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RxPrep
Tuberculosis
| Question | Answer |
|---|---|
| Is MTB acid-fast? | Yes, MTB is an acid-fast bacillus (AFB) |
| How is active pulmonary TB transmitted? | Aerosolized droplets |
| Is latent TB contagious? | No |
| Is active TB contagious? | Yes |
| Classic symptoms of active TB? | Cough, hemoptysis, purulent sputum, fever, night sweats, unintentional weight loss |
| What is latent TB? | TB is present but contained by the immune system |
| Symptoms of latent TB? | none |
| How many drugs are usually used for LATENT TB? | 1-2 |
| What is active TB? | Symptomatic TB |
| How many drugs are used in preferred ACTIVE TB treatment? | 4 drugs initially |
| What is the preferred regimen for TB? What drugs are included? | RIPE (Rifampin, isoniazid, pyrazinamide, ethambutol) |
| Main goal of treating latent TB? | Prevent progression to active TB |
| Main goal of treating active TB? | Cure infection and prevent resistance/transmission |
| Two main tests for latent TB? | TST (TB Skin Test) and IGRA (interferon-gamma release assay) |
| Does a positive TST or IGRA automatically confirm active TB? | No |
| Which test is not specific/definative for TB? | AFB smear |
| Which test confirms TB 100%? | PCR or sputum culture |
| What TST value would likely indicate TB? | >5-15 (depending on risk factors/immigration history/travel history) |
| Preferred tx duration for active TB? | 6 months |
| How long is the intensive phase for standard active TB treatment? | 2 months |
| How many drugs used in intensive phase for active TB? | 4 drugs (usually RIPE) |
| What are the 2 phases of active TB treatment for the standard regimen? | 1)intensive phase (2 months) 2)continuation phase (4 months) |
| How many drugs are usually used for the standard, active TB during the continuation phase? | 2 drugs |
| Which drugs are usually used during contiuation phase? | Isoniazid and rifampin |
| How often can active TB drugs be given according to the table? | Daily or 5 times per week using DOT (direct observed therapy, where the governement ppl watch you take the meds for adherence) |
| Preferred general concept for latent TB regimens? | Usually shorter regimens (3-4 months) for most adults |
| Why do we use shorter tx duration for latent TB? | Increases adherence and reduces hepatotoxicity |
| What is the common/main regimen for latent TB? | isoniazid (INH) + rifapentine for 12 weeks |
| Can the 12-week INH + rifapentine regimen be self-administered (not by DOT)? | Yes, but can still use DOT does is not required |
| Can INH + rifapentine be used in pregnancy? | NO, rifapentine is contraindicated in pregnancy |
| Can rifampin alone be used for latent TB? | Yes, but needed for 4 months |
| Can INH alone be used for latent TB? | Yes, but need to be 6-9 months |
| Which latent TB regimen may be preferred in HIV-positive patients on antiretrovirals? | INH 300 mg daily for 9 months (has to be 9 months if they have HIV, non-HIV patients can do 6 months) |
| Rifampin brand name? | Rifadin |
| Rifampin dose for active TB? | 10 mg/kg PO daily (max 600 mg) |
| How should rifampin be taken? | On an empty stomach |
| Major rifampin contraindication? | Do not use with protease inhibitors |
| rifampin DDI concerns? | Yes, Strong enzyme inducer that lowers concentrations/effects of many drugs (induces 1A2, 2C8, 2C9, 2C19, 3A4, and P-glycoprotein). |
| What drug classes are we most concerned about with rifampin for DDIs? | Warfarin (drops INR, requires increase warfarin dose) Birth controls (decreased efficacy, backup contraception) DOACs (decreased efficacy, avoid) |
| For a patient HIV who needs RIPE, what do we do if theyre currently on anti-retrovirals? | You could switch the rifampin to rifabutin |
| Rifampin common ADRs? | increased LFTs, GI upset, rash, flu symptoms, |
| Which TB drug can cause orange/red discoloaration of body secretions? | Rifampin |
| Major warnings with rifampin? | Hemolytic anemia (positive Coombs test) Dont use with protease inhibitors (-navir drugs) |
| INH (isoniazid) dosing for *active TB? | 5mg/kg PO daily (max 300mg daily) |
| How should isoniazed be taken? | On empty stomach |
| Which TB drug requires vitamin supplementation? | Isoniazid (need to take pyridoxine aka B6); to avoid neuropathy) |
| Usual pyridoxine dose with INH? | 25-50 mg daily |
| Boxed warning for isoniazid? | Severe (and fatal) hepatitis |
| INH contraindications? | Active liver disease, previous severe adverse reaction to isoniazid |
| Major INH warning? | Peripheral neuropathy |
| Which TB drug can cause DILE (drug included Lupus) | Isoniazid |
| Common lab changes on isoniazid? | Increased LFTs |
| Major warnings for isoniazid | Lupus, hemolytic and aplastic anemia, skins rashes, pancreatitis, skin reactions, eye damage (optic neuritis) |
| Pyrazinamide dose? | 1–2 g PO daily, varies based on weight |
| Is pyrazinamide renally dosed? | Yes, CrCl <30 mL/min needs extended interval |
| Major pyrazinamide contraindication? | Acute gout, severe heaptic damage |
| Common pyrazinamide side effects? | GI upset, malaise, arthralgia, myalgia, rash |
| Important pyrazinamide lab abnormalities? | Increased LFTs and hyperuricemia |
| Ethambutol brand name? | Myambutol |
| Is ethambutol adjusted in renal impairment? | Yes, if CrCl <50 mL/min: extend interval |
| Ethambutol dose? | 800–1,600 mg PO daily, varies by weight |
| ethambutol should be avoided in what conditions? | Young children, unconscious patients, or anyone who cannot report visual changes and Optic neuritis patients |
| Key monitoring needed for ehtambutol? | Baseline + monthly vision exams |
| Other ethambutol side effects? | Confusion, hallucinations, N/V, rash, headache |
| Important lab changes seen with ethambutol? | Increased LFTs |
| Which RIPE drugs raise LFTs? | All RIPE drugs |
| Which RIPE drug causes orange body secretions? | Rifampin |
| Which RIPE drug requires pyridoxine (vit B6)? | Isoniazid |
| Which RIPE drugs can cause hemolytic anemia with positive Coombs test? | Rifampin and isoniazid |
| Which RIPE drug increases uric acid? | Pyrazinamide |
| Which RIPE drug can cause visual changes? | Ethambutol |
| Which RIPE drug is the main concern with protease inhibitors? | Rifampin |
| Which RIPE drug has the boxed warning for severe hepatitis? | Isoniazid |
| Can you give a shorter TB regimen for active TB? | Yes, there is a 4 month active regimen, which uses a different drug combo than RIPE |
| How is the 4 month regimen different from ripe? | Initial phase (8 weeks): Isoniazid + *rifapentine + *moxifloxacin + pyrazinamide Continuation phase (9 weeks): Isoniazid + *rifapentine + *moxifloxacin |
| What is one advantage of the alternative 4-month regimen for active TB? | Shorter treatment duration and avoids ocular toxicity from ethambutol |
| When is TB considered MDR-TB (multi-drug resistant)? | When it is resistnant to isonioazid and rifampin |
| What is the RIPE treatment (standard treatment) schedule for active TB? | RIPE for 2 months Isoniazid + rifampin for 4 months |
Created by:
cdaughtry