Antitubercular drugs- PP
caseation and cavitation
Some people will harbor TB organisms and end up with
Only people with _________ TB are at risk of infecting others
TB risk factors
-high risk residential living
-health care workers w/ high risk pts
-people from countries w/ high prevelance
Symptoms of TB
-Bloody or acid fact sputum
-cough, fever, night sweats
-GI distress, weight loss, anorexia
TB prophylaxis recommended for
-conversion from negative to positive, or latent
-IV drug users
-Immigrants from high prevalence countries
BCG (Bacilli Calmette-Guerin) vaccines will cause a positive _______ but do not affect ___________.
IGRA- Interferon Gamma Release Assay
Single drug therapy for TB is
Multi-drug therapy for TB prevents
Multidrug therapy for TB decreases
Prophylactic TB treatment is given to those with
Latent TB or clinically significant TB tests results
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
-Immunosuppression due to >15 mg prednisone per day
-Those taking TNF antagonists
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
TB surrounded by a granuloma, does not cause symptoms, and is not contagious
Latent TB may cause disease
later in life
TB leisions are called
Caseous tubercle is "cheese like and is often
found in the center of necrotic tissue
TB lesions can cause
First line TB drugs are
more effective and less toxic than second line TB drugs
In combination therapy for TB, a minimum of
3-5 drugs are used
Initial TB therapy drugs last
COntinuation phase of TB therapy lasts
Rifampin turns body fluids orange and may
Permanently discolor contact lenses
Side effects of TB drugs in general
-headaches, dizziness, confusion
-eye, ear, renal, liver toxicity
Pyridoxamine (Vit B6!!!!) is an antitubercular drug that causes
Who is at risk of peripheral neuropathy as a result of Ionazid?
-Those who are malnourished
In pregnant women with TB, benefits of treatment
outweigh the risk, but there is a special regimen used
TB is the leading cause of death for people with _______ so they need a __________ course of TB drugs
Pediatric populations tend to respond to TB with ____________ and they need _____________ of treatment
more severe illness
In TB treatment, you must assess for __________if streptomycin is used
INH must be administered
1 hr before or 2 hrs after meals
Antitubercular drugs given, what must be assessed?
Antacids with antitubercular drugs?
Signs of peripheral neuropathy?
Burning, numbness and tingling in hands and feet
Sunlight and antitubercular drugs
SPF of 30+
Big adverse reaction to ionazid?
Transplant pts are on special diets to avoid
e coli and listeria, etc
The function of monoclonal antibodies
Inhibiting the action of lymphocytes and prevents the body from mounting an immune response against transplanted organ
Monoclonal antibodies side effects
Dizziness, sore throat, dyspnea
Dysuria, edema, blood dyscrasias
sepsis, cytokine release syndrome
Diabetes, malignancy, capillary leak syndrome
how does Cyclosporine work?
Binds to cytoplasmic proteins that inhibit calcineurin phosphatase
INHIBITS T LYMPHOCYTE PROFILERATION
What is cyclosporine treat?
Organ transplant rejection prophylaxis
Do not take ___________ with grapefruit, but apple and orange can be used to improve the taste.
What are DMARDS?
Disease modifying antirheumatic drugs
What are BRMs?
Biological response modifiers
Aspirin is an
How does azathioprine work?
Brock purine metabolism and DNA synthesis suppressing Band T lymphocyte proliferation
Chronic immunosuppression from Azathioprine (Purine antimetabolite immunosuppressive) puts pt at risk of
When should azathioprine dosage be reduced?
Renal dysfunction, even mild
What is azathioprine used to treat?
Can be used in Crohn's disease
Azathioprine can be found in breast milk, therefore it is
contraindicated in pregnancy and lactation
Azathioprine side effects
Bone marrow suppression
How is dosage for Azathioprine determined?
By weight and condition
What should pts on Azathioprine be told to report to their physician?
Black, tarry stools (bleeding)
Signs of rejection
Azathioprine pts should be very cautious around other with
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
What is used when NSAIDS dont treat autoimmune disease pain and inflammation?
