Week 5 TB

Question 1

Inhaled Droplets of Mycobacterium

Answer 1

Tuberculosis

Question 2

Infection can occur in

Answer 2

2-20 weeks

Question 3

___________ occurs and TB__________ lymphocytes kill the bacilli

Answer 3

Phagocytosis, specific

Question 4

Are the bacteria live or dead bailli?

Answer 4

Both form granulomas in the lung tissue

Question 5

Over time these granulomas form a

Answer 5

Fibrous Mass

Question 6

At center of fibrous mass

Answer 6

Called Ghon tubercle

Question 7

What happens to fibrous mass?

Answer 7

Becomes necrotic, calcifies, and forms a collagenous scar.

Infection becomes latent at this point

Question 8

If weakened immune system, the latent TB can _____-

Answer 8

Become infectious again

Question 9

The Ghan tubercle does what?

Answer 9

Ulcerates and the bacilli push out into the bronchioles where they can become airborne droplets

Question 10

More scar tissue develops due to

Answer 10

Increase inflammatory responses, more tubercles form and bronchopneumonia develops

Question 11

Common Symptoms of TB

Answer 11

Cough with sputum and blood- Hemoptysis
Chest Pain
Weakness
Weight Loss
Fever
Night Sweats

Question 12

Prevalence

Answer 12

High in minorities
71% of known cases are those born outside of US
Higher in DM, CAncer, and HIV
Higher in homelessness and incarceration

Cali ranked #4
Alaska #1

Question 13

How is TB spread?

Answer 13

Droplets
Exposure time and proximity to a person with active TB

Question 14

What is the Tx of latent TB?

Answer 14

Treated so it does not become active
Isoniazid
Rifapentine
Rifampin

• 3-4 months of once weekly- isoniazid and rifapentine
  4 months of daily rifampin
  3 months of daily isoniazid and rifampin

Make sure Pt finishes regimens

Question 15

Rifampin has ?

Answer 15

Hepatotoxicity

Question 16

Hepatoxicity side effects

Answer 16

Upper stomach pain, tiredness, loss of appetite, dark urine, clay colored stools, jaundice

Question 17

Rifampin has a

Answer 17

Narrow therapeutic range

Protect from light
Take WITHOUT food

Red orange discoloration of mucous fluids and body fluids

Question 18

Anti TB that is a hydrazide derivative

Answer 18

Isoniazid

Question 19

Hydrazide Derivative

Answer 19

Interferes with metabolism of bacterial proteins, nucleic acids, carbs, and lipids

Question 20

Isoniazid

Answer 20

Hepatoxic and Nephrotoxic

Affects Nervous system- Peripheral Neuritis

May be relieved by Vitamin B6 (pyroxidine)

Question 21

Rifapentine

Answer 21

Rifamycin Derivative- Binds to and inhibits the mycobacterial DNA dependent RNA polymerase

Always used in conjunction with other antituberculosis agents
Hepatoxic
Anemic affects
Take WITH food
Urine, sweat, sputum, tears, and breast milk may have red- orange discoloration

Question 22

Active TB care involves

Answer 22

IV fluids- CV support
Ventilation- Cardiopulmonary Support
IV- Antibiotics- Treat infections-RIPE
Rifampin, Isoniazid, Ethambutol, Pyrazinamide)

Question 23

After Tx or to rule out active Pt have 3 negative sputum cultures

Answer 23

True

Question 24

Ethambutol

Answer 24

Miscellaneous Anti- TB agent

Inhibits synthesis of one or more metabolites in susceptible bacteria resulting in impairment of cellular metabolism, arrest of multiplication, and cell death

Nephrotoxic

May cause vision problems- Decreased visual acuity, constriction of visual fields, central and peripheral scotomas, and loss of red and green color

May take with food

Always used in conjunction with other Anti TB agents

Question 25

Synthetic niacinamide derivative

Answer 25

Pyrazinamide

Disrupts membrane energetics and inhibit membrane transport function in susceptible M. Tuberculosis

Hepatotoxic

Question 26

Joint pain or muscle pain

Answer 26

Gout flare ups

Hyperuricemia
Prevents renal excretion of urates

Question 27

Pt Education on TB

Answer 27

Educate importance on compliance

Antibiotic Resistance

Worsening Condition

It is a community health issue and jail time served if refused

Question 28

DOT Therapy

Answer 28

Staff of local health department meet regularly with patients who have TB to watch them take their medications

Helps complete Tx in least amount of time

Question 29

TB testing includes

Answer 29

The Mantoux Skin Test

Intradermal Injection of TB
Read between 48-72 hours

If positive only tells the person has been affected with TB

Does not indicate active disease

Chest X ray or sputum cultures are needed for positive skin TB test

Question 30

BCG Vaccine

Answer 30

Bacille Calmette -Guerin

Not recommended in the United States - administered in 3rd world countries

Does not fully prevent TB

Contributes to false positive TB test skin

Question 31

Prevention of TB

Answer 31

N 95 mask for droplet precautions
PAPR- Powered Air purifying System
Annual TB skin test
Chest X ray for previous positive skin TB test

IGRA- Interferon Gamma Release Assay

• Blood test to detect latent TB - Detects T lymphocytes

Question 32

TB Signs and Symptoms

Answer 32

Progressive Fatigue
Malaise
Anorexia
Wt. Loss
Chronic Cough
Night Sweats
Hemoptysis- Advanced State
Pleuritic Chest Pain
Low Grade Fever

Question 33

Tx of TB

Answer 33

TB medications for 6 months or longer
Decreased Activity
Resp isolation until negative sputum
Frequently Outpatient Tx

Question 34

Dx of TB

Answer 34

TB skin Test
Chest X Ray
Sputum Studies
3 Specimens collected on different days

Question 35

RIPE

Answer 35

Rifampin
Isoniazid
PZA
Ethambutol