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