thera II test I TB

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thera II test I TB
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2013-02-22 12:18:31
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thera II test I TB
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  1. 4 stages of pathogenesis of TB
    • 1. tubercle bacillis ingested by macrophages but survive inside
    • 2. Inflammation response brings more defensive cells to the area. alveolar walls damaged by cytokines
    • 3. Tubercle formed with caseous center
    • 4. Tubercle ruptures, bacteria spread to other parts of lungs and other organs
  2. 8 characteristics of LTBI
    • 1. small amount of live, inactive TB bacteria
    • 2. Can't spread
    • 3. don't feel sick, but may become sick
    • 4. TB skin test shows infection
    • 5. radiograph is typically normal
    • 6. sputum smear & culture are negative
    • 7. should consider Tx to prevent TB disease
    • 8. doesn't require respiratory isolation
  3. 8 characteristics of TB disease
    • 1. large amount of active TB bacteria
    • 2. may spread TB bacteria
    • 3. may feel sick and have symptoms - cough, fever, weight loss
    • 4. TB skin test indicating infection
    • 5. radiograph is abnormal
    • 6. sputum smear & culture may be positive
    • 7. needs Tx for TB disease
    • 8. may require respiratory isolation
  4. 7 general symptoms of TB disease
    • 1. fever
    • 2. chills
    • 3. night sweats
    • 4. weight loss
    • 5. loss of appetite
    • 6. fatigue
    • 7. malaise
  5. 3 extrapulmonary TB disease symptoms
    • 1. Spine - back pain
    • 2. Kidneys - blood in urine
    • 3. lymph nodes - swelling in the neck
  6. 3 symptoms of pulmonary TB
    • 1. cough lasting 2 or more weeks
    • 2. chest pain
    • 3. coughing up blood or sputum
  7. 4 cases where an induration of 5mm or more is considered positive for the TST test
    • 1. HIV
    • 2. recent contact with infectious TB disease
    • 3. chest X-ray suggesting previous TB disease
    • 4. organ transplant or immunosuppressed
  8. 7 cases where 7mm induration is condidered positive for TST
    • 1. come to the US in last 5 yrs from TB area
    • 2. IV durg users
    • 3. residents and employees of high risk settings
    • 4. mycobacteriology laboratory personnel
    • 5. conditions that increase risk for progression of TB disease
    • 6. children less than 4 years of age
    • 7. infants, children and adolescents eposed to adults that are high risk
  9. cases where induration of 15mm or more is considered positive of TB disease
    anyone
  10. 5 components of bacteriologic examination
    • 1. specimen collection
    •     three sputum speciments
    • 2. AFB smear classification
    • 3. NAA testing
    • 4. culture and identification
    • 5. drug-susceptibilty testing
  11. AFB positive
    indicates TB disease - doesn't comfirm diagnosis of TB
  12. AFB negative
    doesn't exclude TB disease
  13. culture positve
    • confirms diagnosis of TB
    • results in 4-14 days
    • culture monthly until you get 2 consecutive negatives
  14. culture negative
    • M.tubersulosis not identified
    • doesn't exclude diagnosis of TB disease
  15. what is drug-susceptibility testing
    • determines which drug can kill the tubercle bacilli
    • susceptible - no growth
    • resistant - growth
  16. mono-drug resistant TB
    resistance to one of the first line drugs
  17. multidrug-resistant (MDR-TB)
    resistance to isoniazid and rifampin
  18. extensively-drug resistant (XDR-TB)
    • resistance to fluoroquinolones and at least one of three injectable drugs
    •    amikacin
    •    kanamycin
    •    capreomycin
  19. 3 latent TB Tx regimens
    • 1. isoniazid INH) daily for 9 months
    • 2. isoniazid (INH) and rifapentine (RPT) 12, once weekly doses under direct observation therapy (DOT)
    • 3. Rifampin (RIF) daily for 4 months or daily for 6 months
  20. AE of isoniazid
    • neuropathy - give vitamin B6 (pyridoxine)
    • dark urine
  21. AE of isoniazid and rifapentine
    • HoTN
    • hepatotoxicity
    • pseudo jaundice
  22. who is INH and RPT not recommended for
    • children < 2
    • HIV/AIDS on antiretroviral TX
    • pregnant women, or expecting to be
  23. when should medications be withheld in respect to transaminase levels
    • 1. > 3 times upper limit of normal in presence of symptoms
    • 2. > 5 times upper limit of normal in asymptomatic patient
  24. AE of rifampin (RIF)
    • hepatitis
    • bleeding problems
    • orange discoloration of bodily fluids
  25. AE of rifapentine (RPT)
    • polyarthralgia - painful inflammation and stiffness of the joints
    • orange discoloration of bodily fluids
  26. additional concerns for rifampin (RIF)
    • significant interaction
    •    HIV medications
    •    methadone
    •    oral contraceptives
  27. additional concerns for rifapentine (RPT)
    • used once weekly with INH, in the continuation pahse only for HIV-seronegative patients with non-cavitary
    • drug susceptible pulmonary TB who have negative sputum smears at 2 months
  28. AE of rifabutin (RBT)
    • flu-like symptoms
    • orange discoloration of bodily fluids
    • uveitis - swelling and irritation of the uvea (middle layer of the eye)
  29. AE of pyrazinamide - PZA
    • hepatitis
    • hyperuricemia
  30. AE of ethambutol
    optic neuritis - inflammation of the optic nerve
  31. additional concerns for rifabutin - RBT
    substitute for RIF if tolerance occurs of taking drugs that have unacceptable interactions with RIF
  32. additional concerns of pyrazinamide - PZA
    reduce dose in patients with renal insufficiency
  33. additional concerns for ethambutol - EMB
    adjust dose or dosing interval when creatinine clearance is <30 ml/min
  34. drug regimen for culture positive, drug-susceptible TB
    • INDUCTION PHASE
    • 1. RIPE - 7 days/wk for 56 doses - 8wks or           5 days/wk for 40 doses - 8wks
    • CONTINUATION PHASE
    • 2. INH/RIF - 7days/wk for 126 doses-18wks or 
    •                  5 days/wk for 90 doses - 18wks
    • 2. INH/RIF 2x/wk for 36 doses - 18wks
    • 2. INH/RPT 1x/wk for 18 doses (18wks)
  35. 3 conditions requiring additional considerations for Tx
    • 1. renal insufficiency/end-stage renal disease
    • 2. hepatic disease
    • 3. extrapulmonary TB
  36. Tx interruption process
    • 1. if > 14 days, restart treatment
    • 2. if < 14 days, continue as long as all doses are completed within 3 months
    • 3. recieved > 80% of doses
    •     sputum smear negative - may be done
    •     sputum smear positive - continue therapy
    • 4. received < 80% of doses and lapse is
    •    <3months, continue therapy
    •    >3months, restart therapy from beginning of initial phase

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