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967 Block 3 - Pulmonary > TB > Flashcards

TB Flashcards

(57 cards)

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1
Q

What is the staining results of mycobacterium tuberculosis?

A

acid fast

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2
Q

Mycobacterium tuberculosis is very slow growing (T/F)

A

True

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3
Q

What species are reservoirs for mycobacterium tuberculosis?

A

only humans

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4
Q

How is TB transmitted?

A

horizontal transmission via respiratory droplets

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5
Q

Patients must be kept in what type of isolation?

A

respiratory

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6
Q

What factors affect the transmission of TB?

A
  • infectiousness of patient
  • environmental conditions
  • duration of exposure
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7
Q

Most exposed persons become infected with TB. (T/F)

A

False, most do not

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8
Q

Define LTBI.

A
  • Once inhaled, bacteria travel to lung alveoli and establish infection.
  • 2-12 weeks after infection, immune response limits activity; infection is detectable.
  • Bacteria are potentially viable for years
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9
Q

LTBI patients are asymptomatic and non-infectious. (T/F)

A

True

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10
Q

What factors increase the risk for infectiousness?

A
  • coughing
  • cavitation on X-ray
    • acid-fast bacilli sputum smear result
  • inadequate TB treatment
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11
Q

What is a cavitation?

A

TB gets walled off by immune system in the lung

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12
Q

When do you test for TB?

A
  • HIV
  • IV drug use
  • homeless
  • incarcerated
  • contact with persons with TB
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13
Q

When should you treat a patient with LTBI?

A

always

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14
Q

When is a PPD of ≥ 5mm a positive test?

A
  • recent close contact
  • HIV+
  • chest X-ray shows healed TB
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15
Q

When is a PPD of ≥ 10 mm a positive test?

A
  • IV drug users
  • homeless shelter
  • arrived within 5 years from country with high prevalence
  • low income
  • children < 4
  • minors exposed to high risk adults
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16
Q

When is a PPD of ≥ 15 mm a positive test?

A

always

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17
Q

What are the signs/symptoms of active TB?

A
  • weight loss
  • fatigue
  • productive cough
  • fever
  • night sweats
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18
Q

What are the lab results of active TB?

A
  • moderate WBC elevation

- lymphocyte predominance

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19
Q

What does the chest radiograph of active TB look like?

A
  • patchy or nodular infiltrates in upper lobes

- cavitation

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20
Q

If you suspect your patient has active TB, what tests should you run?

A
  • AFB stain
  • culture
  • susceptibility testing
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21
Q

When should a patient be placed in respiratory isolation?

A
  • suspected or confirmed smear-positive
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22
Q

When is a patient considered noninfectious?

A
  • effective therapy
  • clinical improvement
  • negative results for 3 consecutive sputum AFB on different days
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23
Q

What are the first line drugs?

Study These Flashcards
A
  • Isoniazid (INH)
  • Rifampin (RIF)
  • Pyrazinamide (PZA)
  • Ethambutol (EMB)
  • Rifapentine (RPT)
24
Q

What are the 2 phases of drug therapy?

Study These Flashcards
A
  • initial

- continuation

25
What is the duration of the initial phase?
2 months
26
What is the main regimen for the initial phase?
INH + RIF + PZA + EMB
27
When can EMB be dropped from regimen?
When bacteria is susceptible to INH, RIF, PZA.
28
What is the duration of the continuation phase?
4 months
29
What are the 2 main continuation regimens?
- INH + RIF | - INH + RPT
30
How frequently is RPT administered?
weekly
31
When might the continuation phase be extended to 7 mo?
1. initial chest X-ray shows cavitation and culture + at 2 months 2. used only INH/RIF/EMB in initial phase 3. Culture + at 2 mo and want to use 1x/week INH and RPT
32
Why might someone choose 1x/week INH/RPT?
Otherwise, you may be required to take dose in front of healthcare worker - directly observed therapy
33
When might you treat a culture negative patient?
- abnormal chest X-ray - clinical symptoms - no other diagnosis - + TB skin test
34
What should patients with negative culture but high suspicion of TB be treated with?
placed on initial phase regimen: INH/RIF/EMB/PZA for 2 months
35
In patients with active TB, when should we do sputum collection for AFB and culture?
- AFB smear daily until out of isolation - AFB smear q 1-2 weeks to assess early response - culture initially and at 2 mo, then monthly until negative
36
When should a second drug-suseptability test be conducted?
culture positive after 3 mo of treatment
37
What needs to be tested if on EMB for > 2 mo?
visual acuity and color vision monthly
38
When should a chest X-ray be repeated?
- culture negative: at completion of initial treatment phase and at the end of treatment - culture positive: none
39
What is the treatment of choice for LTBI?
INH x 6 – 9 mo
40
What is the new recommendation of LTBI treatment?
INH weekly + RPT weekly with DOT for 12 mo
41
What are risk factors for drug resistant TB?
- prior TB therapy - from high resistance area - homeless/institutionalized/ IV drug use/ HIV infection - failed or relapsed treatment - known MDR-TB exposure
42
What is done if pt is resistant to INH?
- RIF + PZA + EMB for 6 – 9 mo - can sub SM for EMB - RIF + EMB + ( optional 2nd line) for 12 mo
43
How is MDR-TB defined?
resistant to INH + RIF
44
How is MDR-TB treated?
- consult specialist | - ≥ 4 susceptible drugs
45
How is XDR-TB defined?
- resistant to INH and RIF and FQ plus one injectable drug
46
How is "treatment failure" defined?
positive cultures after 4 months of treatment and ensured compliance
47
How is a treatment failure resolved?
- Add at least 3 new drugs to existing regimen - retest for drug resistance - no single drug should ever be added
48
What are ADRs associated with isoniazid?
- hepatitis | - peripheral neuropathy
49
What is a major counseling point for patients taking isoniazid?
NO alcohol
50
What are ADRs associated with Rifampin?
- GI - skin rash - hepatitis - thrombocytopenia
51
What is a major counseling point for Rifampin?
colors all body fluids red/orange and can stain clothing and contacts
52
What are ADRs associated with Pyrazinamide?
- hepatic injury - hyperuricemia - rash - GI upset
53
Which 2 drugs when used in combination are linked to severe liver toxicity?
Pyrazinamide and Rifampin
54
What are ADRs associated with Ethambutol?
- retrobulbar neuritis (monitor visual acuity)
55
In what cases can you use rifampentine?
- used once weekly with INH in continuation - HIV negative - negative sputum smears following initial phase
56
In what patient population is Rifabutin used commonly in?
HIV+
57
What drug is newly approved for drug-resistant TB?
Bedaquiline (Sirturo)

967 Block 3 - Pulmonary (3 decks)

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