TB - Drugs

Question 1

TB Skin Test (TST) (PPD)

• Give
• Read

Answer 1

• Give intra-dermal

- Read 48-72H after it’s given

Question 2

CXR

Answer 2

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

Question 3

TB Blood tests

Answer 3

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

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

Question 4

Acid Fast Bacilli (AFB)

Answer 4

• To test for TB

- AFB + means active TB

Question 5

S/S of TB

Answer 5

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

Question 6

5mm = + for

10mm

15mm

Answer 6

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

Question 7

BCG

Answer 7

• 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

Question 8

What is?

• Thiamine
• Ravin
• Niacin
• Pyridoxine
• Folic
• Cyanabolic

Answer 8

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

Question 9

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

Answer 9

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

Question 10

Empty stomach

Take with food

Answer 10

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

Take with Food
- Bedaquiline - Sirturo

Question 11

Color body red/orange

Answer 11

Rifampin

Rifapentine - Priftin

Question 12

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

Answer 12

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

Question 13

All TB drugs are bactericidal except

Answer 13

Ethambutol

Question 14

Hyperuricemia

Answer 14

• Rifapentine - Priftin
• Pyrazinamide
• Ethambutol - Myambutol

Question 15

Rifapentine - Priftin

- SEs

Answer 15

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

Question 16

Pyrizinamide

• SE
• Avoid in

Answer 16

SEs

• Hepatoxocity
• Hyperuricemia

Avoid in renal dysfxn

Question 17

Cause optic neuritis

Answer 17

Ethambutol - Myambutol

Question 18

CI in pregnancy

• SE

Answer 18

StreptOmyciN

=> SE: Nephrotoxicity, ototoxicity

Question 19

Streptomycin

• Monitoring monthly
• Forms
• SEs

Answer 19

Monitor monthly

• Auditory
• Renal function
• Electrolytes

Forms
- IV/IM

SEs

• Nephrotoxicity
• Ototoxicity

Question 20

QT

Answer 20

• Bedaquiline - Sirturo

Question 21

Bedaquiline - Sirturo

• Indication
• Administer by
• SEs
• DDI

Answer 21

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

Question 22

Referred regimen to treat TB

Answer 22

Take for the 1st 8 weeks

• Isoniazid
• Rifampin
• Pyrazinamide
• Ethambutol

Then for 18 weeks (4.5 mo)

• INH
• Rifampin

Question 23

Rec tx for LTBI

ALT

Answer 23

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

Question 24

TB Drugs - RIPES

Answer 24

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

Question 25

Ethambutol (Myambutol) - SEs - Direction to take

Answer 25

- 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.