TB II

Question 1

What are the side effects of Rifampicin?

Answer 1

Nausea, GI disturbances
Discolouration of body fluids
(tears, saliva, urine, faeces) orange/red
Enzyme induction

Question 2

What pt education will you give the pt regarding taking rifampicin?

Answer 2

Must be taken with food

Question 3

What is a contraindication of Rifampicin?

Answer 3

Oral contraceptives

Question 4

What are the side effects of isoniazid?

Answer 4

Peripheral neuropathy (burning / pins & needles in feet & legs)

Question 5

How can you prevent SE of Isoniazid?

Answer 5

Supplement with pyridoxine

Question 6

What are the side effects of Ethambutol?

Answer 6

Optic neuritis
Vision check-ups are NB

Question 7

What are the side effects of Pyrazinamide?

Answer 7

Hepatotoxicity and joint pain

Question 8

Where is rifampicin metabolised?

Answer 8

In the liver
cause autoinduction and potent enzyme inducer

Question 9

Where is rifampicin eliminated?

Answer 9

Primarily biliary-fecal route

Question 10

Drug interaction with Rifampicin

Answer 10

Drug-interactions with drugs
metabolised in the liver
* Oral contraceptives & progestin implants (replace with injectable contraceptives)

Question 11

Describe distribuution of isoniazid

Answer 11

Distribution: wide including the CSF

Question 12

Explain metabolism of isoniazid

Answer 12

Metabolism in the liver via
acetylation (slow acetylators at
greater risk of neurotoxicity)

Question 13

Excretion of isoniazid

Answer 13

Inactive metabolites excreted in the urine

Question 14

Adverse effects of isoniazid

Answer 14

Hepatotoxic
* Neurotoxic (peripheral
neuropathy, seizures, psychosis,
ataxia & optic neuritis)

Question 15

How to reverse neurotoxic effects of isoniazid

Answer 15

Pyridoxime (vit B6)

Question 16

Drug interactions with isoniazid

Answer 16

Drug-interactions with drugs
metabolised in the liver (weak
enzyme inhibitor)

Question 17

When prescribing isoniazid, caution is given in patient with ________________

Answer 17

Epilepsy

Question 18

Ethambutol distribution

Answer 18

Wide but not in CSF

Question 19

Metabolism of ethambutol

Answer 19

Metabolism in the liver up to 15%

Question 20

Ethambutol elimination

Answer 20

Mainly unchanged in the urine. Dose adjustment is key, depending on creatinine clearance

Question 21

CI of ethambutol

Answer 21

Optic neuritis

Question 22

3 Cautions when prescribing ethambutol

Answer 22

-renal failure, in
-children under 8 years (visual
symptoms cannot always be monitored),
-hyperuricaemia

Question 23

Adverse effect of ethambutol

Answer 23

Ocular toxicity – patient self
monitoring (reading fine print),
monitor: colour discrimination
and visual field

Question 24

Distribution of pyrazinamide

Answer 24

Wide including the CSF

Question 25

Adverse effect of pyrazinamide

Answer 25

Dose-related hepatotoxicity Hyperurecaemia (caused by decreased uric acid clearance) associated with arthralgia (may precipitate gout)

Question 26

State 3 wanted outcomes of TB treatment

Answer 26

-Prevent TB transmission * Cure with minimal problems * Cure with chronic lung disease

Question 27

state 3 unwanted outcomes of TB treatment

Answer 27

Transmission of TB * MDR / XDR * Death

Question 28

List types of Drug resistant TB

Answer 28

Mono-resistant TB * Poly-resistant TB * MDR-TB * Rifampicin resistant-TB (RR-TB) * Resistance to at least rifampicin * Extensively drug-resistant TB (XDR-TB) * Pre-XDR-TB

Question 29

What is MDR TB?

Answer 29

In vitro resistance to: * Rifampicin * Isoniazid With or without resistance to other anti-TB drugs

Question 30

XDR TB definition

Answer 30

MDR TB + * In vitro resistance to: * Any fluoroquinolone AND * Any injectable drug Extremely difficult and expensive to treat with a high mortality (90%) in HIV co-infected patients

Question 31

How to test for isoniazid resistance?

Answer 31

Resistance tests: * inhA mutation and * katG mutation

Question 32

What to use when there is inhA mutation only?

Answer 32

use high dose INH: 10mg/kg/day

Question 33

What to use when there is katG mutation?

Answer 33

Use ethionamide

Question 34

T/F: When there is complete resistance (both), use both INH and ethionamide

Answer 34

F Do not use INH or ethionamide