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First line of medication for TB?
- Isoniazid (INH)
- Rifampin (Rifadin)
- Ethambutol (Myambutol)
- Pyrazinamide (PZA)
taken for 8 weeks
What is the resistant strain called?
why does it occur?
- occurs when pt receives 2 meds and discontinues ONE of the medications
what are s/s of TB?
- night sweats
- low garde fever
Dx of TB?
- Mantoux skin test is positive. Duration
- Acid-fast bacillus test
- Chest x-ray, sputum culture (3+) is most definative
what type of isolation is TB?
Treatment of TB lasts?
why do pts stop too early?
- 6-12 months
- stop early bcuz the meds make them feel bad
what is definative for nontransmissionable?
how long on meds?
- 3 negative sputum checks
- > 14 days on meds
what are other airborne diseases for airborne precations?
chicken pox, shingles, meningitis
Direct Observation Treatment Surveillance
A Mantoux test should be administered...
- intradermal injection to inner forearm
- reviewed in 48 hrs for induration
in order to avoid spreading Tb the pt should...
cover mouth when coughing, family members may need to be treated also
if a pt has a positive skin test result, what would next step be?
have pt perform a definative test to determine of they have the "active" (infectious) disease
what is best precaution to take when caring for this pt?
- Use of N-95
- high-efficiency particulate air mask (HEPA)
Positive skin TB test, but not "active", what is the recommended treatment?
prophylactic therapy with INH for 6 months
what is isoniazid contraindicated in?
hypersensativity or acute liver disease, use caution in chronic liver disease, alcoholism or renal impairment. those taking Niancin
why is Pyridoxine prescribed with Isoniazid?
reduce risk of neurotoxicity
how is Isoniazid taken in regards to meals?
1 hr before or 2 hr after meal and before antacids
Rifampin inhibits the bacterial RNA synthesis but has several SE:
hypersensitivity, fever, chills, shivers, headache, red-orange colored secretions, vision changes, hepatotoxicity, increased uric acid levels
Second line drugs for TB?
Capreomycin, ethionamide, prar-aminoslicylate sodium and cycloserine
which 1st line med can be stopped after 8 weeks?
which meds are continued for full 6 months?
INH and Rifampin
due to nerupathy of INH which vitamin can be given?
meds - unique effects
- INH - neuropathy
- rifampin - reddish brown fluids
- Pyrazinamide - gout, purines monitored Streptomycin - ototoxicity, nephrotoxicity, neurotoxicity - monitor peaks/troughs Ethambutol - Visual acity red/green