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Chpt 90 - Pharmacology for Nursing Care
Antimycobacterial Agents: Drugs for Tuberculosis, Leprosy, and mycobacterium avium Complex Infection
26
Nursing
Undergraduate 1
12/02/2012

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Cards

Term
Why does treatment of mycobacteria take so long?
Definition
Because they are slow growing 
Term
What are some of the problems presented by the long treatment times needed to treat mycobacterial infections?
Definition

1. Drug toxicity

2. poor patient adherence

3. drug resistance by the target bacteria

Term
Why are some mycobacteria referred to as acid-fast bacteria?
Definition
Because they resist decolorizing by the dilute acid used in some staining protocols
Term
What is the principal cause underlying the emergence of resistance to tuberculosis drug therapy?
Definition
Inadequate drug therapy
Term
What is the Prime Directive in tuberculosis treatment?
Definition
Always treat TB with two drugs or more to reduce the likelihood of the vacteria becoming drug resistant.
Term
In the standard four-drug tuberculosis regimen, which two drugs are almost always included?
Definition
Rifampin and isoniazid
Term
What are the two phases of TB treatment?
Definition

Initial (induction) phase

Continuation phase

Term
What is the goal of the Initial phase of TB treatment?
Definition
Eliminiation of actively dividing extracellular tubercle bacilli and noninfectious sputum
Term
What is the goal of the Continuation phase of TB treatment?
Definition
Elimination of intracellular 'persisters'
Term
Do all people infected with M. tuberculosis exhibit symptoms of the disease?
Definition
No.  Most people remain asymptomatic, though they will harbor dormant bacteria for life in the absence of drug therapy.
Term
What two ways can a person develop active TB?
Definition

1. reactivation of an old infection

2. recent person-to-person transmission of a new infection

Term
How long does treatment for TB last?
Definition
six months to two years
Term
What can be done to greatly increase patient adherence to TB therapy?
Definition
by using directly observed therapy combined with intermittent dosing rather than daily dosing
Term
What are the three methods employed to evaluate TB therapy?
Definition

1. bacteriologic evaluation of sputum

2. clinical evaluation

3. chest radiographs

Term
What are the four first line drugs used for TB?
Definition
Isoniazid, rifampin, pyrazinamide and ethambutol
Term
How many drugs may be needed for initial treatment of MDR-TB and XDR-TB?
Definition
Up to seven
Term
What is the greatest risk factor for liver damage in patients taking Isoniazid?
Definition
Advancing age
Term
What can be given to a patient taking Isoniazid to prevent drug induced peripheral neuropathy?
Definition
pyridoxine supplements
Term
Which medications can be metabolized more quickly by Rifampin?
Definition
oral contraceptives, warfarin, certain protease inhibitors and NNRTIs used for HIV infection
Term
What is the greatest risk for patients taking combination Rifampin, Isoniazid and Pyrazinamide?
Definition
Liver injury due to the severe hepatotoxicity of medications that are already liver toxic separately.
Term
How is Ethambutol different from Rifampin, Isoniazid and Pyrazinamide?
Definition
It is bacteriostatic, not bactericidal
Term
What is the principle adverse effect of Ethambutol?
Definition
Optic Neuritis
Term
What is given under the skin during the TB skin test?  How long does it take to react in an infected person?
Definition

Purified protein dirivative (PPD)

48-72 hours

Term
What new regimen is just as effective as Isoniazid for the treatment of latent TB and may replace it soon as the standard treatment?
Definition
Isoniazid plus rifapentine taken once a week for three months, which is half as long as the standard 9 month treatment with Isonizid alone.
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