Term
| What are the risk factors for TB? |
|
Definition
- Urban area
- Foreign birth
- Close contact w/ infected
- Minority
- HIV infection**
- Immunosuppression |
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Term
| What are signs and symptoms of TB? |
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Definition
Weight loss
Fatigue
Productive Cough
Fever
Night sweats – get up during the night to change clothes**
Hemoptysis |
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Term
|
Definition
- Clinical presentation
- Radiography - UPPER lobe infiltrates
- Epidemiology of area
- AFB sputum x3, C&S (takes a month) |
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Term
|
Definition
5-15 mm of induration
A negative rxn can be measured only for 72 hours. A false positive can be seen w/ vaccine |
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Term
|
Definition
Interferon-Gamma Release Assays - blood test to detect TB infection
- Measures IFN-gamma released by RBCs in response to antigen.
**Result in 24 hours. T-spot can be borderline |
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Term
| What are the pros and cons of IGRAs? |
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Definition
- Pros - Single visit, 24 hours, does not boost response, no false+ from vaccine
- Cons - error in collection affects, limited data, expensive |
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Term
| What is infection control for TB? |
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Definition
| In airborne isolation/negative pressure until AFB negative x 3 or 2 weeks of Tx/AFB negative |
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Term
| What labs must be done before TB tx? |
|
Definition
- Liver
- Visual acuity - the ishihara test |
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Term
| What are the first line TB agents? |
|
Definition
- R - Rifampin
- I - Isoniazid
- P - PZA/Pyrazinamide
- E - Ethambutol |
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Term
|
Definition
- AE: Hepatotoxicity and peripheral neuropathy
- Given w/ pyridoxine to reduce neuropathy |
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Term
| How is Rifampin used for TB? |
|
Definition
- AE: Hepatotoxicity, 3A4 inducer:antiretrovirals, OCs, methadone, anticonvulsants, cardiac meds, statins, sulfonylureas, antipsychotics
- Turns fluids orange |
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Term
|
Definition
| - AE: hepatotoxicity, polyarthralgias |
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Term
| How is ethambutol used for TB? |
|
Definition
| - AE: Baseline visual acuity test needed, test monthly |
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Term
| What AG is 2nd line for TB? |
|
Definition
Streptomycin
- AE: Ototoxicity and neurotoxicity. Less common nephrotoxicity |
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Term
| What is direct observed therapy (DOT)? |
|
Definition
- Watch as patient takes TB meds
- A preferred initial strategy - identify early tx failure and noncompliance |
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Term
| Why is 4 drug therapy used for TB? |
|
Definition
- To kill TB organisms rapidly
- Prevent drug resistance
- Eliminate TB organisms from bodily tissues
- Combo therapy is key |
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Term
| What is the tx for drug susceptible TB? |
|
Definition
No prior tx:
- 8 weeks of RIPE
- 18 weeks of rifampin + isoniazid
- Total: 26 weeks |
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Term
| What is the tx for drug susceptible TB in an HIV-positive patient? |
|
Definition
Same 26 week therapy except:
- once and twice weekly regimens NOT preferred
- CD4 < 100 - daily, 5d/week, 3d/week
- Rifabutin can replace rifampin |
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Term
| When does TB tx last 9 months? |
|
Definition
Cavitation at the end of induction
No PZA used in initial tx |
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Term
| How is latent TB treated? |
|
Definition
- Isoniazid for 9 MONTHS!
- INH + rifapentine weekly x3mo by DOT
**This includes exposure |
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Term
| How is disseminated TB treated? |
|
Definition
- No meningeal involvement: RIPE induction, then RIF+INH for 6-9 mo
- Meningeal involvement: RIPE induction, then RIF+INH for 9-12 mo, + steroids |
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Term
| How is active TB monitored? |
|
Definition
- Sputum culture every month until negative x2
- Frequent AFBs
- Monthly clinical exam |
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Term
| What leads to TB tx failure? |
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Definition
| Main risk factor: Cavitation + positive culture at end of induction - Failure - positive culture 4 months after Tx initiation - Relapse - Recurrence 6-12 months after cure. **Non-adherence, cavitation, MDR, error |
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Term
| How is a relapse due to drug resistant TB treated? |
|
Definition
INH + RIF + PZA + 3 additional:
- FQN
- Streptomycin
- Amikacin, kanamycin, or capreomycin |
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Term
| What complications are common with TB tx? |
|
Definition
- GI - 1st month, give at bedtime WF
- Rash - If petechiae, check platelet count. May be due to RIF (D/C if platelets low). Erythmatous w/ mucous involvement could be steven-johnson/serious (stop ALL drugs, restart 1 at a time)
- Drug fever - exclude other causes, stop ALL drugs and restart 1 at a time |
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Term
| What is hepatitis in TB patients? |
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Definition
- LFTs 3x normal w/ sx, 5x w/o sxs
- Incr alk phos and bilirubin due to RIF
- STOP INH, RIF, PZA. Consider other agents until LFTs <2x normal, then restart 1 at a time |
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Term
|
Definition
| Worsening of TB sxs despite tx in HIV patients |
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Term
|
Definition
- MDR: Resistant to >/= 2 agents: INH and RIF
- XDR: Resistant to INH + RIF AND any FQN AND capreomycin/kanamycin/or amikacin
**Use 4 or more agents: Always and injection (group 2) and a FQN (group 3). Remember - resistant to INH + RIF. |
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Term
| What is group 2 of TB tx? |
|
Definition
Aminoglycosides:
- Amikacin - not FDA approved
- Kanamycin - 1st choice of all injectables**
- Streptomycin - last line due to resistance
- Capreomycin - very expensive, high rate of resistance. Increased hypokalemia
**Use only 1, usually Kanamycin. Always used for MDR/XDR |
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Term
| What is group 3 of TB tx? |
|
Definition
FQNs:
- Ofloxacin
- Levofloxacin - FQN of choice according to WHO
- Moxifloxacin - Most potent
**Use only one. ALWAYS used in MDR/XDR |
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Term
| What drugs are group 4 for TB tx? |
|
Definition
Oral 2nd line bacteriostatic:
- Ethionamide/Prothionamide - 1st choice, cross resistance w/ INH
- Cycloserine/Terizidone
- PAS - least effective
**Use cycloserine + ethionamide |
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Term
| What drugs are group 5 for TB tx? |
|
Definition
< effective w/ sparse clinical data:
Only augmentin is used as salvage therapy |
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Term
| What is an ideal MDR TB regimen? |
|
Definition
| ETH + PZA + Kanimycin + Levofloxacin |
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