TB 2

Question 1

who should not use isoniazide

Answer 1

someone with an AST or ALT 6-8 times normal

Question 2

what should always be given in combination with isoniazide? why

Answer 2

vitamin B6 (pyridoxine)
prevent neurotoxic side effects

Question 3

what does rifampin compete with for uptake by hepatocytes

Answer 3

bilirubin

Question 4

what are two major adverse effects of pyraxinamide

Answer 4

hepatotoxicity
hyperuricemia (avoid with gout)

Question 5

which TB drug has no risk of hepatotoxicity?

what risk does it have?

Answer 5

ethambutol

optic neuritis

Question 6

what is the least likely to be resistant of all first line TB agents

Answer 6

ethambutol

Question 7

what are the non-pharm steps for TB

Answer 7

1. respiratory isolation = prevent spread
2. contact investigation
3. return pt. to state of normal weight

Question 8

what are steps of treatment of active TB in initial phase

Answer 8

1. obtain smears and cultures
2. 4 drug regimen for 2 months
3. smears and cultures at end of 2 months

Question 9

how long do TB cultures take to get results?

how long for smears?

Answer 9

cultures = 6-8 weeks

smears immediate results

Question 10

what are the 4 drugs in TB regimen

Answer 10

1. isoniazid
2. rifampin
3. pyrazinamide
4. ethambutol

Question 11

what are steps of treatment of active TB in continuation phase

Answer 11

1. check for cavities in chest xray or positive smear
2. if culture is negative continue isoniazid and rifampin for 4 more months (6 months of treatment)
3. if culture is positive continue isoniazid and rifampin for 7 more months (9 months of treatment)
   (same treatment if xrays or smear are negative)

Question 12

what are 4 things to do/ note with drug resistant TB

Answer 12

1. consult TB specialist
2. avoid monotherapy
3. avoid adding only a single agent at a time
4. try and use at least 3 previously unused, susceptible drugs

Question 13

how is monitoring response to TB therapy done

Answer 13

1. smears and cultures monthly until 3 are negative
2. follow up at 6 months and 1 year after therapy
3. if still positive after treatment consult ID specialist

Question 14

how is latent TB treated

Answer 14

isoniazid for 9 months and no alcohol for that time

Question 15

what is the option for latent TB treatment if isoniazid is not tolerated

Answer 15

rifampin

Question 16

what is the preferred treatment for latent TB in pregnant women

Answer 16

isoniazid