1. Tuberculosis care and control in refugee and displaced population: An interagency field manual 2 nd edition © World Health Organization 2007 Edited by M.A. Connolly, M. Gayer and S. Ottmani http://whqlibdoc.who.int/publications/2007/9789241595421_eng.pdf

2. 2. What side effects/complications should be monitored in a patient taking anti-TB medications? DrugSide EffectManagement RifampinRash Liver dysfunction Flulike syndrome Red-orange urine Drug interactions Fever, chills Observe patient; stop drug if significant Monitor AST; limit alcohol consumption; monitor for hepatitis symptoms Administer at least twice weekly; limit dose to 10 mg/kg (adults) Reassure patient Consider monitoring levels of other drugs affected by rifampin, especially with contraceptives, anticoagulants, and digoxin; avoid use with protease inhibitors Stop drug IsoniazidHepatitis Peripheral neuritis Optic neuritis Seizures Monitor AST; limit alcohol consumption; monitor for hepatitis symptoms; stop drug at first symptoms of hepatitis Administer vitamin B 6 Administer vitamin B 6 ; stop drug Administer vitamin B 6 Harrison’s Principles of Internal Medicine, 17 th ed.

3. 2. What side effects/complications should be monitored in a patient taking anti-TB medications? DrugSide EffectManagement PyrazinamideHepatitis Hyperuricemia Monitor AST; limit daily dosage to 15-30 mg/kg; discontinue with signs or symptoms of hepatitis Monitor uric acid level only in cases of gout or renal failure EthambutolOptic neuritisUse 25 mg/kg daily only for first 2 months, then use lower daily dose (15 mg/kg) when possible; monitor visual acuity and red-green color vision at baseline and with any visual complaint; stop drug at first change in vision, get ophthalmologic evaluation Streptomycin, amikacin, capreomycin Ototoxicity, renal toxicity Limit dose and duration of therapy as much as possible; avoid daily therapy in patients >50 years old; monitor BUN and serum creatinine levels and possibly conduct audiometry before and as needed; question patient regularly about tinnitus, dizziness, vertigo and decreased hearing; measure serum drug levels; stop drug at first development of adverse effect Harrison’s Principles of Internal Medicine, 17 th ed.

4. Etiology of ARDS Most cases (>80%) are caused by clinical disorders (e.g. Severe sepsis syndrome and/or bacterial pneumonia, trauma, multiple transfusions, aspiration of gastric contents, drug overdose) Other clinical variables associated with the development of ARDS: old age, chronic alcohol abuse, metabolic acidosis, severity of critical illness CLINICAL DISORDERS COMMONLY ASSOCIATED WITH ARDS DIRECT LUNG INJURY Pneumonia Aspiration of gastric contents Pulmonary contusion Near-drowning Toxic inhalation injury INDIRECT LUNG INJURY Sepsis Severe trauma (multiple bone fractures, flail chest, head trauma, burns) Multiple transfusions Drug over dose Pancreatitis Post cardiopulmonary bypass

5. Diagnostic criteria for ARDS OxygenationOnsetChest RadiographAbsence of left atrial HPN Pa0 2 /Fl02 ≤200mmHg acuteBilateral alveolar or interstitial infiltrates PCWP ≤18mmHg or no clinical evidence of increase left atrial pressure Note: ARDS – acute respiratory distress syndrome; Fl02 – inspired 02 percentage; PCWP - pulmonary capillary wedge pressure