TB Nurse Case Management
|
|
- Valerie Randall
- 5 years ago
- Views:
Transcription
1 TB Nurse Case Management San Antonio, Texas March 2-4, 2011 TB Medications and Adverse Effects Debbie Onofre, RN, BSN March 3, 2011 Debbie Onofre, RN, BSN has the following disclosures to make: No conflict of interests No relevant financial relationships with No relevant financial relationships with any commercial companies pertaining to this educational activity 1
2 TB Medications and Adverse Effects Debbie Onofre RN, BSN Nurse Consultant/ Nurse Educator Heartland National TB Center Objectives Describe the monitoring process for adverse drug events associated with anti-tb drugs Side effects and drug toxicities Recognizing the most common adverse effects of TB therapy Discuss the nursing interventions and medical management of the most common adverse drug events seen in patients on first-line anti-tuberculosis therapy Case studies 2
3 Monitoring Process Ongoing process Begins with initial nurse assessment Requires nurse patient relationship Case management plan Patient Education Toxicity assessment Daily/BIW when administering DOT Monthly Drug Monitoring Goals Recognize adverse drug events Assess appropriately Intervene rapidly Prevent further morbidity/mortality Minimize treatment interruptions Minimize treatment interruptions Reduce opportunities for medical mismanagement Avoid development of psychological intolerance Support adherence and the therapeutic relationship 3
4 Side Effects Unpleasant, but mild reactions No long lasting health effects Do not usually require changes in therapy -Gas Bloating Mild nausea Discoloration of body fluids Irritability Difficulty sleeping Photosensitivity Adverse Drug Reaction More serious Significant GI disturbances May be life threatening Require modifying the dose/discontinuation of drug May require additional therapy and/or hospitalization Hepatotoxicity Dermatologic and hypersensitivity reactions Ophthalmic toxicity CNS toxicity Neurotoxicity Ototoxicity Musculoskeletal adverse effects Renal toxicity 4
5 First-line Drugs Isoniazid (INH) Rifampin (RIF) Rifabutin Ethambutol (EMB) Pyrazinamide (PZA) Isoniazid Common Reactions Epigastric discomfort Elevated liver transaminases, mild Hypersensitivity rxn, mild Paresthesias, mild Peripheral neuropathy Pyridoxine deficiency Nausea / vomiting Serious Reactions Agranulocytosis Hypersensitivity rxn Optic neuritis Peripheral neuropathy Seizures Thrombocytopenia Toxic psychosis Aplastic anemia Hepatotoxicity, incl. fatal 5
6 Hepatotoxicity Early Signs Fatigue Poor appetite Taste alteration Nausea Abdominal discomfort Bloating Minimal rash Later Signs Vomiting Abdominal pain Jaundice Change in color of urine and stool Changes in behavior, memory loss Most at Risk for Hepatotoxicity Underlying liver disease Hepatitis B and C Alcoholics Immediate (4 months) post-partum period Those on other hepatotoxic medications 6
7 Hepatotoxic Drugs Tylenol Tetracycline, erythromycin, others Dilantin Valproate Cholesterol lowering medications Antifungal drugs Glucose lowering drugs Valium Monitoring Patients at Risk for Hepatotoxicity Establish rapport Take a good medical history Take a good medical history Clarify preexisting conditions that may increase risk of hepatotoxicity: History of Hepatitis B or C History of other liver disease Take a good social history ETOH use (be specific) Educate patient of signs and symptoms of hepatotoxicity 7
8 Managing Hepatotoxicity Hold medications and repeat LFT s immediately Continue therapy LFT s (AST/ALT) up to 5 times upper limit of normal and asymptomatic Stop therapy ALT > 3 times upper limit of normal and symptomatic ALT > 5 times upper limit of normal and asymptomatic Hepatotoxicity Restarting therapy LFT s must be < 2 times upper limit of normal Rechanllege Medications Introduce one drug at a time Monitor enzymes carefully Stop therapy if symptomatic or increased enzymes and eliminate i last drug added d from regimen 8
9 Case Study # 1 - Hepatotoxicity 38 year old male diagnosed with Pulmonary TB during incarceration. On Mar. 13, he started standard RIPE regimen. Baseline laboratory values were ALT 42, AST 63. On April 15, 1 month later, he was changed to BIW dosing. EMB was discontinued when susceptibility results showed isolate to be susceptible to INH/RIF. Patient was released from jail and continued medication on DOT by local health department. On June 4, two months after starting ti anti TB therapy, follow-up lab results were ALT 304, AST 97. He was Asymptomatic for hepatitis. Case Study # 1 - Hepatotoxicity What would be the next step for this patient with elevated LFT s? Take the following into consideration: Baseline LFT s : ALT 42, AST 63, Follow up LFT s : ALT 304, AST 97 (normal values: AST u/l, ALT u/l) 9
10 Calculation Normal values: AST: u/l ALT: u/l Divide lab result by higher number of normal value AST 97/42 = 2.3 X ULN ALT 304/40 = 7.6 XULN Case Study #1- Hepatotoxicity What is the next step for this patient with elevated LFT s? Hold TB medications! ALT > 5 times upper limit of normal and asymptomatic ALT > 3 times upper limit of normal and symptomatic 10
