Tuberculosis Flashcards
Multi Drug Resistant TB
So prevalent, it might be the primary infection, resistant to IRPE therapy, and added ABXs, may require up to 7 drugs per day
First line of drugs to give
RIPE: Rifampin, INH, PZA, Ethambutol for 2 months, then for the next 4-7 months continue with only INH and Rifampin
Isoniazid (INH): class and agent
Antitubercular; primary agent for treatment and prophylaxis
Highly selective for mycobacteria (Taken by all individuals infected with INH sensitive strains of M tuberculosis)
(INH) MOA?
Inhibits the synthesis of mycolic acid, bacteriocidal for rapidly diving organisms, bacteriostatic for dormant mycobacteria
IF RESISTANCE OCCURS THEN REGIME NEEDS TO CHANGE
INH administration and pharmokinetics:
PO or IM (alone in latent TB, with other abx in active TB)
Metabolized by the liver
Excreted in the urine
INH adverse effects:
Neurotoxicity: primary adverse effect; causes peripheral neuropathy where the pt will complain of numbness, tingling, burning, if they experience this they should come off of it.
Hepatotoxicity: PT SHOULD NOT DRINK
Inhibits vit B 6 so patient needs a supplement
Rifampin
Brother to INH * one of the most effective
Antitubercular, broad spectrum ABX
Rifampin MOA
Inhibits DNA dependent polymerase, decreases tubercle bacilli replication (Bactericidal)
Rifampin Pharmokinetics
Absorbed well on empty stomach Eliminated primarily by the liver (20% leaves in urine) Take in AM same time everyday DOC for pulmonary of disseminated TB ALWAYS used in combo to avoid RESISTANCE
Rifampin Adverse Effects
Hepatotoxicity
Discoloration of body fluids
(Yellow contact lenses)
What drugs are contraindicated with Rifampin?
Oral Contraception (need other contraception)
HIV meds
Oral hypoglycemic
Pyrazinamide (PZA) class
Antitubercular
Bactericidal to TB
PZA MOA?
Interferes with lipid nucleic acid biosynthesis
PZA Pharmacokinetics
Well absorbed orally
Metabolized by the liver
Excreted in urine
PZA Adverse Effects:
Hepatotoxic (NO ALCOHOL)
Photosensitivity
Hyperurecemia
Arthralgias
Ethambutol class
Antitubercular
Ethambutol MOA
Inhibits RNA synthesis, decreases tubercle bacilli replication
Ethambutol Adverse Effects
**Optic Neuritis: Blurred vision, constriction of the visual field, disturbance of color discrimination. Usually resolves once med is stopped.
Pruritis
GI upset
confusion
acute gouty arthritis
Ethambutol Nursing Implications
ALWAYS given in combination to avoid resistance!!
NEEDS to be given 2 hours prior to antiacids bc antiacids decrease the effects of ethambutol
Streptomycin Class
Aminoglycoside Antibiotic
Second line agent
Streptomycin MOA
Causes bacterial death by interfering with protein synthesis
Streptomycin Administration
MUST BE IM/IV
NOT ABSORBED BY GI TRACT
Streptomycin peak:
20-30 mins after IM, trough levels drawn hrs later
Streptomycin Adverse Effects
Toxicity to the 8th cranial nerve
Neprhotoxic
Ototoxic
Neurotoxic
General TB therapy Nursing Implications
Pt Education is critical!!! **
Therapy may last up to 24 months
Take med exactly as ordered, same time every day
Emphasize the importance of strict adherence to regimen for improvement of condition or cure
Which lab tests are important in TB drug therapy
Liver and Kidney: especially in INH and Rifampin
NO alchohol!
Recommended on an empty stomach (unless GI upset)
TB implications continued
Monitor for therapeutic effects:
decrease in symptoms such as cough and fever
Lab studies (C/S tests) and CXR should confirm clinical findings
WATCH FOR LACK OF CLINICAL RESPONSE TO THERAPY, INDICATING POSSIBLE DRUG RESISTANCE
