Antitubercular drugs- PP

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1

TB is

acid fast

gram positive

gram negative

Acid fast

2

TB transmission

Droplet

3

TB causes

caseation and cavitation

necrosis

4

Some people will harbor TB organisms and end up with

Latent TB

5

Only people with _________ TB are at risk of infecting others

Active

6

TB risk factors

-high risk residential living

-drug users

-immunocompromised

-health care workers w/ high risk pts

-people from countries w/ high prevelance

7

Symptoms of TB

-Bloody or acid fact sputum

-cough, fever, night sweats

-GI distress, weight loss, anorexia

8

TB prophylaxis recommended for

-HIV/immunocompromise

-close contact

-conversion from negative to positive, or latent

-IV drug users

-Immigrants from high prevalence countries

9

BCG (Bacilli Calmette-Guerin) vaccines will cause a positive _______ but do not affect ___________.

TB test

IGRA- Interferon Gamma Release Assay

10

Single drug therapy for TB is

Ineffective

11

Multi-drug therapy for TB prevents

bacterial resistance

12

Multidrug therapy for TB decreases

treatment duration

13

Prophylactic TB treatment is given to those with

Latent TB or clinically significant TB tests results

14

A positive TB test is a reaction of 5mm or more in cases of

-recent contact with active TB

-Fibrotic changes on chest radiography consistent w/ old TB

-Transplant recipients

-Immunosuppression due to >15 mg prednisone per day

-Those taking TNF antagonists

-HIV positive

15

A positive TB test is a reaction of 10mm or more in cases of

-recent immigrants from high prevalence countries<5 years

-IV drug users

-residents/employees of high risk congregate facilities

-Mycobacteriology lab personnel

-Under age 4

-minors exposed to high risk adults

16

TB surrounded by a granuloma, does not cause symptoms, and is not contagious

latent TB

17

Latent TB may cause disease

later in life

18

TB leisions are called

Tubercles

19

Caseous tubercle is "cheese like and is often

found in the center of necrotic tissue

20

TB lesions can cause

cavitation

necrosis

21

First line TB drugs are

more effective and less toxic than second line TB drugs

22

In combination therapy for TB, a minimum of

3-5 drugs are used

23

Initial TB therapy drugs last

2 months

24

COntinuation phase of TB therapy lasts

4-7 mo

25

Rifampin turns body fluids orange and may

Permanently discolor contact lenses

26

Side effects of TB drugs in general

-headaches, dizziness, confusion

-GI distress

-Peripheral neuropathy

-eye, ear, renal, liver toxicity

-Thrombocytopenia

-Respiratory depression

27

Pyridoxamine (Vit B6!!!!) is an antitubercular drug that causes

hyperglycemia

Hyperkalemia

Hypophosphatemia

Hypocalcemia

28

Who is at risk of peripheral neuropathy as a result of Ionazid?

-Diabetics

-Those who are malnourished

-Alcoholics

29

In pregnant women with TB, benefits of treatment

outweigh the risk, but there is a special regimen used

30

TB is the leading cause of death for people with _______ so they need a __________ course of TB drugs

HIV

9 month

31

Pediatric populations tend to respond to TB with ____________ and they need _____________ of treatment

more severe illness

9 months

32

In TB treatment, you must assess for __________if streptomycin is used

ototoxicity

33

INH must be administered

1 hr before or 2 hrs after meals

34

INH blocks

B6 absorption

35

Antitubercular drugs given, what must be assessed?

-Hepatic function

-respiratory

36

Antacids with antitubercular drugs?

No!

Decreases absorbtion

37

Signs of peripheral neuropathy?

Burning, numbness and tingling in hands and feet

38

Sunlight and antitubercular drugs

Photosensitivity!

SPF of 30+

39

Big adverse reaction to ionazid?

Hepatotoxicity

40

Transplant pts are on special diets to avoid

e coli and listeria, etc

41

The function of monoclonal antibodies

Inhibiting the action of lymphocytes and prevents the body from mounting an immune response against transplanted organ

42

Monoclonal antibodies side effects

Fever

ab/back pain

fatigue

weakness/chills

Dizziness, sore throat, dyspnea

N/V

Dysuria, edema, blood dyscrasias

tremor

sepsis, cytokine release syndrome

Diabetes, malignancy, capillary leak syndrome

43

how does Cyclosporine work?

Binds to cytoplasmic proteins that inhibit calcineurin phosphatase

INHIBITS T LYMPHOCYTE PROFILERATION

44

What is cyclosporine treat?

