TB - Drugs Flashcards Preview

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Flashcards in TB - Drugs Deck (25):
1

TB Skin Test (TST) (PPD)
- Give
- Read

- Give intra-dermal
- Read 48-72H after it's given

2

CXR

- Assisted with locating infected areas of lungs in active TB or to rule out active TB if PPD+

3

TB Blood tests

- QuantiFERON-TB Gold in Tube test (GFT-GIT)
- T-SPOT TB test

=> Expensive & only if pt can't come back in 2 days

4

Acid Fast Bacilli (AFB)

- To test for TB
- AFB + means active TB

5

S/S of TB

- Chronic cough
- Fever
- Weight loss
- Night sweats
- Fatigue
- Hemolysis: cough up blood

6

5mm = + for

10mm

15mm

5mm
- Low immunity: HIV & steroid therapy
- High risk for TB infection: close contact w/ a TB person

10mm
- DM
- CKD
- Health care workers

15mm
- Everyone else

7

BCG

- Bacillus of Calmette and Guerin (BCG) is a vaccine against TB given in countries with high prevalence of TB

=> make the pt has PPD+ but may wear off after years

8

What is?

- Thiamine
- Ravin
- Niacin
- Pyridoxine
- Folic
- Cyanabolic

**The Rabi Need Prayer for Comfort**
- Thiamine: B1
- Ravin: B2
- Niacin: B3
- Pyridoxine: B6
- Folic: B9
- Cyanabolic: B12

9

Isoniazid (INH)
- SEs
=> D/C when?
- DDI
- Dose

SEs
- Hepatotoxicity => check LFT periodically
=> D/C if AST > 3x UL w/ s/s of toxicity
=> D/C if AST > 5x UL w/ no s/s
- Peripherally neuropathy
=> prevent by take B6 10-50mg QD

DDI
- 1A2, 2C9 inhibitors
- Theophylline, warfarin, phenytoin

Dose
- 5mg/kg up to 300mg PO QD

10

Empty stomach

Take with food

Empty stomach:
- Rifampin
=> Rifamate & Rifater => b/c contain rifampin

Take with Food
- Bedaquiline - Sirturo

11

Color body red/orange

Rifampin
Rifapentine - Priftin

12

Rifampin (Rifadin)
- SEs
- DDI
=> Never give with
- Dose

SEs
- Hepatotoxicity
- Fever, rash, flu-like illness, GI upset
- Thrombocytopenia
- Change body fluid red/orange

DDI
- Strong inducer of 1A2, 2C9, ad 3A4
- NEVER give w/ PI = hepatotoxicity

Dose
- 10mg/kg up to 600 mg PO/IV QD

Take on empty stomach

13

All TB drugs are bactericidal except

Ethambutol

14

Hyperuricemia

- Rifapentine - Priftin
- Pyrazinamide
- Ethambutol - Myambutol

15

Rifapentine - Priftin
- SEs

- Hepatotoxicity
- Thrombocytopenia
- Hyperuricemia
- Orange/red body fluid

16

Pyrizinamide
- SE
- Avoid in

SEs
- Hepatoxocity
- Hyperuricemia

Avoid in renal dysfxn

17

Cause optic neuritis

Ethambutol - Myambutol

18

CI in pregnancy

- SE

StreptOmyciN

=> SE: Nephrotoxicity, ototoxicity

19

Streptomycin

- Monitoring monthly
- Forms
- SEs

Monitor monthly
- Auditory
- Renal function
- Electrolytes

Forms
- IV/IM

SEs
- Nephrotoxicity
- Ototoxicity

20

QT

- Bedaquiline - Sirturo

21

Bedaquiline - Sirturo

- Indication
- Administer by
- SEs
- DDI

Indication:
- Part of combo therapy w/ 3 other drugs for >/= 18 y.o w/ multiple drug resistant
- Adm by directly observed therapy (DOT)

SEs
- QT
- Hepatotoxicity

DDI
- CYP 3A4 inducers/inhibitors

22

Referred regimen to treat TB

Take for the 1st 8 weeks
- Isoniazid
- Rifampin
- Pyrazinamide
- Ethambutol

Then for 18 weeks (4.5 mo)
- INH
- Rifampin

23

Rec tx for LTBI

ALT

Rec
- Isoniazid 300 mg PO QD x 9 mo

ALT
- Rifampin 600 mg PO QD x 4 months
- INH + rifapentine (Priftin) QW x 3 months

24

TB Drugs - RIPES

All bactericidal except ethambutol
- Isoniazid (INH)
- Rifampin (Rifadin) - Empty stomach
- Pyrazinamide
- Ethambutol (Myambutol): use to prevent resistant
- Streptomycin

- Bendaquiline (Sirturo)
- Rifamate = INH + Rifampin- Empty stomach
- Rifater = INH + Rifampin + pyrazinamide- Empty stomach

25

Ethambutol (Myambutol)

- SEs
- Direction to take


- SEs: E = Eye = Optic neuritis: test color vision and visual acuity monthly if > 15mg/kg/d
- Increase uric acid

- Give 4H before Al containing antacids, sucralfate, buffered didanosine.