Tuberculosis

Question 0

Multi Drug Resistant TB

Answer 0

So prevalent, it might be the primary infection, resistant to IRPE therapy, and added ABXs, may require up to 7 drugs per day

Question 1

First line of drugs to give

Answer 1

RIPE: Rifampin, INH, PZA, Ethambutol for 2 months, then for the next 4-7 months continue with only INH and Rifampin

Question 2

Isoniazid (INH): class and agent

Answer 2

Antitubercular; primary agent for treatment and prophylaxis

Highly selective for mycobacteria (Taken by all individuals infected with INH sensitive strains of M tuberculosis)

Question 3

(INH) MOA?

Answer 3

Inhibits the synthesis of mycolic acid, bacteriocidal for rapidly diving organisms, bacteriostatic for dormant mycobacteria

IF RESISTANCE OCCURS THEN REGIME NEEDS TO CHANGE

Question 4

INH administration and pharmokinetics:

Answer 4

PO or IM (alone in latent TB, with other abx in active TB)
Metabolized by the liver
Excreted in the urine

Question 5

INH adverse effects:

Answer 5

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

Question 6

Rifampin

Answer 6

Brother to INH * one of the most effective

Antitubercular, broad spectrum ABX

Question 7

Rifampin MOA

Answer 7

Inhibits DNA dependent polymerase, decreases tubercle bacilli replication (Bactericidal)

Question 8

Rifampin Pharmokinetics

Answer 8

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

Question 9

Rifampin Adverse Effects

Answer 9

Hepatotoxicity
Discoloration of body fluids
(Yellow contact lenses)

Question 10

What drugs are contraindicated with Rifampin?

Answer 10

Oral Contraception (need other contraception)
HIV meds
Oral hypoglycemic

Question 11

Pyrazinamide (PZA) class

Answer 11

Antitubercular

Bactericidal to TB

Question 12

PZA MOA?

Answer 12

Interferes with lipid nucleic acid biosynthesis

Question 13

PZA Pharmacokinetics

Answer 13

Well absorbed orally
Metabolized by the liver
Excreted in urine

Question 14

PZA Adverse Effects:

Answer 14

Hepatotoxic (NO ALCOHOL)
Photosensitivity
Hyperurecemia
Arthralgias

Question 15

Ethambutol class

Answer 15

Antitubercular

Question 16

Ethambutol MOA

Answer 16

Inhibits RNA synthesis, decreases tubercle bacilli replication

Question 17

Ethambutol Adverse Effects

Answer 17

**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

Question 18

Ethambutol Nursing Implications

Answer 18

ALWAYS given in combination to avoid resistance!!

NEEDS to be given 2 hours prior to antiacids bc antiacids decrease the effects of ethambutol

Question 19

Streptomycin Class

Answer 19

Aminoglycoside Antibiotic

Second line agent

Question 20

Streptomycin MOA

Answer 20

Causes bacterial death by interfering with protein synthesis

Question 21

Streptomycin Administration

Answer 21

MUST BE IM/IV

NOT ABSORBED BY GI TRACT

Question 22

Streptomycin peak:

Answer 22

20-30 mins after IM, trough levels drawn hrs later

Question 23

Streptomycin Adverse Effects

Answer 23

Toxicity to the 8th cranial nerve
Neprhotoxic
Ototoxic
Neurotoxic

Question 24

General TB therapy Nursing Implications

Answer 24

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

Question 25

Which lab tests are important in TB drug therapy

Answer 25

Liver and Kidney: especially in INH and Rifampin
NO alchohol!
Recommended on an empty stomach (unless GI upset)

Question 26

TB implications continued

Answer 26

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