Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Spring 2015 PNT Exam 5 > Tb > Flashcards

Tb Flashcards

1
Q

Tb caused by

A

Mycobacterium tuberculosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define latent Tb

A

exposed but immune system keeps in check.
asymptomatic
+/- PPD and granulomas on CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

define Active Tb

A

organisms released from granulomas and begin mutltiplying extracellularly
usually within 2 years of infection
symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

2 main risk factors for active Tb

A

recently exposed

weakened immune system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

5 categories of recently exposed

A

close contacts of TB cases
immigrants from contries with high TB rates
Children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

factors for weakened immune system

A 
hiv
substance abuse
transplant recipients
DM
renal failure
malignancies
immunosuppressive drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

s/s of TB

A

weight loss
productive cough
fever/night sweats
hemoptysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PE findings for TB

A

dullness in chest percussion
rales
vocal fremitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CXR findings in TB

A

patchy or nodular infiltrates
cavitation
miliary tb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

% of patients with active TB who will be negative on PPD

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

dose of PPD

A

5 tuberculin unit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

alternate names for PPD

A

mantoux test
tuberculin skin test
tuberculin purified protien derivative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

5 categories who are PPD + with 5 mm induration

A

HIV +
recent contact with TB case
fibrotic changes on CXR suggesting prior TB
Organ transplant recipients
> or = 15 mg/day of prednisone or equivalent for at least 1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

categories who are PPD+ with 10 mm induration

A

Recent immigrants (within 5 years, from high prevalence countries)
IVDU
residents of institutions (prisons, nursing homes, long term hospital, AIDS residences, homeless shelters)
mycobacteria lab personnel
DM, CRF, malignancies
children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

categories who are PPD+ with > or = 15 mm induration

A

no risk factors

employees of institutions as long as otherwise low risk and negative PPD at start of employment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

categories who are PPD+ with > or = 15 mm induration

A

no risk factors

employees of institutions as long as otherwise low risk and negative PPD at start of employment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Alternative tests to PPD

A

Interferon gamma release assays:
Quantiferon - TB gold
T-spot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

when is interferon gamma release assay preferred

A

unlikely to return for PPD reading

received BCG vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when is PPD preferred

A

children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

treatment of choice for latent TB

A

isoniazide
300 mg daily x 6/9 months
900 mg twice weekly x 6/9 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

who receives 9 months of treatment for active tb

A

HIV
fibrotic lesions
children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

alternative treatments for latent TB

A

isonazide and rifapentine (weekly) x 3 months

Rigampin or rifabutin x 4 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is not recommended for latent TB treatment

