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IOS 11 Exam 3
Treatment of TB and MDR
| Question | Answer |
|---|---|
| Prevalence if TB Global and in US | 2-3 million deaths world wide, US has 14,000 infected |
| Latent Infection is | Patient who are not infectious and have no s/s of infection |
| BCG vaccination | Some countries treat latent children with BCG to prevent the development of meningitis but this does not prevent the development of TB as an adult |
| TB virulence | It can infect anyone- T-cells and monocytes are important hose defense systems that keep the infection in check |
| Site of TB infection | Lungs are the most common, but atypical sties are present in immune compromised hosts |
| Symptoms of TB infection | Dyspnea, night sweats, weight loss Atypical symptoms are Diarrhea, hepatomegaly, splendomegaly, lymphadenopathy |
| Susceptibility testing | Traditional (concentration, 3-6 weeks), Direct (Plate sample & sample with drug, 2-3 weeks) Indirect-(isolate and culture it in drugs) or Bactec Radiometric(C14 label, 1.5-2 weeks) |
| FDA medication to treat TB | Isoniazid (300mg-PO, IM, IV), Rifampin (600mg PO, IV)Pyrazinamide (oral 25-30mg/kg)Ethambutol (15-25mg/kg PO) |
| Isonaizid MOA and SIde effects | Inhibits cell wall synthesis- Hepatotoxic, peripheral neuropathy |
| Rifampin MOA and Side effects | Inhibits RNA polymerase-#A4 inhibitor hepatotoxic |
| Pyrazinamide MOA and Side effects | Affect FA synthesis-Hepatotoxic, increase in uric acid (complicance tester) |
| Ethambutol MOA and Side Effects | Inhibits cell wasll synthesis-Ocular toxicity and rash |
| Tb drugs excreted via liver | Isonaizide, rifampin, Rifabutin, Pyrazinamide |
| TB drugs that are renal excretion | Ethambutol, streptomycin, Levofloxacin, Moxifloxin |
| Treatment of latent TB | Isonaizid 300mg QD for 9 months or Rifampin + Pyrazinamide -monitor LFT |
| MDR- TB | If patient is considered to have a resistant strain treat for 18-30 months |
| Therapeutic monitoring of TB | Do theraputic monitoring of serum concnetrations as a surrogate for drug concentrations at site of action, HIV med have low theraputic index |
| 3A4 inducers | Rifampin is a hug inducer which takes 1 week to start and 1 week to remove. Protease inhibitors will be reduced but less so with Rifabutin (substrate), with can use Efavarinz |
| 3A4 inhibitor | Inhibition occurs in hours-Clarithromycin, erythromycin, fluconazole and Protease inhibitors will show and increase in concentration -careful |
| TB +HIV treatment | rule of thumb is start the patient on TB therapy for 2 months then start HIV meds. To not overwhelm the patient with meds and get infection started to clear |
| Paradoxial TB reaction | Tb temporary worsens |
| Treatment of Non-TB infection-MAC | Azithromycin +Rifabutin+Ethambutol and may need to add Streptomycin |
Created by:
liza001
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