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Spring 2015 PNT Exam 5 > Tb > Flashcards

Tb Flashcards

1
Q

Tb caused by

A

Mycobacterium tuberculosis

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2
Q

Define latent Tb

A

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

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3
Q

define Active Tb

A

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

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4
Q

2 main risk factors for active Tb

A

recently exposed

weakened immune system

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5
Q

5 categories of recently exposed

A

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

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6
Q

factors for weakened immune system

A 
hiv
substance abuse
transplant recipients
DM
renal failure
malignancies
immunosuppressive drugs
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7
Q

s/s of TB

A

weight loss
productive cough
fever/night sweats
hemoptysis

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8
Q

PE findings for TB

A

dullness in chest percussion
rales
vocal fremitus

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9
Q

CXR findings in TB

A

patchy or nodular infiltrates
cavitation
miliary tb

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10
Q

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

A

20%

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11
Q

dose of PPD

A

5 tuberculin unit

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12
Q

alternate names for PPD

A

mantoux test
tuberculin skin test
tuberculin purified protien derivative

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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

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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

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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

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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

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17
Q

Alternative tests to PPD

A

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

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18
Q

when is interferon gamma release assay preferred

A

unlikely to return for PPD reading

received BCG vaccine

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19
Q

when is PPD preferred

A

children

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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

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21
Q

who receives 9 months of treatment for active tb

A

HIV
fibrotic lesions
children

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22
Q

alternative treatments for latent TB

A

isonazide and rifapentine (weekly) x 3 months

Rigampin or rifabutin x 4 months

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23
Q

what is not recommended for latent TB treatment

A

rifampin and pyrazinamide

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24
Q

when is DOT used

A

any regiment that is less than once daily

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25
Q

what is the purpose of DOT

A

reduce public health implications

reduce risk of resistance

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26
Q

what is the purpose of DOT

A

reduce public health implications

reduce risk of resistance

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27
Q

First line treatment for active TB

A

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)

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28
Q

Who is ineligble for weekly INH + rifapentine for continuation

A

HIV positive
extrapulmonary TB
cavitary lesions on initial CXR
AFB smear positive after initial phase

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29
Q

Who is ineligble for weekly INH + rifapentine for continuation

A

HIV positive
extrapulmonary TB
cavitary lesions on initial CXR
AFB smear positive after initial phase

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30
Q

Rifampin MOA

A

inhibits bacterial RNA synthesis
dose dependent killing
bactericidal

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31
Q

rifampin AEs

A 
elevated LFTs
Hyperbilirubinemia
Rash
Flu-like symptoms (dose dependent) 
Thrombocytopenia, leukopenia, anemia
Allergic reactions
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32
Q

Rifampin metabolism

A

substrate of: PGP and SLCO1B1

inducer of: 3A4, 1A2, 2A6, 2B6, 2C19, 2C8, 2C9, and PGP

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33
Q

Rifampin monitoring

A

LFTs and bilirubin at baseline and q2-4 weeks

CBC at baseline and q2-4 weeks

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34
Q

rifampin counseling

A 
empty stomach
orange-red secretions
flu-like symptoms
jaundice
fatigue
N/V
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35
Q

which rifamycin is choice in HIV+ patients on ARVs

A

rifabutin

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36
Q

When is rigapentine used

A

in continuation phase only

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37
Q

When is rifapentine used

A

in continuation phase only

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38
Q

Isoniazid MOA

A

inhibits mycolic acid synthesis -> cell wall disruption
bactericidal - rapid growing
bacteristatic - slow growing

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39
Q

isoniazid BBW

A

hepatitis within first 3 months
age related
other risk factors

40
Q

Isoniazid AEs

A 
Peripheral neuropathy (dose related) 
Elevated LFTs
41
Q

What is given to prevent isoniazid peripheral neuropathy

A

pyridoxine -> HIV, DM, pregnancy, alcoholics

42
Q

Isoniazid metabolism

A

substrate and inducer of 2E1

43
Q

Drug interactions with isoniazid

A 
carbamezapine
citalopram
clopidogrel
phenytoin
warfarin
44
Q

isoniazid monitoring

A

LFTs at baseline + if increased risk for hepatotoxicity

45
Q

isoniazid counseling

A

empty stomach

s/s of hepatitis (fatigue, weakness, malaise, anorexia, N/V, abdominal pain, jaundice)

