571 - TB, Fungal, & Miscellaneous Pulm Diseases

What are the 4 drugs used to treat TB?

Rifampin (RIF)

Isoniazid (INH)

Pyrazinamide (PZA)

Ethambutol (EMB)

Isoniazid

contraindications:

-drug induced hepatitis; monitor LFT

-peripheral neuritis; pyridoxine inhibition

Ethambutol

adverse effects:

-optic neuritis

-color blindness

Pyrazinamide

MOA:

-shortens intial tx from 9-12 mo → 6 mo

adverse effects:

-arthralgia

-hepatitis

Rifampin

adverse effects:

-strong INDUCER of metabolism; lots of drug interactions

-hepatitis

-discoloration of saliva, tears, urine*

Rifampin should be carefully used due to it being a strong _________ of metabolism.

inducer

1 multiple choice option

TB tx: Initial phase

2 months of INH + RIF + PZA + EMB

TB tx: Continuation phase

4 months INH + RIF or INH + RPT

What is the regiment of choice for latent TB?

INH x9 months

Which two bacteria are resistant to fluconazole & itraconazole?

C. glabrata

C. krusei

3 multiple choice options

Aspergillosis tx

Voriconazole

Itraconazole

Posaconazole

Which antifungal used to treat aspergillosis is reserved when azoles are contraindicated or for salvage therapy?

amphotericin B

Cryptococcus tx:

Severe:

amphotericin B

pulmonary disease:

fluconazole

maintenance:

fluconazole

Histoplasmosis tx:

moderate-severe disease:

-amphotericin B

Blastomycosis tx:

moderate-severe disease:

-amphotericin B

mild-moderate disease:

-itraconazole

Coccidiomycosis tx:

DOC:

fluconazole

severe disease:

-amphotericin B

Pneumocystis:

DOC & prophylaxis:

Bactrim

alternative:

Dapsone

How often should you monitor sputum for AFB smear & culture (for TB)?

every 1-2 weeks to assess early response

AND

monthly until 2 consecutive (-) results

True or False. Tx for ARDS is largely supportive, and aims to tx underlying cause.

True

1 multiple choice option

Pertussis tx:

Macrolides (preferred tx):

-azithromycin (preferred agent)*

-clarithromycin

-erythromycin

Alternative:

-bactrim

Which macrolide abx has cardiac dysrhythmia as a side effect?

azithromycin

2 multiple choice options

True or False. Maternal immunization is highly recommended for pertussis.

True

1 multiple choice option

RSV tx:

tx:

largely supportive

O2

contraindicated:

-bronchodilators; mortality risk

-steroids for pts w/ bronchiolitis

Croup tx:

preferred:

-dexamethasone*

moderate-severe croup w/ stridor:

-racemic or L-epi via nebulizer