Organ transplant rejection prophylaxis

RA

Psoriasis

45

Do not take ___________ with grapefruit, but apple and orange can be used to improve the taste.

Cyclosporine

46

What are DMARDS?

Disease modifying antirheumatic drugs

47

What are BRMs?

Biological response modifiers

48

Aspirin is an

Antiinflammatory

49

How does azathioprine work?

Brock purine metabolism and DNA synthesis suppressing Band T lymphocyte proliferation

50

Chronic immunosuppression from Azathioprine (Purine antimetabolite immunosuppressive) puts pt at risk of

malignancy

51

When should azathioprine dosage be reduced?

Renal dysfunction, even mild

52

What is azathioprine used to treat?

Antirejection

RA

SLE

Can be used in Crohn's disease

53

Azathioprine can be found in breast milk, therefore it is

contraindicated in pregnancy and lactation

54

Azathioprine side effects

Leukopenia

Thrombocytopenia

Bone marrow suppression

N/V

Rash

Myalgia

Diarrhea

Hepatotoxicity

55

How is dosage for Azathioprine determined?

By weight and condition

56

What should pts on Azathioprine be told to report to their physician?

Black, tarry stools (bleeding)

Fever, chills

Signs of rejection

Severe diarrhea

57

Azathioprine pts should be very cautious around other with

contagious diseases

58

What does a transplant recipient need to be taught?

-the benefits of a healthy diet & exercise

-proper drug adherence

-avoid sick people

-signs/symptoms of infection

59

What is used when NSAIDS dont treat autoimmune disease pain and inflammation?

DMARDS

60

DMARDS include

immunosuppressants

61

Types of DMARDS

-IMMUNOSUPPRESSIVE AGENTS

-immunomodulators

-Antimalarials

62

Uses of DMARDS

RA if other treatments fail

Osteoarthritis/Ankylosing Spondylitis

Severe Psoriasis/Psoriatic arthritis

Crohns/UC

63

How does Infliximab/Remicade work?

Blocks tumor Necrosis Factor Alpha, which has an important role in promoting inflammation

64

Infliximab (Remicade)

A prototype antibody for treating several chronic inflammatory disorders

65

Infliximab/Remicade uses

RA

Psoriasis

Psoriatic Arthritis

Ankylosing Spondylitis

UC

Crohn's

66

Infliximab/Remicade side effects

HA

Fatigue

Chills

Myalgia

Infections/Leukopenia/Neutropenia/Pancytopenia

Steven's Johnson's Syndrome

67

Steven-Johnson Syndrome, AKA Erythema Multiforme, is associated with

a T-cell mediated response to a drug or microorganism

68

When is erythema multiforme (Stevens johnsoms syndrome) a severe mucotaneous bullous form?

It covers 10% of the body

69

Hydroxychloroquine is also called

Plaquenil

70

Hydroxychloroquine is an

Immunosuppressant, anti-inflammatory who's mechanism of action is not known

71

Side effects of hydroxychloroquine

Headache/Dizziness

N/V/Stomach pain

Hepatotoxicity

Retinopathy

Dysrhythmias

72

Vision changes due to hydroxychloroquine

Inability to see red

Night vision issues

73

Methotrexate is chemotherapy used for

RA

Psoriasis

74

What is the only chemo agent that can be given without a specialized cert?

Methotrexate

75

Methotrexate is chemo that is used as an

Immunosuppressive

76

Methotrexate side effects

-Bone marrow suppression

-N/V

-Fever

77

The first and only biological approved for Lupus in 50 years

Benlysta (Belimumab)

78

Benlista (Belimumab) is given

IV or Subcu

79

Benlysta (Belimumab) is approved for ages

5 and up

80

Benlysta (belimumab) labs

CBC

antibodies

RA factor

INR/SED rate

C-Reactive protein

81

Types of antiretrovirals

-NRTIs Nucleoside/Nucleotide reverse transcriptase inhibitors

-NNRTIs Non-Nucleoside reverse transcriptase inhibitors

-Protease inhibitors (PIs)

-Fusion Inhibitors (Entry Inhibitors)

-CCR5 antagonists

-INSTIs (Integrase strand transfer inhibitors)

82

How do NRTIs work?

