Antitubercular Drugs

Question 1

Isoniazid (isonicotine hydrazine

Answer 1

• primary drug used to treat TB and is used widely
• cell wall synthesis inhibitor
• resistant strains emerging
• metabolized in the liver through acetylation
• used alone or in combo
• contraindicated with previous ioniazid-associated liver injury or acute liver disease
• adverse effects: perpheral neuritis, hepatotoxicity, hyperglylcemia, discolouration of body fluids
• may need vitamin B6 for peripheral neuropathy
• interacts with antiacids

Question 2

Ethambutol hydrochloride

Answer 2

• first line therapy for TB
• contraindicated in children under 13 years of age
• may cause retrobulbar neuritis
• oral form only
• may cause visual changes such as optic neuritis, blindness and altered color preception

Question 3

Pyrazinamide

Answer 3

• first line therapy for TB
• contraindicated in pts with gout and severe liver disease
• not normally used in pregnant patients as there is not enough evidence

Question 4

Rifampin

Answer 4

• first line therapy for TB, used with at least one other first line drug
• may experience discolouration of skin, sweat, tears, urine, feces, sputum, saliva, cerebrospinal fluid and tongue
• hepatitis and hematological disorders

Question 5

Adverse Effects

Answer 5

INH: Isoniazid and Rifapentine: peripheral neuropathy, hepatotoxicity, optic neuritis and visual disturbances, hyperglycemia
ethambutol: retrobulbar neuritis, blindness
rifampin: hepatitd, hematological disorders, red- orange discoloured urine, stools and tears

Question 6

Bacille Calmette- Guerin (BCG)

Answer 6

• vaccine injection from inactive strain of mycobacterium bovis
• used in first nations communities in the NWT and used to treat young children against TB
• doesnt prevent infection but reduces TB by 60-80%
• can cause false postive results on the TB skin test

Question 7

Therapy Considerations

Answer 7

• can be on medications for 24 months
• Some family members exposed to an individual with active TB may require prophylactic drug therapy for up to 9 months
  *

Question 8

Second- Line Treatments

Answer 8

amikacin sulphate
* injection for short term treatment
* often used for MDR TB
levofloxacin hemihydrate
* kills dormate TB cells before they become active
moxifloxacin hydrochloride
* quinolone antibiotic

Question 9

Nursing Implications

Answer 9

• liver function test in patients who recieve INH or rafampin (espically older pateints and those who use alcohol daily)
• strict adherance to regimen
• contagious during intial period of illness, proper hygine and prevention of the spread of infected droplets
• dont not consume alcohol while taking these medications
• rafampin causes oral contracprtives to become ineffective
• pridoxine may need to be given to combat neurological adverse effects assoicated with INH
• oral dosages may be given with foos to reduce GI upset
• adverse effects include fatigue, nausea, vomiting, numbness and tingling of extremities, fever, depression and jaundice
• visual changes and color aperance should be reported