11 Case Sudy #1 Hepatotoxicity When assessing this patient, what significant information is important for identifying if this patient is at risk for developing hepatotoxicity? Identify any underlying liver disease (hepatitis A, B, C) Identify if patient drinks any alcoholic beverages? Identify if patient is taking any other Hepatotoxic MEDICATIONS Case Sudy #1 Hepatotoxicity Anti-TB therapy was re-started by re-introducing one medication at a time when liver enzymes < 2 times upper limit i of normal. Liver enzymes were monitored carefully. At a follow up appointment patient admitted to drinking 6-12 oz. beers almost every day with his neighbor What risk factors can you identify that place this patient at risk for developing hepatoxicity? He drinks 6-12 oz. beers almost every day with his neighbor. 11
12 Case Study No. 1- Hepatotoxicity How do we monitor him for the remainder of his treatment? Monitor closely Re-educate patient to abstain from alcohol while on anti-tb medication Review adverse effects Encourage compliance Instruct patient to self monitor for side effects while on meds Consider a liver friendly regimen (Amikacin, levofloxacin, EMB) Most importantly: Instruct patient to stop taking TB medications immediately and seek medical attention if symptoms of hepatitis occur again. 12
13 Rifampin Common Reactions Abdominal pain Anorexia Diarrhea Dizziness / Ataxia Dyspnea Elevated liver transaminases Fatigue / Drowsiness Headache Hypersensitivity rxn, mild Nausea / Vomiting Reddish-orange body fluids Contact lens staining Visual changes Rash Serious Reactions Agranulocytosis / Leukopenia Anaphylaxis Hemolytic anemia Hemorrhage / DIC Hepatitis Interstitial nephritis / Renal failure Porphyria exacerbation Pseudomembranous colitis Psychosis Thrombocytopenia Shock Stevens-Johnson syndrome / Toxic epidermal necrolysis / Erythema multiforme Mild Rash Common Often resolve after first several weeks of treatment Usually do not require stopping medication Treated symptomatically with Benadryl, other Treated symptomatically with Benadryl, other antihistamines, low-dose prednisone 13
14 Drug Rash Usually begins on chest and later spreads to upper arms and thighs Itches Maculopapular Urticaria/hives Occurs and worsens after medications May be associated with more severe symptoms of airway compromise, angioedema, etc. Hold medications until reaction resolves May have to modify the drug regimen Evaluate the Rash Where is it? What does it look like? Does it itch? When did it start? Has it spread? What makes it better or worse? Have you had an insect bite? 14
15 Other Possible Causes Insect bites Scabies Contact dermatitis Question patient about new soaps, lotions, perfumes, laundry detergents, etc Sunburn Dry skin Other drugs, especially new agents Viral or fungal infections Managing & Monitoring Rifampin Monitor CBC monthly Advise women using hormonal contraceptive to use another form of control Reduction of methadone almost to an ineffective level Cannot use with some Antiretroviral drugs 15
16 Common Reactions Asthenia Chest pain Diarrhea Dyspepsia Eructation Fever Flatulence Insomnia Myalgias Pain Rash Taste changes Yellow skin Rifabutin Same as Rifampin + Serious Reactions Clostridium difficile associated diarrhea Uveitis Neutropenia (agranulocytosis) Ethambutol Common Reactions Abdominal pain / Dyspepsia Anorexia Blurred vision / Dizziness Disorientation / Hallucinations Elevated LFTs Fever Headache Hyperuricemia Joint pain Malaise Nausea / Vomiting Rash / Pruritus Serious Reactions Anaphylaxis Blindness, irreversible Erythema multiforme Hepatotoxicity, incl. fatal Hypersensitivity syndrome Leukopenia Neutropenia Optic Neuritis Decreased visual acuity Decreased red-green color discrimination Peripheral neuropathy Thrombocytopenia 16
17 Managing & Monitoring EMB Baseline & monthly visual acuity test (Snellen chart) Baseline & monthly color discrimination test (Ishihara tests) Question pt regarding possible visual disturbances: blurred vision eye rubbing excessive blinking, sitting close TV Hold Rx Refer for Ophthalmologic evaluation Permanent vision impairment if Rx continued Ophthalmic Toxicity 21 year old male arrested and incarcerated in county jail in February. After being incarcerated for 3 months he began to complain of fever, chills, productive cough, chest pain, night sweats, and weight loss. On October 7, five months after onset of symptoms, he continued to complain of previous symptoms. He was finally evaluated, CXR showed left upper lobe cavitary infiltrate, AFB smear (+) 1-10 per high power field. He was diagnosed with pulmonary TB. On October 12, he was started on the standard 4 drug therapy. The isolate was reported as isoniazid and streptomycin resistant. Pt. was improving, i he was afebrile, had 6 lb wt. gain, night sweats had resolved, cough was improving. INH discontinued once susceptibilities were known, and he continued on RIF, PZA, EMB to complete 9 months of adequate therapy. 17