Inhibit viral replication by interfering with HIV viral RNA dependent DNA polymerase

83

NRTIs can be taken without regard for

food

84

Didanosine should be taken

30 mins before or 2 hrs after meals

85

NRTI side effects

nausea

diarrhea

rash

peripheral neuropathy

pancreatitis

lipoatrophy

myopathy

86

NNRTI action

Binds to reverse transcriptase blocking DNA dependent activities like HIV replication

87

NNRTI side effects

Nausea

rash

diarrhea

dizziness/insomnia

neuropathy

liver failure

88

Protease inhibitor action

Inhibits protease activity resulting in immature, defective, noninfectious viral HIV particles

89

Protease inhibitor side effects

Rash

N/V/Diarrhea

Dyslipidemia

Insulin resistance

Hemolytic anemia

Stevens-Johnson syndrome

90

Fusion inhibitors

self explanatory

91

Fusion inhibitors side effects

Rash

diarrhea

inj site reaction

anaphylaxis

fever

hypotension

92

CCR5 antagonists action

self explanatory receptor blocker

93

CCR5 antagosist side effects

URI/Cough/pyrexia (aka fucking fever)

rash/dizziness

abdominal pain

hepatotoxicity

94

INSTIs (Integrase strand transfer inhibitors) action

Limits HIV ability to replicate by interfering with integrase, which is needed for HIV to replicate and divide

95

INSTIs side effects

Nausea/Diarrhea

Rash, insomnia, fever

HA

Myopathy/Hepatic damage

Rhabdo

96

What is IRIS?

Immune Reconstitution Inflammatory Syndrome

97

What is IRIS (Immune Reconstitution Inflammatory Syndrome related to?

Opportunistic pathogen inflammatory response in patients with antiretroviral therapy being initiated or changed

98

What is IRIS (Immune Reconstitution Inflammatory Syndrome

Two distinct entities: Paradoxical

an exacerbation of treated opportunistic infection

99

What is IRIS (Immune Reconstitution Inflammatory Syndrome

Two distinct entities: Unmasking

Response to subclinical or undiagnosed opportunistic infection

100

Risk factors for IRIS (Immune Reconstitution Inflammatory Response)

-Low CD4 cell count

-High baseline HIV RNA

101

What happens when HIV antiretroviral drugs are not taken properly (nonadherence)?

HIV viral replication

potentiate drug resistance

102

How to support antiretroviral therapy adherence?

-drug diaries

-drug organizers

-mobile devices alarms

-drug map with pictures

-Support system

-Pt education

103

Signs of Kaposi's sarcoma

Dark blue lesions on skin, mucous membranes, GI tract, lungs or lymph nodes

104

Pneumocystis Jiroveci pneumonia is

a fungal opportunistic infection of the lungs

105

What is toxoplasmosis?

An opportunistic encephalitis due to a protozoa found in uncooked meat and cat feces

106

What is cryptosporidiosis?

An opportunistic infection of the bowel mucosa due to a protozoan parasite

107

What is mycobacterium avian complex?

Blood infection due to a bacteria related to TB (opportunistic)

108

WHat is CMV?

An opportunistic infection of a virus infecting the entire body that can result in retinitis and potential blindness

109

Antiretroviral drugs used in pregnancy may have

Different timing, different drug selection and different regimens, because, like, fucking duh

110

What is the goal of antiretroviral use during pregnancy?

Preventing transmission to the fetus (SERIOUSLY? DUH)

Maximal viral suppression

111

HIV infected pregnant pts can infect their fetus

literally any time, including during breastfeeding. Poor moms :(

112

Post exposure prophylaxis (aka PEP) should be initiated how long after potential exposure? How long should it continue?

72 hrs

4 weeks

113

What are the most common side effects reported by healthcare providers on PEP (Post exposure prophylaxis)?

Nausea

Malaise

Fatigue

114

Linked potential causes of SLE

Hormonal

Drug

Genetic

Environmental

115

Women to men: how common is SLE?

10:1

116

Racially, who gets SLE the most?

African Americans

Asian Americans

African Caribbean

Hispanic Americans

117

What does EVERYONE with SLE have at some time?

Swelling & Joint Pain

(Most common: Fingers, hands, wrists and knees)

118

The butterfly rash over the cheeks and nose that gets worse w/ sun exposure is seen in about 50% of sufferers of:

SLE

119

SLE may become:

Arthritis

120

Symptoms of SLE according to the assigned article (even though it's a fucking crazy disease with a million symptoms, making it often misdiagnosed no matter what is said in my nursing class)

chest pain w/ deep breaths

fatigue

fever w/ no cause

general discomfort and uneasiness/malaise

Hair and weight loss

Mouth sores/swollen lymph nodes

Sunlight sensitivity

121

Effects of SLE if it effects the nervous system

HA

weakness

numbness

weakness

tingling

seizures

vision problems

personality and memory changes

122

Effects f SLE if it effects the GI tract

Ab pain

N/V

123

Effects of SLE if it effects the heart

valve problems

swelling

124

Effects of SLE if it effects the lungs

Build up of fluid in the pleural space

Difficulty breathing

Coughing up blood

125

Effects of SLE if it effects the skin

Mouth sores (but, like, that's the mucosa, article)

