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Flashcards in Tb Deck (41)
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1
Q

Tb is what type of bacteria

A

Aerobe Acid fast bacili

2
Q

hiv/aids riks for tb is

A

10% every year

3
Q

Left untreated each person with active TB disease will infect between

A

10 to 15 people every year

4
Q

Negative for ppd skin test

A

can react to other microbacteria

5
Q
HIV+ (or IVDU and unknown HIV)
Close contact of active case
Fibrotic CXR lesions
Persons on steroids/immunosuppressive drugs
Transplant patients
A

> 5mm

6
Q
High prevalence country
IVDU and HIV negative
Medically underserved
Long-term care facilities
Healthcare workers
A

> 10mm

7
Q

Normal reactive size

A

> 15mm

8
Q

Complexities impacting tb

A

immigration
*immunosuppression drugs
non-compliance
MDR/XDR (resistance)

9
Q

Describe new blood test for TB

A
Interferon release gamma assays
1- take blood 
2- expose blood mononuclear cells to antigen
3- look for sign of immune response
ELISA OR ELISPOT
10
Q

benefits to igra

A

results in 24 hour with out return visit
not subject to biases or error
increase acceptacne to treatemtn for LTBI

11
Q

Latent vs active TB

A
 Cough (3 weeks or longer)
 Hemoptysis
 Unexplained weight loss
 Fever/chills/night sweats (drenching)
 Chest pain
 Fatigue
 Loss of appetite
12
Q

Treatment for LTBI

A

RIFAPENTINE 900mg once weekly x12weeks and Isoniazid

13
Q

Directly Observed Therapy (DOT)

A

Watch patient take medications

14
Q

Active TB workup

A

cxr

acid fast sputum with abdnormal cxr

15
Q

Active TB workup

A

cxr
acid fast Bacili sputum stain with abdnormal cxr
higher the number more positive

16
Q

tympically takes 8-10weeks for sputum culture what else can be done quicker

A

use PCR to start treatment earlier

17
Q

Active TB treatment

A
RIPE
rIFAMPIN
Isoniazid
Pyrazinamide
Ethambutol
18
Q

When can Pyrazinamide and Ethambutol be discontinue

A

all 4 drugs can be used for 2 months if no resistance discontinue P & E

19
Q

How long is Active TB treated

A

6 months

20
Q

How long is active tb treated in cavitary dz or patients with HIV

A

9 months if cavitation is continued to be seen on CXR every 2 months

21
Q

Precautions that should be used even after treatemen

A

airborn

22
Q

How long after starting treatment can ppl come out of quarentine

A

2weeks

must be symptomatic to spread

23
Q

what screening is important for Ethambutol use

A

baseline and periodic color vision

24
Q

What vitamin deficiency can be risk factor for TB

A

VIT D

25
Q

Is there evidence that treating vit d Deficiency prevents TB

A

NO

26
Q

What benefit does giving vit d supplement to TB patients with normal vit D provide

A

none

27
Q

Tb infection control plan designed to ensure

A

Prompt detection of infectious patients
-Airborne precautions (; neg air, PPE, UV)
-Treatment of people suspected/
confirmed TB

28
Q

some who has had BCG, asympotomatic with positive PPD and positive blood test may see

A

LTBI

many ppl from other countries will have BCG

29
Q

WHO does not recommend use of BCG in countries with

A
  • annuanl positive TB rate under 5/100,000
  • average children with TB menigitis under 5 below 1/10m
  • avereage annual risk of TB below 0.1%
30
Q

10 years after someone receives BCG for TB prophylaxis will the PPD look like? should different test be used?

A

may still be right under 10mm, Interferon gamma release assay should be used

31
Q

Insoniazid side effects and consideration

A

SE: rash, lupus like syndrome, liver enzyme elevation, hepatitis, peripheral neuropathy,

Considerations: Hepatitis risk increases with age and ETOH; Pyridoxine prevent neuropathy;adjust for kidney injuries

32
Q

Rifampin side effects and considerations

A

SE: rash, hepatits, GI upset

Considerations: care with protease inhibitorss and NNRTIs;

-change urine orange

33
Q

Rifapentine side effects and considerations

A

SE: rash, hepatitis, GI upset

Considerations: Contraindicated in HIV positive patients (failure and relapse)

34
Q

Rifabutin side effects and considerations

A

SE: Rash, Hepatitis, thrombocytopenia, severe arthralgia, uveitis, leukopenia

Considerations: adjust with protease inhibitors and NNRTIs;
-HAART drugs should be monitored for toxicity and effectiveness;

35
Q

Pyrazinamide side effects and considerations

A

SE: Rash, Hepatitis, GI upset, hyperuricemia

Considerations: Glucose control difficult
adjust for kidney injury

36
Q

Ethambutol side effects and considerations

A

SE: optic neuritis, rash

considerations: baseline and periodic vision acuity and color screen
Adjust for kidney injury

37
Q

Second line TB agent:

Streptomycin and Capreomycin

A

SE: auditory vestibular and kidney toxic

Consideration: Avoid (strepto) or reduce in age >59; monitor kidney and hearing (both meds)

38
Q

Second line TB agent:

Cycloserine

A

SE: psychosis, convulsions depression, HA, rash drug interactions
Considerations: pyridoxine by help with CNS side effects; monitor serurm drug levels

39
Q

Second line Tb agent:

Ethionamide

A

SE: hypersensitiviy, hepatotoxicity, GI upset

Consideration: hypothyroidism

40
Q

Second line TB agents;

levofloxacin, moxifloxacin, gatifloxacin

A

SE: Hypersensitivity, GI upset, drug interactions

Consideratoin: NOT FDA APPROVED

41
Q

Second line TB agents:

Para-aminosalicylic acid

A

SE; hypersensitiviy, Hepatotoxiciy, GI upset

Consideration: hypothyroidism
monitor LFT