18 Case Study #2- Opthalmic Toxicity After reviewing this case study, identify what should have been done differently in diagnosing this patient Could have been diagnosed earlier, 5 months ago Should have been screened for TB TST Symptom review Baseline CXR If prior exposure, identify if patient had preventative treatment, if not offer LTBI treatment Case Study # 2 Opthalmic Toxicity What Toxicities is a patient on EMB at risk for? Optic Neuritis Decreased visual acuity Decreased red-green color discrimination 18
19 Case Study #2: Ophthalmic Toxicity What baseline testing should you do for your patient t who is starting ti EMB? Visual Acuity (Snellen) Ishihara Case Study #2 - Ophthalmic Toxicity In March, 5 months after start of treatment, patient started c/o difficulty driving and reading road signs. As a nurse managing this patient s anti-tb therapy, what would you do? Stop the EMB Refer to the Opthalmologist 19
20 Case Study #2 - Ophthalmic Toxicity Called his nurse by yphone, she instructed him to see his eye doctor. On March 21 he was seen by optometrist and given RX for corrective lenses. EMB continued Case Study # 2 - Ophthalmic Toxicity On May 3 (7 months on anti-tb therapy) he complains of worsening vision. Nurse finally assess his vison. Baseline visual acuity in October was 20/20 both eyes, follow up visual acuity was now 20/200 in both eyes. On May 5 the EMB discontinued; continued on RIF, PZA and Levo added to regimen to complete 9 mo of treatment and referred to a retinal specialist. 20
21 Ophthalmic Toxicity Follow-up Seen by retinal specialist in May and June DX: EMB optic neuropathy Central scotoma on right and parascotoma on left Vision uncorrected: 20/200 Nurse admitted to not performing visual acuity screening (Snellen chart), she only did color discrimination testing (Ishihara plates) Pyrazinamide Common Reactions Anorexia Arthralgia Elevated LFTs Gout Hyperuricemia Malaise Nausea / Vomiting Photosensitivity Rash / Urticaria Serious Reactions Anemia Hepatotoxicity Interstitial nephritis Porphyria Thrombocytopenia 21
22 Common in the first few weeks of therapy Evaluate for other causes Give a light snack before meds Administer antiemetics Phenergan Zofran Gastrointestinal Upset Second-line Drugs Cycloserine PAS Ethionamide Levofloxacin Moxifloxacin Streptomycin Amikacin Kanamycin Capreomycin 22
23 Second-Line TB Drugs Amikacin -Rash - Renal toxicity - Ototoxicity - Vestibular toxicity - Electrolyte abnormalities - Local pain at IM injection site Capreomycin -Rash - Renal toxicity - Ototoxicity - Vestibular toxicity - Electrolyte abnormalities Local pain at IM injection site Levofloxacin, Gatifloxacin, Moxifloxacin -Rash - GI upset - Mild CNS toxicity - Arthralgias, rare tendon rupture - Photosensitivity - EKG abnormalities Ethionamide -Rash - GI upset, may be significant - Hepatotoxicity - Endocrine effects - Peripheral neuropathy Second-Line TB Drugs Cycloserine -Rash - CNS toxicity (seizure, depression, suicidal ideation, psychosis) - Peripheral neuropathy - Skin changes (lichenoid eruptions, Stevens- Johnson Syndrome) Para-Aminosalicylate (PAS) -Rash - GI upset, may need to stop meds - Hepatotoxicity - Reversible hypothyroidism Clofazimine -Rash - GI upset - Discoloration and dryness of skin - Photosensitivity - Retinopathy Linezolid -Rash - Myelosuppression - Nausea and diarrhea - Optic neuropathy - Peripheral neuropathy 23
24 In Summary Establish and Maintain a good a Nurse Patient relationship Have a Case management plan Ongoing patient education Ongoing toxicity monitoring 24
25 Reporting ADRs Form EF state tx BEF AdverseDrugReaction.pdf Information forwarded to CDC and/or FDA, if necessary Thank You! 25
TB Nurse Case Management San Antonio, TX. TB Medications and Adverse Effects
TB Nurse Case Management San Antonio, TX April 1 3, 2014 TB Medications and Adverse Effects Debbie Onofre RN, BSN Nurse Consultant/ Nurse Educator Heartland National TB Center April 1, 2014 Debbie Onofre,
More informationMoving Past the Basics of Tuberculosis Phoenix, Arizona May 8-10, 2012
Moving Past the Basics of Tuberculosis Phoenix, Arizona May 8-10, 2012 Managing Anti-TB Therapy Side Effects and Complications Lisa Armitige, MD, PhD May 9, 2012 Lisa Armitige, MD, PhD has the following
More informationDebbie Onofre, RN, BSN March 18, TB Nurse Case Management March 17 19, 2015 San Antonio, Texas
Managing and Monitoring Side Effects and Toxicities of Anti TB Therapy Debbie Onofre, RN, BSN March 18, 2015 TB Nurse Case Management March 17 19, 2015 San Antonio, Texas EXCELLENCE EXPERTISE INNOVATION
More informationAnti Tuberculosis Medications: Side Effects & adverse Events
Anti Tuberculosis Medications: Side Effects & adverse Events Diana Fortune, RN, BSN September 13, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Diana Fortune, RN,
More informationEvaluation and Treatment of TB Contacts Tyler, Texas April 11, 2014
Evaluation and Treatment of TB Contacts Tyler, Texas April 11, 2014 Monitoring Patients for TB Adverse Reactions and Managing Side Effects Catalina Navarro, RN, BSN April 11, 2014 Catalina Navarro, RN,
More informationIntroduction to TB Nurse Case Management Online February 4, 11, 18 and 25, 2015
Introduction to TB Nurse Case Management Online February 4, 11, 18 and 25, 2015 TB Medications and Adverse Drug Events Presented by Evelyn Drzymala, RN, BSN February 11, 2015 Evelyn Drzymala, RN, BSN has
