Term
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Definition
Mycobacterium Tuberculosis |
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Term
What stain are used to identify TB pathogen? |
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Definition
Ziehl Neelsen and fluorochrome stain
Acid-fast for bacilli
Grow slowly when cultured |
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Term
What is the most common agar method? |
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Definition
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Term
What are other tests for TB? |
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Definition
BACTEC: takes 9-14 days and give a quantitative measure (MIC)
Rapid identification tests: use technique like PCR, high performance liquid chromatography(HLPC)
Genetic changes associated w/ resistance to particular drugs |
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Term
What is the name of the particles from an infected person? |
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Definition
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Term
What are the 3 factors that the progression of disease depends on? |
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Definition
1) number of organism inhaled
2) virulence of the organism
3) host's immune response |
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Term
T/F: At alveolar surface the bacteria are consumed by the pulmonary macrophages? |
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Definition
True, an eating, releasing, and multiplying process continues until the body can form a more coordinated response |
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Term
Where can the bacteria be found other then the alveolar? |
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Definition
Some macrophages carry replicating bacteria to the lymph nodes
Some bacteria travel to the bloodstream: from here they can travel and infect any area of the body |
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Term
In what region is the M. tuberculosis most happy? |
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Definition
In the posterior apical region of the lungs, where most oxygen is and immune system can't get in. |
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Term
What happens after 3 weeks of invasion? |
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Definition
Cell mediated immunity begins
Macrophages from granulomas to contain organism
Replication begins to slow |
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Term
What happen after 1-3 months? |
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Definition
Most bacteria are now within the granulomas
Tissue hypersensitivity occurs: this is characterized by a + TB skin test |
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Term
What percentage have no further progression? |
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Definition
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Term
What percentage have progression to active disease? |
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Definition
10%
1/2 occurs in the first 2 yrs of infection |
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Term
When does reactivation of the disease occur? |
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Definition
Reactivation occurs in the apices of the lungs. The organisms are in the granulomas surface and begin to replicate, the immune response is reactivated and causes the existing granulomas to liquefy and create a hole in the lungs via necrosis. Bacteria can be transmitted to others during this time |
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Term
What are rare forms of TB? |
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Definition
1) Miliary TB: when a large amount of bacteria enter the bloodstream at once (rapidly progresses to death)
2) Extrapulmonary TB: when liquefied granulomas occur at locations other than the lungs (difficult to diagnose), most common locations lymphatic and pleural locations |
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Term
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Definition
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Term
T/F: key to a succesful treatment is to use one drug and add one drug at a time to regimen? |
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Definition
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Term
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Definition
Extensively drug resistant TB
Resistant to : rifampin, isoniazid, A FQ, one 2nd line injectable drug such as amikacin, capreomycin or kanamycin |
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Term
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Definition
Weight loss, productive cough, frank hemoptysis (3 most common), fatigue, fever, night sweats |
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Term
Which WBC predominate in TB? |
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Definition
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Term
How does an extrapulmonary TB presents? |
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Definition
As slow, progressive loss of organ function |
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Term
What do we call an infection of the spine? |
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Definition
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Term
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Definition
Involves lower and middle lobes
Extrapulmonary TB in the lymph nodes, GI tract, genitourinary tract, bone marrow, and meninges is common. (rapidly fatal) |
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Term
What is the most common sign of Elderly TB? |
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Definition
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Term
What is the preffered skin test for TB? |
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Definition
Mantoux test
It uses tuberculin purified protein derivative (PPD), 5 unit inserted intercutaneously on the volar aspect of the forearm |
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Term
A reaction of ≥ 10mm of induration occur in what patient population? |
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Definition