A

rifampin and pyrazinamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

when is DOT used

A

any regiment that is less than once daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what is the purpose of DOT
reduce public health implications | reduce risk of resistance
26
what is the purpose of DOT
reduce public health implications | reduce risk of resistance
27
First line treatment for active TB
Rifampin/rifabutin x 6 months + isoniazide x 6 months + pyrazindamide x 2 months + Ethambutol x 2 months (or until susceptibility to RIF and INH is known)
28
Who is ineligble for weekly INH + rifapentine for continuation
HIV positive extrapulmonary TB cavitary lesions on initial CXR AFB smear positive after initial phase
29
Who is ineligble for weekly INH + rifapentine for continuation
HIV positive extrapulmonary TB cavitary lesions on initial CXR AFB smear positive after initial phase
30
Rifampin MOA
inhibits bacterial RNA synthesis dose dependent killing bactericidal
31
rifampin AEs
``` elevated LFTs Hyperbilirubinemia Rash Flu-like symptoms (dose dependent) Thrombocytopenia, leukopenia, anemia Allergic reactions ```
32
Rifampin metabolism
substrate of: PGP and SLCO1B1 | inducer of: 3A4, 1A2, 2A6, 2B6, 2C19, 2C8, 2C9, and PGP
33
Rifampin monitoring
LFTs and bilirubin at baseline and q2-4 weeks | CBC at baseline and q2-4 weeks
34
rifampin counseling
``` empty stomach orange-red secretions flu-like symptoms jaundice fatigue N/V ```
35
which rifamycin is choice in HIV+ patients on ARVs
rifabutin
36
When is rigapentine used
in continuation phase only
37
When is rifapentine used
in continuation phase only
38
Isoniazid MOA
inhibits mycolic acid synthesis -> cell wall disruption bactericidal - rapid growing bacteristatic - slow growing
39
isoniazid BBW
hepatitis within first 3 months age related other risk factors
40
Isoniazid AEs
``` Peripheral neuropathy (dose related) Elevated LFTs ```
41
What is given to prevent isoniazid peripheral neuropathy
pyridoxine -> HIV, DM, pregnancy, alcoholics
42
Isoniazid metabolism
substrate and inducer of 2E1
43
Drug interactions with isoniazid
``` carbamezapine citalopram clopidogrel phenytoin warfarin ```
44
isoniazid monitoring
LFTs at baseline + if increased risk for hepatotoxicity
45
isoniazid counseling
empty stomach | s/s of hepatitis (fatigue, weakness, malaise, anorexia, N/V, abdominal pain, jaundice)
46
Prazinamide MOA
lowers pH of environment | static/cidal depending on growth phase and concentration
47
Pyrazinamide dose adjust
renal impairment CrCl
48
Pyrazinamide dose adjust
renal impairment CrCl
49
Pyrazinamide AEs
hepatotoxicity (dose related) GI distress arthralgias increased uric acid
50
Pyrazinamide drug interactions
increased hepatotoxicity with rifampin
51
monitoring for pyrazinamide
LFTs | serum uric acid
52
counseling for pyrazinamide
``` N/V loss of appetite jaundice joint pain blood in urine/easy bruising ```
53
counseling for pyrazinamide
``` N/V loss of appetite jaundice joint pain blood in urine/easy bruising ```
54
ethambutol MOA
inhibits arabinosyl transferase -> cell wall synthesis | bacteriostatic
55
dose adjust for ethambutol
CrCl
56
dose adjust for ethambutol
CrCl
57
Ethambutol AEs
``` optic neuritis (acuity / color green) GI upset dizziness malaise hepatic/renal toxicity ```
58
ethambutol drug interations
antacids decrease absorption
59
ethambutol monitoring
baseline and monthly visual exams | renal and hepatic function at baseline
60
Ethambutol counseling
take with meals - not antacids GI distress, dizziness, drowsiness report visual changes
61
when is active TB treated for 9 months
cavitary disease initial phase excludes PZA INH and rifapentine weekly used for continuation with positive culture at end of inital phase HIV infected with positive culture after initial phase
62
when is active TB treated for 9 months
cavitary disease initial phase excludes PZA INH and rifapentine weekly used for continuation with positive culture at end of inital phase HIV infected with positive culture after initial phase
63
Monitoring TB treatment
``` sputum q2weeks sputum monthly - AFB smear and culture repeat drug susceptibilities if culture positive after 3 months repeat CXR if culture negative Adherence and AE assessments SCr, LFTs, bilirubin, plts ```
64
Monitoring TB treatment
``` sputum q2weeks sputum monthly - AFB smear and culture repeat drug susceptibilities if culture positive after 3 months repeat CXR if culture negative Adherence and AE assessments SCr, LFTs, bilirubin, plts ```
65
define relapse
cultures become negative with treatment, but when finished treatment: cultures become positive again / s/s of active TB
66
when does relapse normally occur
first 6-12 months after treatment completion
67
Who is at risk for relapse
cavitation on initial CXR | culture positive at the end of initial phase
68
Who is at risk for relapse
cavitation on initial CXR | culture positive at the end of initial phase
69
define treatment failure
cultures positive after 4 months of treatment with ensured ingestion
70
how to manage treatment failure
add at least 2 second-line drugs | drug susceptibilitt
71
define MDR-TB
resistant to at least isoniazid and rifampin
72
risk factors of MDR-TB
``` prior TB treatment, failure, or relapse areas of high TB resistance homelessness institutionalized IVDU HIV+ sputum positive for AFB after 1-2 months of therapy positive cultures after 2-4 months of therapy known exposure to MDR-TB ```
73
areas of high TB resistance
``` south africa mexico southeast asia baltic countries former soviet states ```
74
define XDR-TB
resistant to at least isoniazid, rifampin, 1 FQ, and one second-line injectable: amikacin/kanamycin streptomycin capreomycin
75
second line agents for Active TB
``` levofloxacin moxifloxacin amikacin kanamycin streptomycin ```
76
options for drug resistant TB
``` capreomycin ethionamide cycloserine p-aminosalicylic acid bedaquiline ```
77
aminoglycosides cross resistance
only between amikacin/kanamycin
78
AE concerns with aminoglycosides
nephrotoxicity | ototoxicity
79
AEs of capreomycin
nephrotoxicity ototoxicity eosinophilia (dose related)
80
Ethionamide MOA
inhibits peptide synthesis | bacteriostatic
81
Ethionamide AEs
``` GI toxicity (dose limiting) goiter hypothyroid gynecomastia alopecia impotence menorrhagia photodermatitis acne hyperglycemia ```
82
Ethionamide AEs
``` GI toxicity (dose limiting) goiter hypothyroid gynecomastia alopecia impotence menorrhagia photodermatitis acne hyperglycemia ```
83
cycloserine moa
inhibits cell wall synthesis | cidal or static
84
cycloserine AEs
``` dose limiting CNS toxicity lethargy confusion unusual behavior seizure ```
85
p-Aminosalicylic acid MOA
competitive antagonism of PABA | static
86
P-aminosalicylic acid AEs
GI (diarrhea x 1-2 weeks) goiter hypersensitivity hepatitis
87
bedaquiline fumurate brand name
sirturo
88
bedaquiline moa
inhibits proton transfer chain of ATP synthase required for energy genration static at low conc. cidal at high
89
When is DOT required for bedaquiline
ALWAYS!!!!
90
bedaquiline BBW
arrhythmia - QT prolongation | increase in mortality
91
bedaquiline AEs
``` hepatotoxicity HA arthralgia N/V hyperuricemia ```
92
Bedaquiline metabolism
CYP 3A4
93
drugs not used for TB
macrolides | beta lactams
94
when are corticosteroids used for TB
reduce inflammation - | CNS/pericaridal TB
95
treating children with TB
same as adults without EMB dose on mg/kg DOT
96
treatings preggos with TB
Treat active only. Isoniazid, rifampin, ethambutol x 9 months avoid streptomycin and FQs

Spring 2015 PNT Exam 5 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions