Chapter 41 Antituberculosis Drugs

Question 1

Mycobacterium infections

Answer 1

• Common sites of infection are lungs, brain, bone, liver, and kidney
• Most commonly transmitted human to human (also may be from cows and birds)
• Spread by droplets that are expelled by coughing and sneezing
• 90 % of infections become latent
• Drug susceptibility tests are done to know which meds will be effective

Question 2

First line drugs

Answer 2

R - rifampin
I - isoniazid
P - pyrazinamide
E - ethambutol (adverse effects include blindness and retrobulbar neuritis)
* combination is needed

Question 3

Second line drugs

Answer 3

“Reserved for Second Line Meds”

• levofloxacin
• moxifloxacin hydrochloride
• rifabutin
• streptomycin (not available in Canada - Amikican is used instead)

Question 4

Isoniazid

Answer 4

• First drug of choice for treating TB
• Metabolized in the liver through acetylation so watch for slow acetylators (mediation will accumulate)
• Contraindicated with chronic alcohol use, and major kidney or liver dysfunction
• Adverse effects includes peripheral neuritis and hepatotoxicity
• Interactions include reduces absorption of antacids, and has additive effect with rifampin (increases CNS and liver toxicity)

Question 5

Rifampin

Answer 5

• Adverse effects include hepatitis, discoloration of urine, stools, saliva, sputum, sweat, or tears to a reddish orange color
• Interactions include B blockers, benzodiazepines, oral anticoagulants, oral antihypoglycemics, oral contraceptives (increases metabolism so decreases effects)

Question 6

Nursing implications

Answer 6

• Direct observed therapy involves watching the person swallow the medication
• Therapy may last up to 24 months
• Patients should take medication at the exact time every day
• Emphasize strict adherence
• Do not consume alcohol while on these medications
• Oral contraceptives will be ineffective
• Contagious period varies between people (minimum 2 weeks)
• Take vitamin b6/ pyridoxine to combat neurological adverse effects (peripheral neuritis prevention)
• Monitor for a decease in symptoms (cough and fever) and also lab studies and xrays
• Monitor for adverse effects such as fatigue, nausea, vomiting, numbness and tingling of extremities, fever, loss of appetite, jaundice, depression