Types of DMARDS
Uses of DMARDS
RA if other treatments fail
Severe Psoriasis/Psoriatic arthritis
How does Infliximab/Remicade work?
Blocks tumor Necrosis Factor Alpha, which has an important role in promoting inflammation
A prototype antibody for treating several chronic inflammatory disorders
Infliximab/Remicade side effects
Steven's Johnson's Syndrome
Steven-Johnson Syndrome, AKA Erythema Multiforme, is associated with
a T-cell mediated response to a drug or microorganism
When is erythema multiforme (Stevens johnsoms syndrome) a severe mucotaneous bullous form?
It covers 10% of the body
Hydroxychloroquine is also called
Hydroxychloroquine is an
Immunosuppressant, anti-inflammatory who's mechanism of action is not known
Side effects of hydroxychloroquine
Vision changes due to hydroxychloroquine
Inability to see red
Night vision issues
Methotrexate is chemotherapy used for
What is the only chemo agent that can be given without a specialized cert?
Methotrexate is chemo that is used as an
Methotrexate side effects
-Bone marrow suppression
The first and only biological approved for Lupus in 50 years
Benlista (Belimumab) is given
IV or Subcu
Benlysta (Belimumab) is approved for ages
5 and up
Benlysta (belimumab) labs
Types of antiretrovirals
-NRTIs Nucleoside/Nucleotide reverse transcriptase inhibitors
-NNRTIs Non-Nucleoside reverse transcriptase inhibitors
-Protease inhibitors (PIs)
-Fusion Inhibitors (Entry Inhibitors)
-INSTIs (Integrase strand transfer inhibitors)
How do NRTIs work?
Inhibit viral replication by interfering with HIV viral RNA dependent DNA polymerase
NRTIs can be taken without regard for
Didanosine should be taken
30 mins before or 2 hrs after meals
NRTI side effects
Binds to reverse transcriptase blocking DNA dependent activities like HIV replication
NNRTI side effects
Protease inhibitor action
Inhibits protease activity resulting in immature, defective, noninfectious viral HIV particles
Protease inhibitor side effects
Fusion inhibitors side effects
inj site reaction
CCR5 antagonists action
self explanatory receptor blocker
CCR5 antagosist side effects
URI/Cough/pyrexia (aka fucking fever)
INSTIs (Integrase strand transfer inhibitors) action
Limits HIV ability to replicate by interfering with integrase, which is needed for HIV to replicate and divide
INSTIs side effects
Rash, insomnia, fever
What is IRIS?
Immune Reconstitution Inflammatory Syndrome
What is IRIS (Immune Reconstitution Inflammatory Syndrome related to?
Opportunistic pathogen inflammatory response in patients with antiretroviral therapy being initiated or changed
What is IRIS (Immune Reconstitution Inflammatory Syndrome
Two distinct entities: Paradoxical
an exacerbation of treated opportunistic infection
What is IRIS (Immune Reconstitution Inflammatory Syndrome
Two distinct entities: Unmasking
Response to subclinical or undiagnosed opportunistic infection
Risk factors for IRIS (Immune Reconstitution Inflammatory Response)
-Low CD4 cell count
-High baseline HIV RNA
What happens when HIV antiretroviral drugs are not taken properly (nonadherence)?
HIV viral replication
potentiate drug resistance
How to support antiretroviral therapy adherence?
-mobile devices alarms
-drug map with pictures
Signs of Kaposi's sarcoma
Dark blue lesions on skin, mucous membranes, GI tract, lungs or lymph nodes
Pneumocystis Jiroveci pneumonia is
a fungal opportunistic infection of the lungs
What is toxoplasmosis?
An opportunistic encephalitis due to a protozoa found in uncooked meat and cat feces
What is cryptosporidiosis?
An opportunistic infection of the bowel mucosa due to a protozoan parasite
What is mycobacterium avian complex?
Blood infection due to a bacteria related to TB (opportunistic)
WHat is CMV?
An opportunistic infection of a virus infecting the entire body that can result in retinitis and potential blindness
Antiretroviral drugs used in pregnancy may have
Different timing, different drug selection and different regimens, because, like, fucking duh
What is the goal of antiretroviral use during pregnancy?