More informationTuberculosis medications: adverse drug reactions
Tuberculosis medications: adverse drug reactions Rajesh M. Prabhu, M.D. Infectious Diseases Essentia Health, Duluth, MN July 25, 2017 2014 MFMER slide-1 No Finanial Disclosures Learning Objectives 1. Describe
More informationManaging the Patients Response to TB Treatment
Managing the Patients Response to TB Treatment Barbarah Martinez, RN, BSN September 13, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Barbarah Martinez, RN, BSN has
More informationMoving Past the Basics of Tuberculosis Phoenix, Arizona May 8-10, 2012
Moving Past the Basics of Tuberculosis Phoenix, Arizona May 8-10, 2012 LTBI and TB Disease Treatment Cara Christ, MD, MS May 8, 2012 Cara Christ, MD, MS has the following disclosures to make: No conflict
More informationDrug Interactions Lisa Armitige, MD, PhD November 17, 2010
Substance Abuse and Tuberculosis Oklahoma City, Oklahoma November 17, 2010 Drug Interactions Lisa Armitige, MD, PhD November 17, 2010 Drug Interactions Lisa Y. Armitige, M.D., Ph.D. Medical Consultant
More informationStandard TB Treatment
Standard TB Treatment Chris Keh, MD TB Controller, TB Prevention and Control Program, San Francisco Department of Public Health Assistant Clinical Professor, Division of Infectious Diseases, University
More informationDrug Side Effects and Toxicity
Drug Side Effects and Toxicity Gwen A. Huitt, MD MS Professor, Division of Mycobacterial and Respiratory Infections National Jewish Health Disclosures None Toxicity Nausea and vomiting Any Drug Can Cause
More informationMedication Administration and Adverse Reactions Alisha Blair, LVN September 28, 2011
TB Nurse Case Management Davenport, Iowa September 27 28, 2011 Medication Administration and Adverse Reactions Alisha Blair, LVN September 28, 2011 Alisha Blair, LVN, has the following disclosures to make:
More informationShu-Hua Wang, MD, MPH &TM Assistant Professor of Medicine The Ohio State University
Shu-Hua Wang, MD, MPH &TM Assistant Professor of Medicine The Ohio State University For anti-tuberculosis medications: Describe clinical monitoring for adverse drug reactions Review specific drug side
More informationIntroduction to TB Nurse Case Management Online February 4, 11, 18 and 25, 2015
Introduction to TB Nurse Case Management Online February 4, 11, 18 and 25, 2015 Initiation Phase Part 1 Ginny Dowell, RN, BSN February 4, 2015 Ginny Dowell RN, BSN has the following disclosures to make:
More informationTreatment: First Line Drugs TUBERCULOSIS TREATMENT: MEDICATIONS & REGIMENS TREATMENT: GENERAL PRINCIPLES MECHANISM OF ACTION MID 27
TUBERCULOSIS TREATMENT: MEDICATIONS & REGIMENS Treatment: First Line Drugs 1. ISONIAZID = INH Bacteriocidal against dividing organisms Dose = 300mg = one pill = well absorbed Good CNS penetration Can be
More informationManaging and Monitoring Side Effects and Toxicities of Anti TB Therapy Iris Barrera, RN April 11, 2018
Managing and Monitoring Side Effects and Toxicities of Anti TB Therapy Iris Barrera, RN April 11, 2018 TB Nurse Case Management April 10 12, 2018 San Antonio, TX EXCELLENCE EXPERTISE INNOVATION Iris Barrera,
More informationDRUG SIDE EFFECTS AND TOXICITY
DRUG SIDE EFFECTS AND TOXICITY Gwen A. Huitt, MD MS Professor, Division of Mycobacterial and Respiratory Infections National Jewish Health Disclosures None Objectives After participating in this lecture,
More informationDana G. Kissner, MD Detroit Department of Health & Wellness Promotion Wayne State University
Dana G. Kissner, MD Detroit Department of Health & Wellness Promotion Wayne State University I reply to those who urge me to take medicine that they should wait at least until I am restored to my strength
More informationPeter Mere Latham English physician & educator
Poisons and medicine are oftentimes the same substance given with different intents Dana G. Kissner, MD Detroit Department of Health & Wellness Promotion Wayne State University Peter Mere Latham 1789-1875
More informationTreatment of Tuberculosis
TB Clinical i l Intensive Seattle Treatment of Tuberculosis June 16, 2016 Masa Narita, MD Public Health Seattle & King County; Firland Northwest TB Center, University of Washington Outline Unique features
More informationLTBI Videos-Treatment
LTBI Videos-Treatment This program is presented by the Global Tuberculosis Institute and is based on recommendations from the Centers for Disease Control and Prevention. This is the third in a series of
More informationDiagnosis and Treatment of Tuberculosis, 2011
Diagnosis of TB Diagnosis and Treatment of Tuberculosis, 2011 Alfred Lardizabal, MD NJMS Global Tuberculosis Institute Diagnosis of TB, 2011 Diagnosis follows Suspicion When should we Think TB? Who is
More information6/8/2018 TB TREATMENT. Bijan Ghassemieh, MD Seattle TB Clinical Intensive Disclosures. None
TB TREATMENT Bijan Ghassemieh, MD Seattle TB Clinical Intensive 2018 Disclosures None 1 Objectives Understand the following Rationale and goals for standard TB regimen When to initiate TB treatment Standard
More informationTreatment of TB Infection Lisa Y. Armitige, MD, PhD April 7, 2015