126

Effects of SLE in the kidneys

Leg swelling

127

Effects of SLE in circulation

vein clots

Renaud's

Vasculature inflammation

128

Effects of SLE on the blood

Low RBC, WBC, and/or platelets

129

SLE if it only affects the skin is called

Discoid Lupus

130

Diagnosis of Lupus requires

4/11 signs

131

Lupus labs

Antinuclear antibody

CBC w/ differential

Chest Xray

Serum creatinine

Urinalysis

132

SLE is more active in

People under 40

During the first year of diagnosis

133

Studies show that use of ____ med in the first year of treatment of RA may be more effective in preventing joint damage

More than one

134

Biological response modifiers are only used in RA if the disease is

severe

135

Surgery is only recommended in RA if

There is damage or the ability to perform day-to-day tasks is hindered

136

Which gender gets RA more?

women

137

RA symptoms may last

a bit, forever or be intermittent

138

RA can effect

joints

eyes

Mouth

lungs

139

What is believed to contribute to RA?

Hormones

Environment

Genes

140

Infliximab ( Remicade) may cause

Itching

Bruising

Pain

Swelling

Redness

HA

Infection

BP changes

SOB

Hives

Chest pain

141

Why did TB increase in the 80s?

-HIV

-Drug resistance

-Increased migration

142

TB is one of the leading causes of death, worldwide, in people older than

5

143

Who is at the highest risk of TB

those around people infected w/ it

144

The best way to decrease transmission of TB is

-Isolating those infected

-treating them

145

The first drug used to treat TB was

streptomycin, but PTs started to deteriorate after 3 months due to drug resistance

146

The "wonder drug" for TB is

INH (Isoniazid)

147

How does Isoniazid work?

It inhibits cell wall synthesis of Tb

148

>5mm TB test result is considered positive for the immunocompromised and >10mm is considered positive for

high risk groups

149

Prophylactic therapy is contraindicated in those with

Liver disease because INH (Isoniazid) is used

150

Multidrug therapy has reduced treatment from ________ to ___________

2 years

6-9 months

151

When drug resistance to TB develops, ___________ are used

aminoglycosides like streptomycin

(or fluoroquinolones)

152

Aminoglycosides should not be taken if

Shitty kidney function is suspected

153

What is DOT

Direct Observation Therapy (drug adherence)

154

Pts with mild kidney dysfunction should have what monitored when using antituberculars?

hepatic transaminases

155

Drugs used in initial TB treatment do appear to cross the placenta but

they do not appear to harm the fetus

156

In HIV, latent TB can become ____ if left untreated

Active TB

157

Give pyrazinamide (B6!!!) with fluids to prevent

renal complications

158

Isoniazid has a bunch of foods that

decrease absorption (bananas, avocados, fava beans, basically foods rich in histamine)

159

Guarana, green tea, and ginseng may potentiate the effects of

Isoniazid

160

Isoniazid has no cross resistance with

other antitubercular drugs

161

Children with latent Tb are more likely than adults to

become sick, and should be treated

162

Who should be involved in pediatric cases of Tb?

pediatric TB expert along with the use of drug susceptibility studies

163

Drug resistant TB is ____________ and _____________ ____________ to treat

harder

more expensive

164

32% of foreign born people in the US with TB were

Latino

165

Current clinical guidelines suggest all infected with AIDS recieve

ARD

166

The first AIDS drug was

Zidovudine

167

Zidovudine adverse reactions

Hepatotoxicity

Myopathy

Lactic acidosis

BONE MARROW SUPPRESSION

HEMATOLOGIC TOX W/OTHER DRUGS

168

NRTIs are also known as

"Nukes"

169

Tenofir adverse reactions

Hep toxicity

lactic acidosis

renal dysfunction

elevated transaminases

N/V/flatulence

Dizziness/Depression/Fever

Hyperlipedemia

170

Efavirenz (NNRTI antiretroviral) side effects

Rash

Nausea/Diarrhea

CNS effects/Abnormal dreams/impaired thinking/concentration/amnesia/agitation/hallucinations/euphoria/anxiety

171

Atazanavir may prolong cardiac

PR interval

172

Atazanavir side effects

N/V/D

cough

fever