Tuberculosis

Question 1

mycobacterium are ___ (slow/fast) growing microbes

Answer 1

slow

Question 2

mycobacterium require ____ (short/long) therapy

Answer 2

long

Question 3

2 methods for determining if pt has latent TB

Answer 3

1. TST (intradermal injection of PPD)

2. IGRA (blood test, WBC will release interferon gamma if latent TB)

Question 4

what does “acid fast bacilli” mean

Answer 4

mycobacterium resist decolorizing by dilute acid used in staining protocols (high content of mycolic acid in cell wall)

Question 5

treatment for latent TB (3 different treatments)

Answer 5

1. isoniazid alone taken daily for 6 or 9 months
2. isoniazid plus rifapentine taken weekly for 12 wks
3. can’t take isoniazid? take rifampin daily for 4 months

Question 6

risk of treating pt with active TB with isoniazid only

Answer 6

would promote emergence of resistant bacilli

Question 7

1st line therapy meds to treat active TB infections

Answer 7

isoniazid
rifampin
pyrazinamide
ethambutol
rifamycin
rifapentine

Question 8

2nd line therapy meds to treat active TB infections

Answer 8

cycloserine
ethionamide
capreomycin
para-amino salicylic acid (PAS)
the aminoglycosides (streptomycin, amikacin, kanamycin)
the quinolones (levofloxacin, moxifloxacin)

Question 9

TB drugs only available in IM or IV route

Answer 9

capreomycin
streptomycin
amikacin
kanamycin

Question 10

4 drugs given as induction therapy for active TB

Answer 10

isoniazid
rifampin
pyrazinamide
ethambutol

Question 11

minimum length of therapy for active TB infection

Answer 11

6 months

Question 12

when is 2nd line drug therapy used for active TB

Answer 12

TB is MDR or XDR (extensively drug resistant)

Question 13

MDR-TB is defined as a strain resistant to which drugs?

Answer 13

isoniazid

rifampin

Question 14

XDR-TB is defined as a strain resistant to which drugs?

Answer 14

isoniazid
rifampin
all fluroquinolones
at least one of the injectable second-line anti-TB drugs (amikacin or capreomycin)

Question 15

what is DOT?

Answer 15

daily observed therapy

Question 16

what is intermittent dosing?

Answer 16

dosing 2 or 3 times a week rather than every day

Question 17

drug selection for active TB based upon which 2 factors?

Answer 17

1. patterns of drug resistance in the community

2. the immunocompetence of the patient

Question 18

difference between induction phase and continuation phase

Answer 18

induction: initially tx, eliminate actively dividing tubercle bacilli
continuation: eliminate persistent intracellular bacteria

Question 19

5 main meds for active TB

Answer 19

isoniazid (INH)
rifampin
ethambutol
pyrazinamide (PZA)
pyridoxine

Question 20

TB meds that cause liver toxicity (3)

Answer 20

INH
rifampin
PZA

Question 21

a major SE of this TB med id optic neuritis

Answer 21

ethambutol

Question 22

this TB med can turn urine an orange-reddish color or stain contact lenses

Answer 22

rifampin

Question 23

pyridoxine (vit B6) is given to prevent peripheral neuropathy caused by this TB drug

Answer 23

INH

Question 24

pt with ETOH use disorder or with liver disease should not take these TB meds (3)

Answer 24

INH
rifampin
pyrazinamide

Question 25

pt on oral contraceptive should use another form of BC with this TB med

Answer 25

rifampin

Question 26

pt on these TB meds should have their liver enzymes (AST, ALT) checked

Answer 26

INH, rifampin, pyrazinamide

Question 27

this TB med should NOT be given with food as it decreases absorption

Answer 27

rifampin

Question 28

significant drug-drug interactions occur with the HIV meds and this TB drug (certain protease inhibitors and NNRTIs)

Answer 28

rifampin

Question 29

routine eye exams should be done to assess for color discrimination and visual acuity when taking this TB drug

Answer 29

ethambutol

Question 30

this TB drug may be given alone for tx of latent TB infection

Answer 30

INH

Question 31

typical drug regimen for someone with active TB

Answer 31

usually initiated with a 4-drug regimen; INH and rifampin are almost always included

Question 32

what would indicate that a TB drug should be discontinued because of hepatotoxicity

Answer 32

``` signs of hepatitis (jaundice, anorexia, malaise, fatigue, nausea) abnormal AST (3-5x tx baseline levels) ```

Question 33

pt being treated for active TB should see improvements: clinical manifestations decrease within ______ CXR manifestations show improvement within ______ sputum culture become negative in over 90% of pt after ______

Answer 33

2 weeks 3 months 3 months