Pts w/ silicosis, DM, chronic renal failure, some hematologic disorders, maligancies, weight loss ≥10% of IBW, gastrectomy, jejunoileal bypass. Residents or employees of prisons, LTC facilities, hospitals, homeless shelters. Recent immigrants from high prevalence contries. Mycobateriology lab personnel. Injection drug users. All children < 4 yrs, children <4 &<18 who were exposed to adults at high risk |
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Term
T/F: Persons w/ no risk factors for TB get a reaction ≥ 15 mm of induration? |
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Definition
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Term
T/F: A diabetic patient w/ no risk factors w/ a PPD induration of 11 mm is considered a positive result? |
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Definition
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Term
T/F: COPD but no other risk factors w/ a PPD induration? |
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Definition
False, because COPD is not a risk factor |
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Term
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Definition
Interferon gamma release assays (IGRA): Measures release of INF-γ in whole blood in response to TB antigens
QuantiFERON-TB Gold test (GFT-G): ELISA test approved in 2005
T-SPOT.TB: Enzyme linked immunospot (ELISPOT) assay approved in 2008
GFT-G & T-SPOT.TB: Results available in <24 hr. Unable to differentiate between active and latent TB |
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Term
What is a radiodense area on a chest X-Ray called? |
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Definition
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Term
What are primary goals of TB TX? |
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Definition
Quick identification
Start specific TB therapy
Resolve signs and symptoms
REach non-infectious state
Adherence to drug regimen
Cure patient, Minimize transmission |
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Term
What are First line treatment of TB? |
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Definition
RIPE:
Rifampin (RIF)or rifabutin or rifapentine
Isoniazid (INH)
Pyrazinamide (PZA)
Ethambutol (EMB) |
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Term
What are 2nd line agents? |
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Definition
Ethionamide, Levofloxacin, Cycloserine, Streptomycin, Amikacin, Kanamycin, Capreomycin, p-aminosalicylic acid (PAS), Moxifloxacin, Gatifloxacin |
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Term
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Definition
Hepatotoxicity, neurotoxicity |
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Term
Which Vitamin should be used with isoniazid to decrease chance of CNS effects and peripheral neuropathy? |
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Definition
Pyridoxine (B6) 10-50 mg
Pts who are pregnant, alcoholics, or have a poor diet need to supplement with B6 |
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Term
What are DDI with isoniazid? |
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Definition
Inhibits metabolism of phenytoin, carbamazapine, primidone, warfarin
Seprate dose from antacids for 2 hrs
(take isoniazid on empty stomach) |
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Term
Isoniazid resistance results from mutations in which genes? |
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Definition
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Term
What are SE of rifampin (PO, 30 min IV infusion)? |
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Definition
Common SE: rash, fever, GI upset
Rare SE: Rash associated with flu-like syndrome, hemolytic anemia or acute renal failure
May change urine and other secretions orange-red Hepatoxicity
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Term
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Definition
Strong inducer of CYP3A4
Caution w/ protease inhibitors, oral contraceptives |
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Term
What is the common site for mutation in rifampin? |
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Definition
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Term
Most common side effects of pyrazinamide? |
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Definition
GI upset, arthralgias, elevations in serum uric acid concentrations (measurement not required)
- Hepatotoxicity (liver test shoud be done)
Occasional SE: Rash and photosensitivity |
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Term
T/F: Ethambutol can be used with antacids? |
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Definition
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Term
What is a major SE of ethambutol? |
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Definition
Retrobulbar neuritis, characterized by changes in visual acuity and inability to see the color green. Monitor monthly via Snellen wall chart and Ishihara red-green color discrimination card
Rare SE: peripheral neuritis and rash |
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Term
What are 1st line combination products? |
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Definition
Rifater: 120 mg rifampin, 50 mg isoniazid, 300 mg pyrazinamide
Rifamate: 150 mg isoniazid, 300 mg rifampin |
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Term
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Definition
Nephrotoxicity (caution in renal dysfunction), and ototoxicity |
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Term
If resistant to streptomycin what other AMG can be used? |
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Definition
amikacin and kanamycin
However, if resistant to amikacin likely resistant to kanamycin |
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Term
When can we use cycloserine? |
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Definition
when MDR-TB, take on empty stomack, can cause dose-related CNS toxicity
Add pyridoxine 50-200 mg QD may help w/ tolerance |
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Term
What is a major toxicity with ethionamide? |
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Definition
GI toxicity, can give at bedtime or w a light snack |
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Term
What other ADE w/ ethionamide? |
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Definition
May cause Goiter (more common when combined w/ p-aminosalicylic acid( (w or w/o hypothyroidism)
SE: gynecomastia, alopecia, acne, impotence, menorrhagia, photodermatitis, hypothyroidism. |
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Term