Treatment of TB Infection Lisa Y. Armitige, MD, PhD April 7, 2015 Tuberculosis Infection Diagnosis and Treatment April 7, 2015 El Paso, TX EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD has
More informationTB Grand Rounds. Reynard McDonald, MD & Henry Fraimow, MD January 30, Outline
TB Grand Rounds Reynard McDonald, MD & Henry Fraimow, MD January 30, 2007 Outline Overview of 2006 ATS statement regarding hepatotoxicity of anti-tb therapy Case examples highlighting management of patients
More informationDose Counting Exercise Elizabeth Foy, RN, BSN September 8, 2016
Dose Counting Exercise Elizabeth Foy, RN, BSN September 8, 2016 TB Nurse Case Management September 7-9, 2016 San Antonio, TX EXCELLENCE EXPERTISE INNOVATION Jessica Quintero, M.Ed., has the following disclosures
More informationAntimycobacterial drugs. Dr.Naza M.Ali lec Dec 2018
Antimycobacterial drugs Dr.Naza M.Ali lec 14-15 6 Dec 2018 About one-third of the world s population is infected with M. tuberculosis With 30 million people having active disease. Worldwide, 9 million
More informationTB: A Supplement to GP CLINICS
TB: A Supplement to GP CLINICS Adverse Drug events With Anti Tuberculosis Therapy What Every GP Should Know Authors: Kavitha Saravu, MD, DNB, DTM&H; Madhukar Pai, MD, PhD Standards of TB Care in India
More informationCase Management of the TB/HIV Infected Patient
TB Nurse Case Management San Antonio, Texas December 8-10, 2009 Case Management of the TB/HIV Infected Patient Sarah Hoffman, MPH, MSN, ACRN December 9, 2009 TB/HIV: Considerations in the Care of the Coinfected
More informationAnti Tuberculosis Medications
Anti Tuberculosis Medications Mary Ann Rodriguez, MD March 8, 2017 TB Nurse Case Management March 7 9, 2017 San Antonio, TX EXCELLENCE EXPERTISE INNOVATION Mary Ann Rodriguez, MD has the following disclosures
More informationTB Nurse Assessment. Ginny Dowell, RN, BSN October 21, 2015
TB Nurse Assessment Ginny Dowell, RN, BSN October 21, 2015 Comprehensive Care of Patients with Tuberculosis and Their Contacts October 19-22, 2015 Wichita, KS EXCELLENCE EXPERTISE INNOVATION Ginny Dowell,
More informationLTBI in Special Populations John Nava, MD October 5, 2010
Understanding and Managing Latent TB Infection Arnold, Missouri October 5, 2010 LTBI in Special Populations John Nava, MD October 5, 2010 2 Treatment of Latent TB Infection in Special Populations John
More informationTreatment and Monitoring
Treatment and Monitoring Disclosures We have no actual or potential conflicts of interest in relation to this presentations. We have no financial relationships to disclose. Learning Objectives After this
More informationPediatric TB Intensive San Antonio, Texas October 14, 2013
Pediatric TB Intensive San Antonio, Texas October 14, 2013 Treatment of Tuberculosis in Children Jeffrey R. Starke, M.D. Professor of Pediatrics October 14, 2013 Jeffrey R. Starke, M.D. has the following
More informationWhat you need to know about diagnosing and treating TB: a preventable, fatal disease. Bob Belknap M.D. Denver Public Health November 2014
What you need to know about diagnosing and treating TB: a preventable, fatal disease Bob Belknap M.D. Denver Public Health November 2014 The Critical First Step Consider TB in the Differential 1. Risks
More informationTB: Management in an era of multiple drug resistance. Bob Belknap M.D. Denver Public Health November 2012
TB: Management in an era of multiple drug resistance Bob Belknap M.D. Denver Public Health November 2012 Objectives: 1. Explain the steps for diagnosing latent and active TB role of interferon-gamma release
More informationDisclosures. Outline. No disclosures or conflicts of interest to report. Special LTBI situations. H t it d id ff t
Selected Topics in LTBI June 2, 2015 Bijan Ghassemieh, MD Senior Fellow UW Division of Pulmonary/Critical Care Disclosures No disclosures or conflicts of interest to report Outline Special LTBI situations
More informationAt the end of this session, participants will be able to:
Advanced Concepts in Pediatric TB: Treatment of Tuberculosis Disease Jeffrey R. Starke, M.D. Professor of Pediatrics Baylor College of Medicine [with help from Andrea Cruz, M.D.] Objectives At the end
More informationDrug Resistant Tuberculosis Self-reporting of Drugrelated. During Treatment
Drug Resistant Tuberculosis Self-reporting of Drugrelated Adverse Events During Treatment Introduction This information has been prepared for people with tuberculosis (TB) that is resistant to the commonly
More informationPre-Treatment Evaluation. Treatment of Latent TB Infection (LTBI) Initiating Treatment: Patient Education. Before initiating treatment for LTBI:
Pre-Treatment Evaluation Before initiating treatment for LTBI: Treatment of Latent TB Infection (LTBI) Amee Patrawalla, MD Associate Professor, New Jersey Medical School Attending Physician, NJMS Global
More informationJanuary 2008 IMPORTANT DRUG WARNING
January 2008 IMPORTANT DRUG WARNING Dear Healthcare Professional: Roche would like to advise you of a recent update to the PEGASYS (Peginterferon alfa-2a) and COPEGUS (Ribavirin, USP) package inserts.
