Antitubercular

Question 1

Kills bacteria

Answer 1

Bactericidal

Question 2

Prevents growth of bacteria (keeps them in the stationary phase of growth

Answer 2

Bacteriostatic

Question 3

Antitubercular drugs are either

Answer 3

bactericidal or bacteriostatic

Question 4

General side effects of antitubercular drugs

Answer 4

Differ according to the drug prescribed

INH- peripheral neuropathy
Rifampin might cause body fluids to turn orange

Hepatotoxicity adverse reaction of many antitubercular drugs

Headaches, blood dyscrasias, GI distress, ocular toxicity may be developed

Question 5

Intended responses of antitubercular drugs

Answer 5

Reduced cough
Reduced sputum production
Reduced fatigue
Weight gain
Negative sputum culture

Question 6

Antitubercular drug used to treat active TB and as a prophylactic measure against TB (inhibits bacterial cell-wall synthesis).

Bactericidal or bacteriostatic depending on drug concentration.

Answer 6

Isoniazid (INH)

Question 7

Side effects & adverse effects of INH

Answer 7

Side effects:
Drowsiness, tremors, photosensitivity, tinnitus, N/V, dry mouth, constipation

Adverse effects:
Peripheral neuropathy, hepatotoxicity, psychotic behavior, seizures, optic neuropathy (usually reversible but may cause permanent vision loss), blood dyscrasias, thrombocytopenia, agranulocytosis

NOTE: risk of neuropathy decreased with Vitamin B-6

Question 8

What is the most serious side effect w/ INH?

Answer 8

Hepatitis is the most serious adverse effect associated with INH

Question 9

Pt teaching for INH

Answer 9

Take INH 1 hour before meals or 2 hours after meals.
Avoid caffeine, avoid alcohol.
Collect sputum specimen in early morning.
Take pyridoxine (vitamin B6) to prevent peripheral neuropathy.
Check liver enzymes, CBC.
Need frequent eye examinations
Report numbness, tingling, burning.
Teach sun precautions, to avoid antacids

Question 10

Antitubercular drug that inhibits enzyme needed for protein synthesis

Answer 10

Rifampin

Question 11

Side effects & adverse effects of Rifampin

Answer 11

Side effects: Abdominal pain, urinary retention, reddish-orange secretions

Adverse effects: Liver toxicity (so use caution in older patients, alcoholics, and chronic liver disease)

Generally well tolerated, most common adverse reactions include N/V, rash

Question 12

Antitubercular drug that is bacteriostatic; inhibits cell wall synthesis

Answer 12

Ethambutol

Question 13

Side effects & adverse effects of Ethambutol

Answer 13

Side effects: increase uric acid (use with caution in patients with gout)

Adverse effects: hepatotoxicity, optic neuropathy (in high doses)

Question 14

Most important adverse effect of Ethambutol

Answer 14

optic neuritis- results in visual acuity and loss of ability to discriminate between red and green

Question 15

Antitubercular drug with unknown mechanism of action

Answer 15

Pyrazinamide (PZA)

Question 16

Side effects & adverse effects of Pyrazinamide (PZA)

Answer 16

Side effects: increase uric acid, aches, pains, photosensitivity, acne
Adverse effects: Liver toxicity

Question 17

First line TB drugs

Answer 17

Isoniazid (INH), Ethambutol, Pyrazinamide, and Rifampin

Question 18

Nursing interventions for antitubercular drugs

Answer 18

-Administer INH 1 hour before or 2 hours after meals.
-Give pyridoxine (vitamin B6) as prescribed with INH to prevent peripheral neuropathy.
-Monitor hepatic function tests.
-Monitor blood glucose and CBS
-Emphasize importance of complying with drug regimen.
-Referral for public health recommendations

Question 19

What is Directly Observed Therapy (DOT)?

Answer 19

Health-care worker watches patient swallow each dose.
DOT is preferred management strategy for all patients.
Can reduce acquired drug resistance, treatment failure and relapse.
Nearly all regimens can be intermittent if given as DOT.
DOT reduces total number of doses and encounters.
For drug-resistant TB, use daily regimen and DOT.

Question 20

Pt teaching for antitubercular drugs

Answer 20

-Keep supply of prescribed drugs on hand at all times
-Continue taking drugs exactly as prescribed!
-Avoid alcohol
-Manage side effects
-No OTC drugs, including herbal supplements, unless approved by prescriber