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PY6010 > Tuberculosis (TB) > Flashcards

Tuberculosis (TB) Flashcards

1
Q

Which bacteria causes tuberculosis?

A

Mycobacterium tuberculosis complex

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2
Q

Who is at a higher risk of developing tuberculosis?

A
  1. Diabetics
  2. HIV/cancer/organ transplants
  3. Immuno-suppressed patients
  4. Excessive alcohol/smoking
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3
Q

What is the difference between active and latent TB?

A

Active TB: illness can occur weeks, months or years after inhaling in the bacteria

Latent TB: no illness and not infectious, the immune system regulates TB to minimal levels. It can also reactivate later in life

  • Remember active TB is always symptomatic
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4
Q

Which vaccine is given for tuberculosis?

A

BCG vaccine.

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5
Q

Which certain populations are offered the TB vaccination?

A
  1. Born in an area where TB is high
  2. Working with animals that can also get TB e.g. chimps or cows
  3. <15years who werent vaccinated as newborn babies
  4. Been in close contact with someone who has had TB
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6
Q

What are some symptoms of active TB?

A
  1. Persistent cough with/without sputum, may contain blood
  2. Loss of appetite/losing weight
  3. Extreme fatigue
  4. Fever with sweats
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7
Q

What does the physical diagnosis of active TB depend on?

A

If the TB is:

  1. Pulmonary
    - CT scan, x-ray
  2. In the lymph nodes
    - MRI, CT scan
  3. In the bones
    - X-ray, CT, MRI

All specimens are also taken for microscopy/histology

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8
Q

What is the mantoux test for latent TB?

A

It is a TB skin test where tuberculin is injected and the skin is inspected for a reaction.

Positive test: if the reaction is >5mm

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9
Q

How can a false positive test occur during the mantoux test?

A

The irritation produced could be from something else other than the tuberculin injected.

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10
Q

What is the interferon gamma release assay (IGRA) test for latent TB?

A

it is a blood test to detect the response of WBC’s to TB antigens.

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11
Q

What are the benefits of the IGRA test compared to the mantoux test?

A

False positive results are less likely to occur, and the results are much quicker.

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12
Q

How is the mantoux test administered?

A

Via intradermal injection.

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13
Q

What can happen after, if the mantoux test has turned out positive?

A
  1. Assess for active TB
  2. Consider IGRA test for more evidence
  3. Offer treatment for a latent infection
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14
Q

What are the treatment options for latent TB?

A
  1. Sometimes does not have to be treated
  2. 3 months isoniazid (300mg daily) + rifampicin (600mg daily) + pyridoxine hydrochloride (vit. B6, 10-20mg daily)
  3. OR 6 months isoniazid (300mg daily) + pyridoxine hydrochloride (vit. B6, 10-20mg daily))
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15
Q

Why is pyridoxine hydrochloride (vit. B6) given with isoniazid?

A

It prevents induced neuropathy

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16
Q

What is the mode of action of rifampicin?

A

It inhibits DNA-dependent RNA polymerase activity, so suppresses RNA synthesis and is hence bactericidal.

17
Q

How is rifampicin taken in TB?

A

Taken on an empty stomach to allow efficient absorption.

18
Q

Why can drug interactions occur when taking rifampicin?

A

Because rifampicin is a CYP450 inducer.

19
Q

What is the mode of action of isoniazid?

A

It interferes with the cell wall synthesis and is hence bactericidal (bacteriostatic in low conc.)

20
Q

What should be monitored when taking isoniazid for TB?

A

Liver function.

21
Q

What occurs in the GI when pyridoxine hydrochloride (vit. B6) is given?

A

It is converted into its active forms

22
Q

What is the standard treatment of active tuberculosis?

A
  1. INITIAL PHASE: REMEMBER ‘RIPE’
    - 4 drugs for 2 months
    - Rifampicin
    - Isoniazid (+ pyridoxine hydrochloride, vit. B6)
    - Pyrazinamide
    - Ethambutol hydrochloride
  2. CONTINUATION PHASE
    - 2 drug for 4 months
    - Rifampicin + isoniazid + pyridoxine hydrochloride
    - Those with active CNS TB need to extent their treatment for 10months
23
Q

What test needs to be regularly conducted when taking ethambutol in active TB?

A

Eye assessments, to avoid severe ethambutol/isoniazid interactions (optic neuropathy)

24
Q

What needs to be monitored when taking pyrazinamide for active TB?

A

Hepatic function.

25
Q

What are rifampicin and pyrazinamide dose dependent on?

A

Weight of the patient.

26
Q

Which tablet contains all 4 TB treatments, and hence aids in patient compliance?

A

Voractive tablets

  • Contains RIPE drugs
27
Q

What is contained in rifinah tablets?

A

Rifampicin + isoniazid

28
Q

What is contained in rifater tablets?

A

Isoniazid + pyrazinamide + rifampicin

29
Q

When should DOT (directly observed therapy) be required in patients with TB?

A
  1. Previously been treated with TB
  2. History of homelessness, alcohol or drug abuse
  3. Too ill to administer for themselves
  4. Major psychiatric, memory or cognitive disorders
30
Q

How many drugs should be given if the patient has resistant TB?

A

6.

31
Q

How many priorities are there in the TB Action Plan for England?

A
  1. Recovery from COVID
  2. Prevent TB
  3. Detect TB
  4. Control TB
  5. Workforce

PY6010 (23 decks)

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