More informationTB Case Management Hepatitis
TB Case Management Hepatitis Chris Keh, MD TB Controller, TB Prevention and Control Program, San Francisco Department of Public Health Assistant Clinical Professor, Division of Infectious Diseases, University
More informationMultiple Drug-resistant Tuberculosis: a Threat to Global - and Local - Public Health
Multiple Drug-resistant Tuberculosis: a Threat to Global - and Local - Public Health C. Robert Horsburgh, Jr. Boston University School of Public Health Background Outline Why does drug resistance threaten
More informationHEALTH SERVICES POLICY & PROCEDURE MANUAL
PAGE 1 of 7 References Related ACA Standards 4 th Edition Standards for Adult Correctional Institutions 4-4350, 4-4355 These guidelines are based on the recommendations of the American Thoracic Society
More informationAntituberculous Agents
Antituberculous Agents Primary or First Line Drugs: Isoniazid (INH) Rifampin Rifadin or Rimactane Ethambutal Streptomycin Pyrazinamide Isoniazid(INH) Most active. Small molecule, water soluble, Structurally
More informationTB in Prisons and Jails Albuquerque, New Mexico November 28, 2012
TB in Prisons and Jails Albuquerque, New Mexico November 28, 2012 Challenges of TB Treatment in Special Populations in Corrections Marcos Burgos, MD November 28, 2012 Marcos Burgos, MD has the following
More informationTreatment of Active Tuberculosis
Treatment of Active Tuberculosis Jeremy Clain, MD Pulmonary & Critical Care Medicine Mayo Clinic October 16, 2017 2014 MFMER slide-1 Disclosures No relevant financial relationships No conflicts of interest
More informationWHOPAR part 3 Suppliers submission of the SRA approved text. Package Leaflet: Information for the user
Package Leaflet: Information for the user Ethambutol Atb 250 mg Ethambutol hydrochloride Ethambutol Atb 400 mg Ethambutol hydrochloride Read all of this leaflet carefully before you start using this medicine
More informationOfficial ATS/CDC/IDSA Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis (Nahid et al, CID 2016)
Official ATS/CDC/IDSA Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis (Nahid et al, CID 2016) APPENDIX C: DRUGS IN CURRENT USE The U.S. Food and Drug Administration (FDA) has approved
More informationManaging MDR TB Treatment Side Effects
Managing MDR TB Treatment Side Effects Barbara J. Seaworth, M.D. Medical Director Heartland National TB Center Pacific Islands TB Controllers Association Conference, September 14, 2017 Honolulu, Hawaii
More informationTB Nurse Case Management San Antonio, Texas April 9-11, 2013
TB Nurse Case Management San Antonio, Texas April 9-11, 2013 TB / Dose Counting Rachel Munoz, RN. TB Nurse Case Manager/Nurse Consultant Austin/Travis County Health Department April 10, 2013 Rachel Munoz,
More informationTreatment of Latent TB Infection (LTBI)
Treatment of Latent TB Infection (LTBI) Mahesh C. Patel, MD June 14, 2017 2014 MFMER slide-1 Mahesh C. Patel, MD Associate Professor Treatment of LTBI Department of Internal Medicine, Division of Infectious
More informationTuberculosis: A Provider s Guide to
Tuberculosis: A Provider s Guide to Diagnosis and Treatment of Active Tuberculosis (TB) Disease and Screening and Treatment of Latent Tuberculosis Infection (LTBI) Alameda County Health Care Services Agency
More informationWARNING: TENDON EFFECTS and EXACERBATION OF MYASTHENIA GRAVIS
DECLESAU (dergrafloxacin) tablets, for oral use DECLESAU (dergrafloxacin) injection, solution for intravenous use WARNING: TENDON EFFECTS and EXACERBATION OF MYASTHENIA GRAVIS Fluoroquinolones, including
More informationSA TB Guidelines The interface with Advanced Clinical Care
SA TB Guidelines The interface with Advanced Clinical Care Dr Kogie Naidoo (MBCHB, PHD) Head: CAPRISA Treatment Research Programme Honorary Lecturer - UKZN Department of Public Heath Medicine Annual Workshop
More informationPediatric Tuberculosis Lisa Y. Armitige, MD, PhD September 14, 2017
Pediatric Tuberculosis Lisa Y. Armitige, MD, PhD September 14, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD has the following disclosures
More informationLatent TB Infection Treatment
Latent TB Infection Treatment Douglas B. Hornick, MD Pulmonologist w/ Infectious Attitude Division of Pulmonary/Critical Care/Occ Med UI Carver College of Medicine 2014 MFMER slide-1 Disclosures: None
More informationDiagnosis and Medical Management of TB Infection Lisa Y. Armitige, MD, PhD September 12, TB Nurse Case Management September 12 14, 2017
Diagnosis and Medical Management of TB Infection Lisa Y. Armitige, MD, PhD September 12, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Lisa Y. Armitige, MD, PhD has
More informationTuberculosis Facts. TB is not spread by: Sharing food and drink Shaking someone s hand Touching bed lines or toilet seats
Tuberculosis Facts Below are frequently asked questions about TB, and their answers. If you have additional questions you may contact the City of Ennis Department of Health Services at 972-875-1234 or
More informationObjectives. 3HP and Flu Syndrome What is the Underlying Mechanism? Case #1 3/23/2016. Christina T. Fiske, MD MPH March 30, 2016
Objectives 3HP and Flu Syndrome What is the Underlying Mechanism? Christina T. Fiske, MD MPH March 30, 2016 Illustrate the side effect of 3HP flu like syndrome after its initiation to raise awareness in
More informationAnti-Tuberculosis Drugs
Tuberculosis in Nursing: Prevention, Treatment, and nfection Control Curry nternational Tuberculosis Center Anti-Tuberculosis Drugs What Nurses Need to Know Objectives Describe the anti-tb medications
More informationManagement of Patients with TB Infection Catalina Navarro, RN, BSN April 7, 2015
Management of Patients with TB Infection Catalina Navarro, RN, BSN April 7, 2015 Tuberculosis Infection Diagnosis and Treatment April 7, 2015 El Paso, TX EXCELLENCE EXPERTISE INNOVATION Catalina Navarro,
More informationTB in Corrections Phoenix, Arizona
TB in Corrections Phoenix, Arizona March 24, 2011 Treatment of Latent TB Infection Renuka Khurana MD, MPH March 24, 2011 Renuka Khurana, MD, MPH has the following disclosures to make: No conflict of interests
More informationPROBLEMS IN TX CASE STUDY. JB is a 42 yo BM who was admitted to
Why TB Drugs Fail Part 2 Why TB Drugs Fail OR How We Fail TB Drugs (and Tb Patients) 1 PROBLEMS IN TX FAILURE TO RESPOND TB MENINGITIS RENAL FAILURE HEPATITIS CAN T SWALLOW PILLS GI INTOLERANCE ADVERSE
More informationTB Drugs. Discuss the common route for transmission of the disease. Discusses the out line for treatment of tuberculosis.
