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20 Cards in this Set
- Front
- Back
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What are the risk factors for the progression from latent to active TB?
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Immunosuppression
Lymphoma, Leukemia Diabetes Renal Dialysis Malnutrition Silicosis Head/Neck cancer HIV |
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What patients would be recognized as TB (+) with a 5mm Induration?
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HIV
Recent contact with TB patient Fibrosis on chest xray Organ transplantation/Immunosuppression |
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What patients would be recognized as TB (+) with a 10mm Induration?
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Recent immigrants
IV drug users Employees/Residents of high risk settings Children < 4 yo Adolescents exposed to adults ***Everyone else is (+) with a 15 mm induration |
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Who is at risk of acquiring tuberculosis infection?
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Foreign born patients from endemic countries
(This includes all of asia, except japan, all of central and south america, all of africa, all of eastern europe) Close contacts of TB patients Healthcare workers who serve high risk clients Residents/Employees of congregate settings (prisons, nursing homes, shelters) Medically underserved |
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Describe how you would treat Tuberculosis empirically.
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Izoniazid 5mg/kg (300 max)
Rifampin 10mg/kg (600 max) Pyrazidamide 30mg/kg(2gmax) Ethambutol 25mg/kg (1.6gmax) All PO once daily x 8 weeks |
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Describe the remainder of therapy.
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You choose 2-3 of the preferred agents that TB is susceptible to. Total of 6 months therapy, unless cavitary disease and positive cultures present after 2 months of therapy. Then you treat for a total of 9 months
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What are the common side effects of Isoniazid?
How often do you want to monitor? |
Peripheral neuropathy
Elevated Liver Function Tests - Abstain from alcohol, d/c if LFT's increase to more than 5x the ULN Monitor monthly |
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What is the major toxicity of Ethambutol?
How often do you want to monitor? |
Optic Neuritis - Need a baseline and monthly visual and color perception screening
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What are the common side effects of Rifampin?
How often do you want to monitor? |
Change in urine color
Increase in LFTs Monitor monthly (already doing this b/c of Isoniazid) |
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What are the common side effects of Pyrazidamide?
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Arthralgia - manage with NSAIDs
Increased LFTs - avoid alcohol like with Isoniazid |
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How do you want to counsel on Isoniazid therapy?
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Take on an empty stomach
Avoid antacids Vitamin B6 can help prevent neuropathy |
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How do you want to counsel Ethambutol therapy?
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Avoid antacids
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How do you want to counsel on Rifampin?
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Take without food
Many drug drug interactions (CYP mediated) |
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Discuss the DDI's involved with Rifampin.
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It is CYP mediated and has many DDI's
It induces the metabolism of Protease Inhibitors leading to decreased concentrations It induces Efavirenz |
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Discuss your options in giving Efavirenz with Rifampin or Rifabutin.
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You must give Efavirenz at a higher dose of 800 mg daily or use Rifabutin
Rifabutin dose is usually 300 mg daily. However, Protease inhibitors inhibit its metabolism, so if given with them the Rifabutin dose must be reduced to 150 mg qod. Efavirenz induces rifabutin metabolism and so Rifabutin must be given at a higher dose of 450 mg daily if given with Efavirenz. |
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What is the BCG vaccine?
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A vaccine given in high prevalence countries.
It can cause a false positive. |
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What do you do if a patient is positive for latent TB but has been administered the BCG vaccine in the past?
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You have to do additional testing to confirm latent TB and see if they need treatment.
You want to do an Interferon Gamma Release Assay |
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What is the IFN-gamma release assay and how does it work?
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This is a blood test used to diagnose active and latent TB infection
If the patient is infected with TB, their WBCs will release IFN gamma in response to contact with the TB antigens Not affected by prior BCG vaccination |
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What is the procedure for someone who yields a positive PPD test?
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You should get a medical history, physical evaluation and a chest x-ray
If the patient evaluation is poor, then treat |
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How do you treat Latent TB?
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Isoniazid daily x 9 months
If they are resistant to Isoniazid, then give Rifampin + Pyrazidamide daily for 2 months If they have an intolerance to Pyrazidamide, then give Rifampin daily for 4 months. |
