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What are the 1st line agents used to treat TB and their most common SE?
- INH:
- The most effective!
- Neurotoxicity (give with 25-50 mg vit B6)
- hepatotox
- Rifampin/Rifabutin/Rifapentine:
- use rifampin, unless HIV+ (then use rifabutin to decrease DI)
- 3A4 inducer
- Hepatotoxic
- Discolors body fluids
- Pyrazinamide:
- Most hepatotoxic
- ↑ uric acid (gout attacks)
- Ethambutol:
- Hepatotoxic
- Optic neuritis
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What is the initial treatment for TB?
- INH + Rif + EMB + PZA x 2mo, then:
- INH + Rif x 4mo
- If cavitation evident, INH + Rif x 3 add'l mo
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What are the 2nd line agents used in TB?
- Cycloserine:
- Lots of AE (including liver failure)
- Ethionamide:
- Neurotoxic (supplement with B6)
- AG:
- Streptomycin best (amikacin and capreomycin other options)
- No hepatotoxicity
- Ototoxic
- nephrotoxic
- p-Aminosalicylic acid (PAS)
- FQ:
- Moxi used most often
- NOT Cipro
- Linezolid
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What is the treatment for Latent TB?
- INH for 6 mo (use for 9 months if HIV+, children, granulomas on x-ray)
- Rifampin for 4 months (Rifabutin if HIV+)
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How should the regimen change for a patient experiencing toxicity?
- Hepatotoxicity:
- INH + RIF + streptomycin + FQ
- (Take out PZA and EMB first)
- (Try to keep pt on INH)
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