46
Q

Prazinamide MOA

A

lowers pH of environment

static/cidal depending on growth phase and concentration

47
Q

Pyrazinamide dose adjust

A

renal impairment CrCl

48
Q

Pyrazinamide dose adjust

A

renal impairment CrCl

49
Q

Pyrazinamide AEs

A

hepatotoxicity (dose related)
GI distress
arthralgias
increased uric acid

50
Q

Pyrazinamide drug interactions

A

increased hepatotoxicity with rifampin

51
Q

monitoring for pyrazinamide

A

LFTs

serum uric acid

52
Q

counseling for pyrazinamide

A 
N/V
loss of appetite
jaundice
joint pain
blood in urine/easy bruising
53
Q

counseling for pyrazinamide

A 
N/V
loss of appetite
jaundice
joint pain
blood in urine/easy bruising
54
Q

ethambutol MOA

A

inhibits arabinosyl transferase -> cell wall synthesis

bacteriostatic

55
Q

dose adjust for ethambutol

A

CrCl

56
Q

dose adjust for ethambutol

A

CrCl

57
Q

Ethambutol AEs

A 
optic neuritis (acuity / color green) 
GI upset
dizziness
malaise
hepatic/renal toxicity
58
Q

ethambutol drug interations

A

antacids decrease absorption

59
Q

ethambutol monitoring

A

baseline and monthly visual exams

renal and hepatic function at baseline

60
Q

Ethambutol counseling

A

take with meals - not antacids
GI distress, dizziness, drowsiness
report visual changes

61
Q

when is active TB treated for 9 months

A

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
Q

when is active TB treated for 9 months

A

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
Q

Monitoring TB treatment

A 
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
Q

Monitoring TB treatment

A 
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
Q

define relapse

A

cultures become negative with treatment, but when finished treatment: cultures become positive again / s/s of active TB

66
Q

when does relapse normally occur

A

first 6-12 months after treatment completion

67
Q

Who is at risk for relapse

A

cavitation on initial CXR

culture positive at the end of initial phase

68
Q

Who is at risk for relapse

A

cavitation on initial CXR

culture positive at the end of initial phase

69
Q

define treatment failure

A

cultures positive after 4 months of treatment with ensured ingestion

70
Q

how to manage treatment failure

A

add at least 2 second-line drugs

drug susceptibilitt

71
Q

define MDR-TB

A

resistant to at least isoniazid and rifampin

72
Q

risk factors of MDR-TB

A 
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
Q

areas of high TB resistance

A 
south africa
mexico
southeast asia
baltic countries
former soviet states
74
Q

define XDR-TB

A

resistant to at least isoniazid, rifampin, 1 FQ, and one second-line injectable: amikacin/kanamycin
streptomycin
capreomycin

75
Q

second line agents for Active TB

A 
levofloxacin
moxifloxacin
amikacin
kanamycin
streptomycin
76
Q

options for drug resistant TB

A 
capreomycin
ethionamide
cycloserine
p-aminosalicylic acid
bedaquiline
77
Q

aminoglycosides cross resistance

A

only between amikacin/kanamycin

78
Q

AE concerns with aminoglycosides

A

nephrotoxicity

ototoxicity

79
Q

AEs of capreomycin

A

nephrotoxicity
ototoxicity
eosinophilia (dose related)

80
Q

Ethionamide MOA

A

inhibits peptide synthesis

bacteriostatic

81
Q

Ethionamide AEs

A 
GI toxicity (dose limiting) 
goiter
hypothyroid
gynecomastia
alopecia
impotence
menorrhagia
photodermatitis
acne
hyperglycemia
82
Q

Ethionamide AEs

A 
GI toxicity (dose limiting) 
goiter
hypothyroid
gynecomastia
alopecia
impotence
menorrhagia
photodermatitis
acne
hyperglycemia
83
Q

cycloserine moa

A

inhibits cell wall synthesis

cidal or static

84
Q

cycloserine AEs

A 
dose limiting CNS toxicity 
lethargy
confusion
unusual behavior
seizure
85
Q

p-Aminosalicylic acid MOA

A

competitive antagonism of PABA

static

86
Q

P-aminosalicylic acid AEs

A

GI (diarrhea x 1-2 weeks)
goiter
hypersensitivity
hepatitis

87
Q

bedaquiline fumurate brand name

A

sirturo

88
Q

bedaquiline moa

A

inhibits proton transfer chain of ATP synthase required for energy genration
static at low conc. cidal at high

89
Q

When is DOT required for bedaquiline

A

ALWAYS!!!!

90
Q

bedaquiline BBW

A

arrhythmia - QT prolongation

increase in mortality

91
Q

bedaquiline AEs

A 
hepatotoxicity
HA
arthralgia
N/V
hyperuricemia
92
Q

Bedaquiline metabolism

A

CYP 3A4

93
Q

drugs not used for TB

A

macrolides

beta lactams

94
Q

when are corticosteroids used for TB

A

reduce inflammation -

CNS/pericaridal TB

95
Q

treating children with TB

A

same as adults without EMB
dose on mg/kg
DOT

96
Q

treatings preggos with TB

A

Treat active only.
Isoniazid, rifampin, ethambutol x 9 months
avoid streptomycin and FQs

Spring 2015 PNT Exam 5 (6 decks)

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