TB Drugs Red : important Black : in male / female slides Pink : in female s slides only Blue : in male s slides only Females doctor notes Grey: Males doctor notes OBJECTIVES: By the end of this lecture,
More informationCHAPTER:1 TUBERCULOSIS. BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY
CHAPTER:1 TUBERCULOSIS BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY GLOBAL EMERGENCY: * Tuberculosis kills 5,000 people a day! * 2.3 million die each year!
More informationPRESCRIBING INFORMATION
PRESCRIBING INFORMATION pdp-pyrazinamide Pyrazinamide Tablets, USP 500 mg Antimycobacterial / Antituberculosis Agent PENDOPHARM, Division of Pharmascience Inc.. 6111, Royalmount Ave, Suite 100 Montréal,
More informationAdvanced Management of Patients with Tuberculosis Little Rock, Arkansas August 13 14, 2014
Advanced Management of Patients with Tuberculosis Little Rock, Arkansas August 13 14, 2014 TB Drugs David Griffith, MD August 13, 2014 David Griffith, MD has the following disclosures to make: No conflict
More informationTuberculosis and Diabetes Dec. 10, 2009 Dean Schillinger, M.D. and Gisela Schecter, M.D., M.P.H. 1 of 18
Screening, Diagnosis, and Treatment of TB in Persons with Diabetes Dean Schillinger, M.D. University of California San Francisco CA Diabetes Program Gisela Schecter, M.D., M.P.H. TB Control Branch CA Department
More informationNURSING PROCESS FOCUS: Patients Receiving Amphotericin B (Fungizone, Abelcet)
NURSING PROCESS FOCUS: Patients Receiving Amphotericin B (Fungizone, Abelcet) ASSESSMENT Prior to administration: Obtain complete health history including allergies, drug history, and possible drug interactions.
More informationTreatment of Tuberculosis
Treatment of Tuberculosis Marcos Burgos, MD April 5, 2016 TB Intensive April 5 8, 2016 San Antonio, TX EXCELLENCE EXPERTISE INNOVATION Marcos Burgos, MD has the following disclosures to make: No conflict
More informationMelanoma Immunotherapy. Nursing Perspective on Immune-Related Adverse Events: Patient education, Monitoring & Management
Melanoma Immunotherapy Nursing Perspective on Immune-Related Adverse Events: Patient education, Monitoring & Management Mike Buljan, NP UCSF Medical Center Melanoma Oncology Disclosures None Only FDA-approved
More informationTB PREVENTION: TREATMENT OF LATENT TB INFECTION AND BCG VACCINATION
TB PREVENTION: TREATMENT OF LATENT TB INFECTION AND BCG VACCINATION Michelle Haas, M.D. Denver Metro Tuberculosis Program Denver Public Health DISCLOSURES No relevant financial relationships OBJECTIVES
More informationMANAGEMENT OF DILI in TB/HIV coinfected patients. Chimoio 31 August 2017 by Dr Ndiviwe Mphothulo
MANAGEMENT OF DILI in TB/HIV coinfected patients Chimoio 31 August 2017 by Dr Ndiviwe Mphothulo ANTI-TB drugs Groups Drugs Group 1: First-line oral drugs Ethambutol (Emb) Pyrazinamide(PZA) Isoniazid (INH)
More informationTuberculosis in Primary Care COC GTA Spring Symposium Dr Elizabeth Rea April 2013
Tuberculosis in Primary Care COC GTA Spring Symposium Dr Elizabeth Rea April 2013 1 TB in Toronto - risk groups Diagnosis of active TB LTBI diagnosis and management Infection control 2 TB in Toronto Case
More informationTips and Tricks for Diagnosing and Treating Tuberculosis
Tips and Tricks for Diagnosing and Treating Tuberculosis Bob Belknap M.D. Director, Denver Metro TB Program December 6, 2017 DenverPublicHealth.org @DenverPublicHealth @DenPublicHealth Disclosures No conflicts
More informationPatient History 1. Patient History 2. Social History. The Role of Surgery in the Management of TB. Reynard McDonald, MD & Paul Bolanowski, MD
Patient History 1 The Role of Surgery in the Management of TB Reynard McDonald, MD & Paul Bolanowski, MD September 16, 2010 42 y/o AA male was initially diagnosed with pansensitive pulmonary TB in 1986
More informationManaging Complex TB Cases Diana M. Nilsen, MD, RN
Managing Complex TB Cases Diana M. Nilsen, MD, RN Director of Medical Affairs NYC Department of Health & Mental Hygiene Bureau of TB Control Case #1 You are managing a patient who was seen at a private
More informationTREATMENT OF LATENT TB INFECTION (LTBI)...
