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39 Cards in this Set
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- Back
- 3rd side (hint)
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Latent TB
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LTBI
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Active TB
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pulmonary-lungs only
extrapulmonary-disease outside of lungs disseminated-in lungs and other parts of body |
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1st line drugs
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Isoniazid (INH) 300mg
Rifampin (RIF) 600mg Rifabutan (RBT) Rifapentine (RPT) Ethambutol= EMB Pyrazinamide= PZA |
EMB: 40-55: 800mg; 56-75; 1200mg 76-90; 1600mg
PZA: 40-55: 1000mg; 56-75; 1500mg 76-90; 2000mg |
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2nd line drugs
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Streptomycin= SM
levo/moxi capreomycin=capro p-aminosalicylic acid=pas ethionamide=eth amikacin linezolid kanamycin(not us) clofazamine (orphan drug) bedaquiline |
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TB transmission
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-airborn
via speaking, coughing, sneezing |
cant transmit latent, active only
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Risk factors
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1. male
2. age: <5, 25-44, >65 3. country of origin (asia,africa, mexico) 4. recent immigration from endemic (5 years) 5. traveler to endemic 6. contact through FH' 7. smoking, drinking, substance abuse 8. DM2, HIV, pulmonary disease |
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INH ADR
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1. pseudo lupus
2. rash 3. visual ascuity 4. peripheral neuropathy 5. HA/dizzy/fatigue 6. hepatotoxic |
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RIF ADR
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1. thrombocytopenia
2. rash 3. hepatotoxic |
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EMB ADR:
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1. visual acuity
2. red/green discrimination 3. hepatotoxic |
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PZA ADR
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1. non-gouty arthritis
2. elevated uric acid 3. hepatotoxic |
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+ Sputum Smear
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-pulmonary active TB
-contagious |
indicative of contagiousness
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+ sputum culture
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-pulmonary active TB
-does not indicate if contagious |
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culture or smear +
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indicatory of active TB
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Smear (sputum)
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indicative of contagious when in lungs
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active TB indications
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-signs and symptoms
-Chest X ray CXR -smears and cultures |
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duration of treatment of active TB
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6 months normally, bone is 6-9 months, CNS is 9-12 months
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duration of treatment for MDR active TB
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18-24 months,
injectable agent is 6 months |
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Isoniazid: monitoring and counseling
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-LFT
-ANA -vision screening |
-B6 supplementation 50mg (peripheral neuropathy)
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Rifampin: monitoring and counseling
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-drug interactions with CYP3A4
-LFT -CBC with differential (thrombocytopenia) |
take without food
-fluids turn orange -decrease birth control |
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Rifapentine (RPT) dose and ADR
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900mg QD
-not for active; only for LTBI use in young >12yo; otherwise health, HIV negative <65YO -no findings in CXR |
rash, nausea, anorexia, hepatotoxicity, thrombocytopenia, body fluids turn orange
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Rifapentine Monitoring and counseling
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--drug interactions with CYP3A4
-LFT -CBC with differential (thrombocytopenia) |
-without food
-fluids orange -decrease birth control |
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LTBI treatments
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1. INHx9 months or 6 months. (Good for HIV and children)
2. Rifampin X 4 months (not for HIV patients) 3. INH+RIF ( 4 months (+CXR) 4. INH +rifapentine (12 weeks) >12<65, otherwise healthy |
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Drugs that make LTBI become active
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TNF-a drugs for rhematoid
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-infliximab (Remicade)
-etanercept (Enbrel) -adalimumab (Humira) |
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tummy problems
per DR MADISON |
ethionamide and paser
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endocrine; check TSH
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QFT:
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quantiferon -interferon gama assays
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-indicates LTBI in adults
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Tspot TB test
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indicates LTBI in children
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Monoresistance (INH)
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add FQN for 6 month regimen
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MDR TB
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resistance to INF and RIF
-treatment for 18-24 months |
-FQN
-PZA -EMB -Injectable Agent (aminoglycoside) -poser or cycloserine normally |
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RIF resistant TB
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add FQ, treatment for 12-18 months
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Traditional TB tx
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-INH and RIF for 6 months
-EMB and PZA for 2 months |
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TB main drugs affect by CrCl<30 or dialysis
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EMB and PZA
-solution is to dose TIW |
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EMB ADR, monitoring, and counseling
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-renal dosing
-visual acuity -need vision checks. -red/green discrimination |
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PZA ADR, monitoring, counseling
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-hepatotoxicity, non gouty arthritis, elevated uric acid
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-monitor LFT, uric acids, joint pain
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Injectable Aminoglycosides ADR
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Nephrotoxic
Ototoxic |
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Cycloserine ADR
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-psyco
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Ethionamide ADR
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hepatotoxic, endocrine check TSH, hypothyroidism
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PASER ADR
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GI, endocrine-tummy ache, monitor TSH
hypothyrodism-may need replacement |
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FQ ADR
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QT prolongation
glucose abnormalities |
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bedaquiline ADR
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LFT, HA, arthralgia
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