WK 2 - Pharm slides

Question 1

MDR - TB
TB is resistant to which drugs?

Answer 1

isoniazid
rifampin

the most effective anti-TB drugs

Question 2

What are the most effective anti-TB drugs?

Answer 2

isoniazid & rifampin

Question 3

XDR-TB

Resistant to which drugs?

Answer 3

• isoniazid & rifampin
• All fluoroquinolones
• at least one injectable second line anti-tb drug

Question 4

TB always contains how many drugs minimum?

Answer 4

two or more

which the organism is sensitive to

Question 5

How do you determine sensitivity for drug for TB?

Answer 5

sputum culture

takes 6 weeks

Question 6

While waiting for sputum culture for TB how do you begin treatment?

what is it based on?

Answer 6

patterns of drug resistance in the community and immunocompromised patient

Question 7

Active TB is how many drug therapy?

Answer 7

4

Question 8

Which two drugs are always used to start treatment of TB?

Answer 8

isoniazid & rifampin

can include as many as 7 drugs

Question 9

If the organism is not resistant to isoniazid & rifampin - what is the treatment protocol?

Answer 9

isoniazid & rifampin & pyrazinamide &
ethambutol – for 8 weeks

Then isoniazid & rifampin for 18 weeks

minimum for active TB

Question 10

Who gets involved when there is a diagnosis of TB?
What agency gets notified?

Answer 10

Public Health

Question 11

What is the standard of care for TB when it comes to adherence?

Answer 11

DOT
Direct Observation Therapy

Healthcare employee watch patient take PO meds

Question 12

How often is a TB evaluated -
Clinical symptoms?
Sputum tests?
After cultures become negative?

Answer 12

Clinical symptoms - each clinic visit

Sputum tests - every 2-4 weeks

After cultures become negative - monthly

Question 13

What is Latent TB treated with?

2 options:

Answer 13

1. Isoniazid
2. Isoniazid & rifampin (12 years or older; HIV infection Not taking antiretroviral drugs

Question 14

What are the clilnical symptoms of TB

Answer 14

fever
malaise
anorexia
cough

Question 15

Areas that are high risk for TB?

Answer 15

Prisons, jails
nursing homes
hospitals
homeless shelters

Question 16

How many drugs for Latent vs Active TB?

Answer 16

Active 4+
Latent 2+

Question 17

Adverse effects of Isoniazid?

Answer 17

Hepatoxicity (no ETOH)
Peripheral neuropathy

Question 18

what does isoniazid treat?

Answer 18

active and latent TB

Question 19

Isoniazid interacts adversely with what drug causing a need to monitor that drug’s levels?

Answer 19

Phenytoin. (seizure med)

Question 20

Rifampin has what common side effect that is normal but alarming to see?

Answer 20

Discoloration of bodily fluids - urine, sweat, saliva, tears

turn a reddish orange color

Question 21

What is the drug of choice for pulmonary TB?

Answer 21

Rifampin and other TB drugs

Also - rifapentine (a long acting rifampin)

Question 22

Adverse effects of Rifampin?

Answer 22

Hepatoxicity
Reddish orange bodily fluids

Question 23

What does rifampin do to oral contraceptives?

Answer 23

renders them ineffective
use alternative

Question 24

In HIV patients, what drug is preferred over rifampin?

Answer 24

rifabutin

Question 25

What is the most hepatotoxic of all first line drugs for TB?

Answer 25

Pyrazinamide

Question 26

What are the side effects of Pyrazinamide?

Answer 26

polyarthralgias (joint pain) hyperuricemia GI disturbances Rash Photosensitivity

Question 27

Is ethambutol bactericidal or bacteriostatic?

Answer 27

bacteriostatic inhibits growth - does not kill all

Question 28

What is the most common side effect of ethambutol?

Answer 28

Optic Neuritis

Question 29

What are two other uses for TB drugs?

Answer 29

Leprosy (Hansen Disease - Rifampin) MAC - MycobacteriumAvium Complex Infection

Question 30

MAC - MycobacteriumAvium Complex Infection -- commonly found where?

Answer 30

food, water, soil

Question 31

What are uses for Fluoroquinolone drugs?

