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pathophar exam finaL
CHAPTER 90 TB, ANTIMYCOBACTERIA, 91 ANTIBACTERIA DRUGS
| Question | Answer |
|---|---|
| TUBERCULOSIS Leprosy, and Mycobacterium avium Complex Infection | CAUSED BY THREE SPECIES OF MYCOBACTERIA M.TB, M.LEPRAE, M.AVIUM TREAT WITH SAME DRUG SLOW GROWING MICROBE PROLONGED TEATMENT POOR PATIENT ADHERENCE=EMERGENCE OF DRUG-RESISTANT MYCOBACTERIA |
| Global epidemic | ~2 billion infected worldwide Kills ~ 1.3 million people a year New cases in the USA are declining Cases outside the United States are increasing •95% occur in developing countries•Increase due to AIDS and emerging multidrug-resis |
| Pathogenesis | M. tuberculosis May be limited to lungs or may disseminate United States: Approximately 10 million people harbor tubercle bacilli but show no symptoms |
| TEACHING | Transmitted from person to person Inhalation of infected, aerosolized sputumtant mycobacteria S/S COUGHING BLOOD, SNEEZING NIGHT SWEAT AND WEIGHT LOSS |
| TEACHING | Immunity usually develops within a few weeks (body fight infection-latent infection) 90% with normal immune systems never develop clinical or radiologic evidence of TB |
| TEACHING-TREAT WITH 2 OR MORE DRUGS | TB IMMUNE SYS. FAILS TO CONTROL PRIMARY INFECTION NECROSIS(DEATH) AND CAVITAION OF LUNG TISSUE SEVER W/O TRTs REACTIVATION RENEWAL OF DORMANT TUBERCLE BACILLI 60% OF NEW INFECTIONS MAY BE CAUSED BY REACTIVATION |
| TEACHING | Treatment is considered effective when no mycobacteria are observed in sputum and no colonies are present in culture |
| DIAGNOSIS | INDICATION FOR TESTING NIGHT SWEAT, HEMOPTYSIS, HIGH RISK, WEIGHT LOSS CHEST X-RAY-SPUTUM CULTURE HIGH IN HOMELESS HIGH RISK GROUP-HEALTHCARE |
| DRUG RESISTANCE | SOME CAN DEVELOP RESISTANCE WHILE BEING TREATED SOME STRAINS THAT ARE ESISTANCE TO SOME |
| MULTIPLE DRUG RESISTANCE(MDR) | TO ISONIAZID AND RIFAMPIN UP TO 24 MONTHS FOR MDR TB OR HIV/AIDS |
| EXTENSIVELY DRUG-RESISTANT TB(XDR TB) | RESISTANT ISONIAZID (INH) RIFAMPIN ALL FLUROQUINOLONES AT LEAST ONE OF THE INJECTABLE 2ND-LINE DRUGS |
| EVALUATION 9MONTHS REGIMENS | • Induction phase: Eliminate actively dividing tubercle bacilli • Continuation phase: Eliminate intracellular “persisters” 6MONTHS FOR DRUG-SENSITIVE TB - Bacteriologic evaluation of sputum - Clinical evaluation - Chest radiographs |
| PROMOTING TREATMNT ADHERENCE | DIRECTLY OBSERVED THERAPY PATIENT NONADHERENCE ALLOWS FOR ONGING ASSESSMENT OF CLINICAL SIGNS INTERMITTENT 2 OR 3 TIMES WEEKLY |
| LATENT TB ACTIVE IS WITH MORE DRUG, TO AVOID | CHEST X-RAY TO MAKE SURE NO ACTIVE TB TREAT W/ 1OR 2 DRUGS 7Y ISONIAZID ALONE FOR 9MTHS ISONIAZID + RIFAPENTINE WEEKLY FOR WEEKLY FOR 3MONTHS |
| ISONIAZID PO/IM | TAKEN AT LEAST 6-9MONTHS LIVER DAMAGE SAFE, EFFECTIVE AND INEXPENSIVE BACTERICIDAL-RESISTANCE ADR OPTIC NEURITIS ANEMIA PERIPHERAL NEUROPATHY |
| ANTITUBERCULOSIS FIRST-LINE | ISONIAZID, RIFAMPIN Rifapentine, rifabutin |
| SECOND-LINE-FLUROQUINOLE | Levofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, streptomycin, para-aminosalicylic acid, ethionamide, and cycloserine |
| RIFAMPIN IV | BROAD SPECTRUM TB ADR HEPATOXICITY DISCOLORATION OF BODY FLUIDS INDUC P450; CAN HASTEN DRUG MUCUS MEMBRANE OF UPPER RESPIRATORY TRACT WARFARIN |
| LEPROSY(HANSEN'S DISEASE) | CHRONIC INFECTION • Causes gross disfiguration if untreated • Affects skin, peripheral nerves, and mucous membranes of upper respiratory tract MULTIDRUG THERAPY 12 months of treatment with three drugs: •Rifampin, dapsone, clofazimine |
| TB skin test (TST) | QuantiFERON-TB Gold (QFT-G) blood test - Blood tests for TB TST-- Test is read 48 to 72 hours after injection - + reaction is indicated by a region of induration (hardness) a |
| FLUROQUINOLONES | BROAD SPECTRUM -DISRUPT DNAREPLICATION AND CELL DIVISION |
| TEACHING | PO/IV RUPTURE ACHILLES TENDON NOT GIVEN <18YRS >60, TAKING GLUCORTICOID, KIDNEY LUNG TRANSPLANT |
| CIPROFLOXACIN | BROAD-SPECTRUM ANTIBIOTICS(GRAM -/+) INHIBIT BACTERIA DNA GYRSE |
| TEACHING | DRUG OF CHOICE FOR ANTHRAX INFECTION-UTI, BONES, JOIN ADR GIN/V/D/ HHEADACHE SEIZURE INCREASE RISK OF CDI |
| TEACHING | OLDER PT MYASTHEMIA GRAVIS CONFUSION, PSYCHOSIS, SOMNOLENCE, VISUAL ISSUE DRUG INTERACTION MILK-DAIRY-MG ANTANCID-AL ANTACID- SULCRATE WARFARIN |
| It is most important for the nurse to avoid administering oral ciprofloxacin to this patient with which food? | Milk |
| The patient is being discharged with continued ciprofloxacin therapy. When providing discharge teaching, the nurse should advise the patient to call the healthcare provider immediately if what develops? | Pain in the heel of the foot |
| A patient has been prescribed oral ciprofloxacin [Cipro] for a skin infection. When administering the medication, it is most important for the nurse to do what? | Withhold antacids and milk products for 6 hours before or 2 hours afterward. |
| Fluoroquinolones should be discontinued immediately if what happens? | Tendon pain or inflammation develops. |
| Which statement about the BCG vaccine does the nurse identify as true? | BCG vaccine can be used to treat carcinoma of the bladder. |
| Which information should the nurse include when teaching a patient about isoniazid (INH) therapy? | An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine. |
| Which information should the nurse include when teaching a patient about rifampin therapy? | Rifampin may be administered intravenously. orange color to urine, sweat, saliva, and tears; patients should be informed of this harmless effect. Permanent staining of soft contact lenses occasionally has occurred, |
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Seka_nurse
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