Term
| What is the causative agent of tb? |
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Definition
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Term
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Definition
| inhalation of aerosolized droplets that reach the lung |
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Term
| Fever, night sweats, fatigue, cough, weight loss, chills are sx of what illness? |
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Definition
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Term
| What is the std test for tb? |
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Definition
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Term
| What is injected under the skin for tb tsting? |
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Definition
| tuberculin purified protein derivative (PPD) containing 5 tb units is injected under the skin on the volar surface of the arm |
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Term
| How do you distinguish between latent and active tb? |
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Definition
| positive ppd does NOT distinguish. cxr required. |
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Term
| What is the no 1 drug for tb? |
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Definition
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Term
| What are 2 goals of tb tx/ |
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Definition
| cure pt, minimize transmission |
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Term
| What is the most important thing in organization and suprevision of tb tx? |
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Definition
| adherence plan that emphasizes directly observed tx: dot |
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Term
| What is the drug of choice for latent tb? |
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Definition
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Term
| what is the moa of isoniazid? |
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Definition
| inhibits synthesis of mycolic A, necessary for cell wall struture |
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Term
| Peripheral neuropathy w/isoniazid tx is more likely in which pts? What percentage of us population has this? |
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Definition
| slow acetylators- 50% of us population |
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Term
| Increase in liver enzymes, hepatitis, peripheral neuropthy caused by b6 deficiency are se of what tb tx? |
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Definition
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Term
| What are drug interactions of inh? |
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Definition
| inhibits cyp2c9 adn 2c19- increase serum levels of *warfarin*, phenytoin, benzodiazepines |
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Term
| What needs to be monitored w/inh? |
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Definition
| periodic msmt of serum transaminase levels |
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Term
| What is the moa of rifampin? |
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Definition
| inhibits bacterial rna polymerase |
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Term
| Which tb tx has the most adverse effects/ |
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Definition
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Term
| What is an alternative single agent for ltbi? |
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Definition
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Term
| When should rifampin be used as single tx for active tb? |
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Definition
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Term
| What drug has the following adverse effects: flu-like illness in up to 50%, potential for hepatic toxicity, esp w/etoh-, and reddish-orange coloration of urine, tears, saliva, contact lens? |
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Definition
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Term
| What is a potent inducer of multiple cyp 450 metabolic enzymes that increases metablism of many drugs, including many for hiv? this is the biggest drawback of the drug. |
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Definition
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Term
| How must rifampin be monitored? |
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Definition
| periodic liver function tests |
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Term
| What are derivates of rifampin w/similar moa and adrs? |
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Definition
| newer rifamycins: rifabutin, rifapentine |
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Term
| What is the least potent inducer of cyp enzymes of the rifamycins? |
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Definition
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Term
| What rifamycin is preferably used in hiv pts? |
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Definition
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Term
| What is intermediate btwn rifampin and rifabutin in drug interaction potential? how frequently can it be given in select pts? |
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Definition
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Term
| what is the exact moa of pyrazinamid? |
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Definition
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Term
| What is the use of pyrazinamide for tb? |
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Definition
| combination tx for active infections, allows reduction in tx duration |
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Term
| Hepatotoxicity, esp in combo w/rifampin, hyperuricemia and gout are adrs of what tb tx? |
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Definition
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Term
| What are the adr's of pyrazinamide? |
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Definition
| blocks hypouricemic action of allopurinol |
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Term
| How is pyrazinamide monitored? |
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Definition
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Term
| What is the moa of ethambutol? |
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Definition
| impairs bacerial metabolism |
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Term
| What is the use of ethambutol for tb tx? |
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Definition
| combination tx for active infection |
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Term
| Optic neuritis at higher doses, and red-green color blindness are adrs of what tb tx? |
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Definition
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Term
| What are the drug interactions of ethambutol? |
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Definition
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Term
| How is ethambutol monitored? |
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Definition
| visual acuity before start of tx and every mo |
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Term
| What is the recommended first line tx of ltbi? |
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Definition
| isoniazid 300 mg daily for 9 mos OR isoniazid 10-15 mg/kg twice weekly w/DOT for *9 mos* |
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Term
| What is 2nd line tx for ltbi? |
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Definition
| rifampin 600 mg dailly for 4 mos |
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Term
| What is 3rd line tx for ltbi? |
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Definition
| isoniazid 300 mg + rifampin 600 mg daily for 3 mos |
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Term
| What is the length of initial phase for active tb? |
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Definition
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Term
| What drugs are included in the intitial phase for active tb? |
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Definition
| isoniazid, rifampin, pyrazinamide, and ethambutol |
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Term
| What drugs are included for cont phase of active tb? |
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Definition
| only isoniazid and rifampin |
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Term
| On what does the duration of cont phase of active tb tx? |
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Definition
| initial presence of cavitary disease and positive sputum at 2 mos |
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Term
| How is the completion of tx for active tb determined? |
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Definition
| total no of doses taken not duration of tx |
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Term
| When should tb pts be referred to clinical specialist? |
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Definition
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Term
| What are 7 drugs given for drug resistant tb? |
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Definition
| aminoglycoside (streptomycin im, kanamycin, amikacin), fluoroquinolone abx, capreomycin, aminosalicylic A, cycloserine, ethionamide |
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Term
| When should you add a single drug to tb tx that isn't working? |
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Definition
| never add a single drug since resistance will be aquired quickly |
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Term
| What type of tb is resistant to at least isoniazide and rifampin? How many drugs are included in the typical tx? |
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Definition
| multi drug-resistant tb (mdrtb)- 5-7 drugs |
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Term
| What tb is resistant to isoniazid, rifampin, any fluoroquinoone, and either capreomycin, kanamycin or amikacin? |
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Definition
| extensively drug resistant tb (xdrtb( |
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Term
| For how long is tx continued for drug-resistant tb? |
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Definition
| 18-24 mos or 12-18 mos after culture becomes negative |
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Term
| What 3 tb drugs involve drug-induced hepatitis? |
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Definition
| inh, rif, pza- at higher risk if previous hx of hepatitis, etoh- abuse |
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Term
| What tb tx involves thrombocytopenia and acute renal failure? |
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Definition
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Term
| What tb tx involves optic neuritis? |
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Definition
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Term
| Why must tb tx must be given w/food? |
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Definition
| gi upset very common during 1st few weeks |
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