Answer 31

* eye infections * TB * Respiratory Infections * Infections of bone, joints & soft tissue * UTIs, STDs

Question 32

Are Fluoroquinolones bactericidal or bacteriostatic?

Answer 32

bactericidal - cell death

Question 33

Adverse effects of Fluoroquinolones are:

Answer 33

* Tendon Rupture (<18 cartilage) * QT prolong * Pregnancy * Seizures * Dizziness, confusion * Photosensitivity

Question 34

What class are Ciprofloxacin?

Answer 34

fluoroquinolones

Question 35

Ciproflaxin used for...

Answer 35

Respiratory infections UTI bone/joint infections

Question 36

Ciprofloxacin side effects

Answer 36

Tendon Rupture diarrhea C-diff & Candida (super infection) Photosensitivity

Question 37

When taking ciprofloxacin should not be given with patients with...

Answer 37

Myasthenia Gravis

Question 38

Ciprofloxacin reacts with milk and calcium - how to administer with those items?

Answer 38

med 6 hours before calcium, milk or 2 hours after calcium milk

Question 39

Use this mnemonic for nursing considerations: F L O X A C I N S

Answer 39

F -fluid intake - 8 oz glass and 2L/day L -long QT intervlas O -older adults - DTR rupture - achiles X -Don't administer Cations - calcium, iron. A -avoid in kids C -C-diff I -interactions with cafeine, pheno, warfarin, theophyline N - neuromuscular - MYASTHENIA GRAVIS S -sunscreen

Question 40

what kills gram + and MRSA?

Answer 40

Daptomycin - cyclic lipopeptides

Question 41

Amphotericin B, ketoconazole, fluconazole, are what class fo drugs?

Answer 41

Antifungals treat systemic fungal infections

Question 42

Amphotericin B treat ?

Answer 42

systemic fungal infections some protozoal infections

Question 43

What route is Amphotericin B given and how?

Answer 43

IV and slow

Question 44

What are four adverse effects of Amphotericin B?

Answer 44

Infusion reactions Nephrotoxicity Hypokalemia - kidney damage bone marrow suppression - monitor RBCs

Question 45

Avoid using what type of drugs when using amphotericin B?

Answer 45

nephrotoxic drugs

Question 46

When taking Amphotericin B - everyone gets nephrotoxicity (kidneys) - how can you minimize this?

Answer 46

by infusing 1 liter of fluid on days drug is given if creatinine >3.5 take action

Question 47

how can you reduce infusion reactions form amphotericin B? pretreat with?

Answer 47

Diphenhydramine + Acetaminophen ASA can also help but increases nephrotoxicity (kidneys)

Question 48

AZOLES - what organ effect toxic

Answer 48

hepatotoxicity liver

Question 49

What is an alternative to amphotericin B -

Answer 49

Azoles less toxic and can be given by mouth

Question 50

Superficial Mycosis are treated locally Tinea...

Answer 50

Tinea Pedis = athlete's foot Tinea corporis = ringworm of the body Tinea Curis = jock itch Candidiasis = vaginal or oral thrush

Question 51

Onychomycosis =

Answer 51

nail fungus and hard to treat

Question 52

Tinea Capitis =

Answer 52

ringworm of the scalp and hard to treat

Question 53

Tinea Pedis =

Answer 53

athlete's foot

Question 54

Tinea corporis =

Answer 54

ringworm of the body

Question 55

Tinea Curis =

Answer 55

jock itch

Question 56

Candidiasis =

Answer 56

vaginal or oral thrush

Question 57

Acyclovir are used for...

Answer 57

antiviral herpes varicella-zoster viruses both shingles and chicken pox

Question 58

Acyclovir adverse effects...

Answer 58

reversible nephrotoxicity (greater risk of dehydrated) contraindicated with pregnancy

Question 59

ACYCLOVIR - When would use IV ? PO ?

Answer 59

IV = acute outbreak - extreme case PO = prevent outbreak

Question 60

What are the contraindications for the influenza vaccine?

Answer 60

Guillain-Barre syndrome egg allergy acute febrile illness (fever) - hold until better

Question 61

When is the best time to vaccinate?

Answer 61

October or November

Question 62

What is a treatment for the flu?

Answer 62

Oseltamivir (Tamiflu) Influenza A & B within 48 hours (2 days)