The physician orders B.A. to begin a 12-dose, once-weekly regimen of isoniazid (INH) and rifapentine (RPT) as directly observed therapy (DOT)

Question

How will you describe LTBI and DOT to B.A?

The medications used to treat LTBI are associated with different side effects. Identify the test
used to monitor each possible side effect listed as follows:
_____ A. Peripheral neuropathy 1. Audiogram
_____ B. Clinical hepatitis 2. CBC (complete blood count)
_____ C. Fever and bleeding
problems
3. Blood urea nitrogen (BUN), creatinine, and
creatinine clearance
_____ D. Nephrotoxicity or renal
failure
4. AST (aspartate transaminase) and ALT (alanine
transaminase)
_____ E. Hyperuricemia 5. Physical examination and monofilament testing
_____ F. Optic neuritis 6. Red-green discrimination and visual acuity
_____ G. Hearing neuritis 7. Uric acid

What additional information does B.A. need to receive before leaving the clinic?

Answer 1

Explain the disease process and rationale for therapy in the absence of symptoms and radiographic
abnormalities. Review the importance of completing therapy.
Tell her she will need to come to the clinic weekly to take her medications. Coinciding with those
visits, she will undergo monitoring that includes weekly inquiries about side effects and monthly
physical assessment for signs of adverse events, including hepatitis.

Answers: A. 5; B. 4; C. 2; D. 3; E. 7; F. 6; G. 1
Physical examination and monofilament testing are used to test sensation in the lower
extremities. Clinical hepatitis may be detected by elevations in AST and ALT with a positive hepatitis
C titer. Upward deviations in the white blood cell (WBC) count may signal an inflammatory event
that accompanies a fever, and alterations in the platelet count can identify patients at risk for
altered coagulopathy. Elevations in creatinine and BUN with a decrease in creatinine clearance
signify diminished renal function associated with nephrotoxicity and acute renal failure. Uric acid
levels are monitored for elevations. Those with optic neuritis might have alterations in red-green
discrimination and visual acuity. An audiogram is used as a diagnostic test for determining the
degree and type of hearing loss and would be used to detect hearing neuritis.

• Review the side effects of INH and RPT therapy. Instruct B.A. to seek medical attention immediately
if she develops a fever, yellow eyes, dizziness, rash, or aches or more than 1 day of nausea,
vomiting, weakness, abdominal pain, or loss of appetite.
• She needs to know the S/S of active TB in case her TB becomes active, including fever, night sweats,
fatigue, anorexia, and weight loss.
• She should be told that she will always have a positive TB skin test result because she has been
exposed. The only way to determine whether she has active disease is by CXR examination.