T/F: Ethionamide can be used in patients with diabetes? |
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Definition
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Term
What to know about p-aminosalicylic acid? |
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Definition
Empty granules will appear in the stool
GI SE common
Rare effects: hypersensitivity rx, hepatotoxicity, malabsorption syndrome, increased clotting time
may cause goiter |
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Term
What are some monitoring parameter done w/ capreomycin (for MDR-TB IV)? |
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Definition
audiogram, vestibular testing, romberg testing, and SCr done at baseline and every month while on therapy, also K+ and Mg2+
Can cause: nephrotoxicity and ototoxicity
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Term
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Definition
Used for MDR-TB
SE: GI upset ans skin discoloration
Rarely may cause severe GI pain due to formation of crystals in the intestines |
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Term
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Definition
Levo, Cipro, and moxif (PO, IV)
used for MDR-TB |
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Term
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Definition
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Term
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Definition
Clarith, and azithr have limited activity against M. tuberculosis (rare use) |
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Term
Extracellular bacteria found within cavities respond to what drugs? |
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Definition
Isoniazid, rifampin, streptomycin |
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Term
Bacteria in caseating granulomas responds to? |
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Definition
Pyrazinamide, rifampin, isoniazid |
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Term
Bacteria within macrophages responds to? |
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Definition
Rifampin, isoniazid, quinolones |
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Term
What is the 1st line therapy for latent TB? |
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Definition
Isoniazid 300 mg QD or 5-10 mg/kg (children) for 9 months (min 6 months)
Can be dosed 900 mg twice weekly if DOT (directly observed therapyused) |
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Term
What is 2nd line tx for latent TB? |
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Definition
Rifampin 600 mg QD for 4 month can be used in case of resistance or person can't tolerate isoniazid
Rifabutin can be substituted in pts at high risk for drug interactions |
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Term
What are new latent TB tx options? |
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Definition
Isoniazid + rifapentine once weekly for 12 weeks has less hepatotoxicity, must use DOT, Expensive |
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Term
What is the Standard active TB treatment? |
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Definition
Isoniazid + rifampin + pyrazinamide + ethambutol (RIPE) for 2 months, Then isoniazid + rifampin for 4 more months
If TB susceptible to "RIP," E can be stopped early |
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Term
T/F: Patients who still have positive cultures after 2 months of Tx, pts w/ HIV, and those w/ cavitary lesions on X-ray, must be treated for 9 months and at least 6 months from time they become smear and culture negative? |
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Definition
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Term
T/F: patients who are not susceptible to isoniazid and riampin treatment lasts for a maximum of 2 years? |
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Definition
False, minimum of 2 years |
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Term
What is the treamtent for TB meningitis and extrapulmonary disease? |
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Definition
Treat for 9-12 months minimum
Isoniazid, pyrazinamide, ethionamide, cycloserine (best CNS penetration)
Variable CNS penetration: rifampin, ethambutol, streptomycin.
Levo is preferred quinolone
Soft tissue tx with RIPE
Site is pericarditis or CNS adjunct corticosteroids recommended |
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Term
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Definition
Isoniazid and rifampin based in weight tx for 9 months |
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Term
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Definition
Rifampin, isoniazid and ethambutol for 9 month
B vitamins (B6, folic acid) |
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Term
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Definition
Isoniazid, pyrazinamide, AMG, capreomycin, ethanbutol, p-aminosalicylic acid, and cycloserine based in IBW |
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Term
T/F: patient with HIV should receive intermittent therapy options? |
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Definition
False, should not always use daily dose
Tx for 9 months |
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Term
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Definition
Streptomycin + levo +ethambutol
Tx minimum of 18 months
typically switched to an isoniazid &/or rifampin when liver gets better |
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Term
Renal failure adjustment? |
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Definition
Pyrazinamide and ethambutol require a frequency reduction
Dosing interval must be increased w/ amikacin, kanamycin, streptomycin, capreomycin, ethambutol, cycloserine, and levofloxacin
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Term
T/F: patients who are acid-fast bacilli smear positive should have sputum samples sent Q 1-2 weeks until 2 consecutive smears are negative? |
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Definition
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Term
Birth defect with some TB meds? |
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Definition
Rifampin has been associated w/ causing limb reduction and CNS lesions
Streptomycin may lead to hearing loss in child
Ethionamide can cause premature delivery and congenital deformities |
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