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Pronunciation |
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(too
BER kyoo lin
tests) |
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U.S. Brand
Names |
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Aplisol®; Aplitest®; Tine Test
PPD; Tubersol® |
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Generic
Available |
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No |
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Synonyms |
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Mantoux; PPD; Tine Test; TST; Tuberculin Purified Protein Derivative; Tuberculin
Skin Test |
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Pharmacological Index |
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Diagnostic Agent, Skin Test |
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Use |
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Skin test in diagnosis of tuberculosis, cell-mediated
immunodeficiencies |
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Pregnancy Risk
Factor |
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C |
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Contraindications |
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250 TU strength should not be used for initial testing |
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Warnings/Precautions |
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Do not administer I.V. or S.C.; epinephrine (1:1000) should be available to
treat possible allergic reactions |
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Adverse
Reactions |
|
1% to 10%:
Local: Pain at injection site |
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Drug
Interactions |
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Decreased effect: Reaction may be suppressed in patients receiving systemic
corticosteroids, aminocaproic acid, or within 4-6 weeks following immunization
with live or inactivated viral vaccines |
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Stability |
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Refrigerate; Tubersol™ opened vials are stable for up
to 24 hours at <75°F |
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Mechanism of
Action |
|
Tuberculosis results in individuals becoming sensitized to certain antigenic
components of the M. tuberculosis organism. Culture extracts called
tuberculins are contained in tuberculin skin test preparations. Upon
intracutaneous injection of these culture extracts, a classic delayed (cellular)
hypersensitivity reaction occurs. This reaction is characteristic of a delayed
course (peak occurs >24 hours after injection, induration of the skin
secondary to cell infiltration, and occasional vesiculation and necrosis).
Delayed hypersensitivity reactions to tuberculin may indicate infection with a
variety of nontuberculosis mycobacteria, or vaccination with the live attenuated
mycobacterial strain of M. bovis vaccine, BCG, in addition to previous
natural infection with M. tuberculosis. |
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Pharmacodynamics/Kinetics |
|
Onset of action: Delayed hypersensitivity reactions to tuberculin usually
occur within 5-6 hours following injection
Peak effect: Become maximal at 48-72 hours
Duration: Reactions subside over a few days |
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Usual Dosage |
|
Children and Adults: Intradermal: 0.1 mL about 4" below elbow; use
1/4
" to 1/2
" or 26- or 27-gauge needle; significant reactions are greater than or equal to
5 mm in diameter
Interpretation of induration of Tine test injections: Positive: >2 mm and
vesiculation present; inconclusive: <2 mm (give patient Mantoux test of 5
TU/0.1 mL - base decisions on results of Mantoux test); negative: <2 mm or
erythema of any size (no need for retesting unless person is a contact of a
patient with tuberculosis or there is clinical evidence suggestive of the
disease) |
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Administration |
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Select a site without acne or hair |
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Mental Health: Effects
on Mental Status |
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None reported |
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Mental Health:
Effects on Psychiatric
Treatment |
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None reported |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
|
Return to physician for reaction interpretation at 48-72
hours |
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Nursing
Implications |
|
Test dose: 0.1 mL intracutaneously; store in refrigerator; examine site at
48-72 hours after administration; whenever tuberculin is administered, a record
should be made of the administration technique (Mantoux method, disposable
multiple-puncture device), tuberculin used (OT or PPD), manufacturer and lot
number of tuberculin used, date of administration, date of test reading, and the
size of the reaction in millimeters (mm). |
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Dosage Forms |
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Injection:
Intermediate test strength: 5 TU/0.1 mL (1 mL, 5 mL, 10 mL)
Second test strength: 250 TU/0.1 mL (1 mL)
Tine: 5 TU each test |
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References |
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Dutt AK and Stead WW, "Tuberculosis," Clin Geriatr Med, 1992,
8(4):761-75. |
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