are steps of treatment of active TB in initial phase
- obtain smears and cultures
- 4 drug regimen for 2 months
- smears and cultures at end of 2 months
how long do TB cultures take to get results?
how long for smears?
cultures = 6-8 weeks
smears immediate results
what are the 4 drugs in TB regimen
- isoniazid
- rifampin
- pyrazinamide
- ethambutol
what are steps of treatment of active TB in continuation phase
- check for cavities in chest xray or positive smear
- if culture is negative continue isoniazid and rifampin for 4 more months (6 months of treatment)
- if culture is positive continue isoniazid and rifampin for 7 more months (9 months of treatment)
(same treatment if xrays or smear are negative)
what are 4 things to do/ note with drug resistant TB
- consult TB specialist
- avoid monotherapy
- avoid adding only a single agent at a time
- try and use at least 3 previously unused, susceptible drugs
how is monitoring response to TB therapy done
- smears and cultures monthly until 3 are negative
- follow up at 6 months and 1 year after therapy
- if still positive after treatment consult ID specialist
how is latent TB treated
isoniazid for 9 months and no alcohol for that time
what is the option for latent TB treatment if isoniazid is not tolerated
rifampin