July, 2018 Page 1 TABLE OF CONTENTS 6.0 TREATMENT OF LATENT TB INFECTION (LTBI)... 2 6.1 Overview... 2 6.2 Procedure for Initiation of LTBI Treatment... 4 6.3 Recommended LTBI Treatment Regimens... 5 6.4
More informationPediatric TB Intensive Houston, Texas
Pediatric TB Intensive Houston, Texas November 13, 2009 Treatment of Pediatric TB Jeffrey R. Starke, M.D. November 13, 2009 MANAGEMENT OF CHILDHOOD TUBERCULOSIS Jeffrey R. Starke, M.D. Professor of Pediatrics
More informationDosage and Administration
SIRTURO product information for healthcare providers 2 WARNINGS: An increased risk of death was seen in the SIRTURO (bedaquiline) treatment group (9/79, 11.4%) compared to the placebo treatment group (2/81,
More informationINITIATING ORAL AUBAGIO (teriflunomide) THERAPY
FOR YOUR PATIENTS WITH RELAPSING FORMS OF MS INITIATING ORAL AUBAGIO (teriflunomide) THERAPY INDICATION AUBAGIO (teriflunomide) is indicated for the treatment of patients with relapsing forms of multiple
More informationPediatric TB Lisa Armitige, MD, PhD September 28, 2011
TB Nurse Case Management Davenport, Iowa September 27 28, 2011 Pediatric TB Lisa Armitige, MD, PhD September 28, 2011 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict of interest.
More informationCarboplatin / Liposomal Doxorubicin CARBO/CAELYX Gynaecological Cancer
Systemic Anti Cancer Treatment Protocol Carboplatin / CARBO/CAELYX Gynaecological Cancer PROCTOCOL REF: MPHAGYNCCX (Version No: 1.0) Approved for use in: Advanced ovarian cancer in women who have progressed
More informationMEDICAL MANAGEMENT OF TB
TB CASE MANAGEMENT AND CONTACT INVESTIGATION INTENSIVE MEDICAL MANAGEMENT OF TB LEARNING OBJECTIVES Upon completion of this session, participants will be able to: 1. Describe the recommended treatment
More informationTuberculosis Tools: A Clinical Update
Tuberculosis Tools: A Clinical Update CAPA Conference 2014 JoAnn Deasy, PA-C. MPH, DFAAPA jadeasy@sbcglobal.net Adjunct Faculty Touro PA Program Learning Objectives Outline the pathogenesis of active pulmonary
More informationVerzenio (abemaciclib) NEW PRODUCT SLIDESHOW
Verzenio (abemaciclib) NEW PRODUCT SLIDESHOW Introduction Brand name: Verzenio Generic name: Abemaciclib Pharmacological class: Kinase inhibitor Strength and Formulation: 50mg, 100mg, 150mg, 200mg; tabs
More informationNursing Process Focus: Patients Receiving Chlorpromazine (Thorazine)
Nursing Process Focus: Patients Receiving Chlorpromazine (Thorazine) Potential Nursing Diagnoses Ineffective Therapeutic Regimen Management Risk for Activity Intolerance, related to side effect of drug
More informationTuberculosis Reporting, Waco-McLennan County Public Health District TB Control WMCPHD (254)
Tuberculosis Reporting, Waco-McLennan County Public Health District TB Control WMCPHD (254)-750-5496 Local health care providers, including physicians offices, labs and hospitals, are required by law to
More informationDR-TB Patient Treatment Log Book
REPUBLIC OF KENYA MINISTRY OF HEALTH DR-TB Patient Treatment Log Book Patient Name: Patient Reg. No.: VERSION 2016 DR-TB treatment outcome summary Outcome Mark one Date Cured Died Failed Defaulted Transferred
More informationDrafting a Coverage Authorization Request Letter
Drafting a Coverage Authorization Request Letter The following information is presented for informational purposes only and is not intended to provide reimbursement or legal advice. Laws, regulations,
More informationTreatment of Tuberculosis
TB Intensive Tyler, Texas June 1-3, 2009 Treatment of Tuberculosis Barbara Seaworth, MD June 3, 2009 Treatment of Tuberculosis Barbara J Seaworth MD Medical Director Heartland National TB Center 1 Purpose
More informationPsychosocial Factors in a TB Patient Adriana Vasquez, MD July 30, 2008
Becoming a TB Nurse Expert San Antonio, Texas July 30-31, 2008 Psychosocial Factors in a TB Patient Adriana Vasquez, MD July 30, 2008 TUBERCULOSIS and MENTAL ILLNESS Adriana Vasquez, MD Staff physician
More informationDIAGNOSIS AND MEDICAL MANAGEMENT OF TB DISEASE
DIAGNOSIS AND MEDICAL MANAGEMENT OF TB DISEASE Annie Kizilbash MD, MPH Assistant Professor University of Texas Health Science Center Staff Physician, Texas Center for Infectious Diseases TB Nurse Case
More informationEtiological Agent: Pulmonary Tuberculosis. Debra Mercer BSN, RN, RRT. Definition
Pulmonary Tuberculosis Debra Mercer BSN, RN, RRT Definition Tuberculosis is a contagious bacterial infection of the lungs caused by Mycobacterium Tuberculosis (TB) Etiological Agent: Mycobacterium Tuberculosis
More informationVandetanib. ICD-10 codes Codes with a pre-fix C73.
Vandetanib Indication First line treatment of histologically confirmed, unresectable, locally advanced or metastatic medullary thyroid cancer in patients with progressive and symptomatic disease. ICD-10
More informationFundamentals of Tuberculosis (TB)
TB in the United States Fundamentals of Tuberculosis (TB) From 1953 to 1984, reported cases decreased by approximately 5.6% each year From 1985 to 1992, reported cases increased by 20% 25,313 cases reported
More informationUpdate on Management of
Update on Management of DR TB Definitions Presumptive MDR-TB A patient suspected of drug-resistant TB, based on RNTCP criteria for submission of specimens for drug-susceptibility testing MDR-TB Case A
More information