Tuberculosis: Treatment and prevention

Question 1

List the Goals for TB treatment

Answer 1

Cure the patient of TB
Prevent transmission of TB to others
Prevent the development of acquired resistance
Prevent relapse
Prevent death from TB or its complication

Question 2

Explain about combination of therapy under principles of TB treatment

Answer 2

Usually combination tablet
Intensive and continuation hase

Question 3

Explain about time period under principles of TB treatment

Answer 3

Time period varies until TB bacteria are eradicated in different places

Question 4

Explain the adherence under principles TB treatment

Answer 4

Counselling sessions

Question 5

what happen in the intensive phase

Answer 5

Bacilli rapidly eradicated from the sutum (after about 2 weeks of treatment) and clinical improvement from illness

Question 6

What is happening in continuation phase

Answer 6

Sterilising effect of treatment, eliminates the remaining viable bacilli and prevent subsequent relapse

Question 7

List drugs that are first line TB treatment

Answer 7

Isoniazid
Ethambutol
Pyrazinamide
Rifampicin

Question 8

explain the mechanism of action of Isoniazid

Answer 8

Inhibits synthesis of the mycolic acid layer of the mycobacterial cell wall

Question 9

explain the mechanism of action of ethambutol

Answer 9

Inhibit synthesis of the arabinogalactan layer of the mycobacterial cell wall

Question 10

explain the mechanism of action of Pyrazinamide

Answer 10

Converted to an acid in the cytoplasm of the mycobacterium, acidify the intracellular environment and compromise the intergity of the cell membrane (only effective in dormant mycobacteria)

Question 11

Explain the mechanism of action of Rifampicin

Answer 11

Inhibits mycobacterial RNA synthesis by binding to and inhibiting the enzyme RNA polymerase

Question 12

Which TB drug is bactericidal for intra and extracellular bacteria . sterillising activity

Answer 12

Rifampicin

Question 13

Which Tb drug is excellent early bactericidal activity

Answer 13

Isoniazid

Question 14

Which TB drug is bacteriostatic (bactericidal at hight doses)

Answer 14

Ethambutol

Question 15

Which TB drug is mycobactericidal for intracellular mycobacteria in an acidic medium. most useful during intensive phase

Answer 15

Pyrazinamide

Question 16

Nmae drugs under intensive phase for extra pulmonary TB

Answer 16

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

Question 17

Period of treatment for intensive phase under extra pulmonary TB

Answer 17

2 months

Question 18

List drugs in continuation phase under extra pulmonary TB

Answer 18

Rifampicin
Isoniazid

Question 19

Explain the period of treatment for continuation phase under extra pulmonary TB

Answer 19

4 months

Question 20

List drugs that are used to treat severe/complicated TB under intensive phase

Answer 20

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

Question 21

What is the period of drug treatment for severe/ complicated TB under intensive phase

Answer 21

2 months

Question 22

List the drugs used for Severe/ complicated Tb under continuation phase and the period of treatment

Answer 22

Rifampicin
Isoniazid
7 months

Question 23

In TB Treatment children <8 years and 30 kg
List drusg for (extra) pulmonary TB intensive phase?

Answer 23

Rifampicin
Isoniazid
Pyrazinamide

Question 24

At every visits assess what ? if the patients is under TB treatment

Answer 24

TB symptoms (refer to DR is symptoms become worse)
Weight (adjust dosing accordingly. if patient is loosing weight refer to doctor)
Trace contacts and screen for TB disease. Also assess eligibilty for isoniazid preventive therapy in children <5 years and HIV infected individuals
Discuss family planning methods
Assess adherence by conducting pill counts, and review patient treatment cards
Assess side effects
Test for HIV status if unknown
Manage co-morbidities including HIV
Fllow-up test results (smear microscoy, culture, line probe essay (LPA) or drug susceptibility testing (DST), if done)

Question 25

Under monitoring safety which TB drugs are associated with Hepatotoxity ?

Answer 25

Rifampicin, isoniazid. pyrazinamide

Question 26

List TB treatment: monitoring safety

Answer 26

• Hepatotoxicity monitoring (rifampicin, isoniazid, pyrazinamide)
• Monitor liver function: DILI (drug-induced liver injury)
• High risk patients: chronic infectious hepatitis, pre-existing liver disease, MDR
  TB patients, high levels of alcohol consumption, other hepatotoxic drugs,
  HIV+, females and elderly
• Screening for hepatotoxicity: new onset abdominal pain, nausea & vomiting,
  jaundice / dark urine
• Check bilirubin and transaminases (5x upper limit/ 3x uper limit with jaundice)

Question 27

List the side effects of Rifampicin and the comments

Answer 27

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

Take with food
CI: oral contraceptives

Question 28

List side effects of Isoniazid and comments

Answer 28

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

Supplement with pyridoxine

Question 29

List side effects of ethambutol and comments

Answer 29

Optic neuritis
vision check-ups

Question 30

List the side effects of Pyrazinamide

Answer 30

Joint pain (gout), hepatotoxic