Preventing transmission to the fetus (SERIOUSLY? DUH)
Maximal viral suppression
HIV infected pregnant pts can infect their fetus
literally any time, including during breastfeeding. Poor moms :(
Post exposure prophylaxis (aka PEP) should be initiated how long after potential exposure? How long should it continue?
What are the most common side effects reported by healthcare providers on PEP (Post exposure prophylaxis)?
Linked potential causes of SLE
Women to men: how common is SLE?
Racially, who gets SLE the most?
What does EVERYONE with SLE have at some time?
Swelling & Joint Pain
(Most common: Fingers, hands, wrists and knees)
The butterfly rash over the cheeks and nose that gets worse w/ sun exposure is seen in about 50% of sufferers of:
SLE may become:
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
fever w/ no cause
general discomfort and uneasiness/malaise
Hair and weight loss
Mouth sores/swollen lymph nodes
Effects of SLE if it effects the nervous system
personality and memory changes
Effects f SLE if it effects the GI tract
Effects of SLE if it effects the heart
Effects of SLE if it effects the lungs
Build up of fluid in the pleural space
Coughing up blood
Effects of SLE if it effects the skin
Mouth sores (but, like, that's the mucosa, article)
Effects of SLE in the kidneys
Effects of SLE in circulation
Effects of SLE on the blood
Low RBC, WBC, and/or platelets
SLE if it only affects the skin is called
Diagnosis of Lupus requires
CBC w/ differential
SLE is more active in
People under 40
During the first year of diagnosis
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
Biological response modifiers are only used in RA if the disease is
Surgery is only recommended in RA if
There is damage or the ability to perform day-to-day tasks is hindered
Which gender gets RA more?
RA symptoms may last
a bit, forever or be intermittent
RA can effect
What is believed to contribute to RA?
Infliximab ( Remicade) may cause
Why did TB increase in the 80s?
TB is one of the leading causes of death, worldwide, in people older than
Who is at the highest risk of TB
those around people infected w/ it
The best way to decrease transmission of TB is
-Isolating those infected
The first drug used to treat TB was
streptomycin, but PTs started to deteriorate after 3 months due to drug resistance
The "wonder drug" for TB is
How does Isoniazid work?
It inhibits cell wall synthesis of Tb
>5mm TB test result is considered positive for the immunocompromised and >10mm is considered positive for
high risk groups
Prophylactic therapy is contraindicated in those with
Liver disease because INH (Isoniazid) is used
Multidrug therapy has reduced treatment from ________ to ___________
When drug resistance to TB develops, ___________ are used
aminoglycosides like streptomycin
Aminoglycosides should not be taken if
Shitty kidney function is suspected
What is DOT
Direct Observation Therapy (drug adherence)
Pts with mild kidney dysfunction should have what monitored when using antituberculars?
Drugs used in initial TB treatment do appear to cross the placenta but
they do not appear to harm the fetus
In HIV, latent TB can become ____ if left untreated
Give pyrazinamide (B6!!!) with fluids to prevent
Isoniazid has a bunch of foods that
decrease absorption (bananas, avocados, fava beans, basically foods rich in histamine)
Guarana, green tea, and ginseng may potentiate the effects of
Isoniazid has no cross resistance with
other antitubercular drugs
Children with latent Tb are more likely than adults to
become sick, and should be treated
Who should be involved in pediatric cases of Tb?
pediatric TB expert along with the use of drug susceptibility studies
Drug resistant TB is ____________ and _____________ ____________ to treat
32% of foreign born people in the US with TB were
Current clinical guidelines suggest all infected with AIDS recieve
The first AIDS drug was
Zidovudine adverse reactions
BONE MARROW SUPPRESSION
HEMATOLOGIC TOX W/OTHER DRUGS
NRTIs are also known as
Tenofir adverse reactions
Efavirenz (NNRTI antiretroviral) side effects
CNS effects/Abnormal dreams/impaired thinking/concentration/amnesia/agitation/hallucinations/euphoria/anxiety
Atazanavir may prolong cardiac
Atazanavir side effects