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TL TB drugs

Drug therapy for TB

QuestionAnswer
Name 5 first-line drugs for TB (I RESP). Isoniazid (INH)(say: I sew NIGH azid), Rifampin (Rifadin), Ethambutol (say: ee THAM bute tall) (Myambutol), Streptomycin, Pyrazinamide (say: Pair –uh- ZIN-amid)
List the common side effects associated with Isoniazid (INH). N&V, abdominal pain
List the rare side effects associated with Isonniazid (INH). Neurotoxicity, Optic neuritis, hepatotoxicity
How is Isoniazid handled by the body? metabolized in the liver; excreted by the kidneys; able to cross BBB
What supplement goes with Isoniazid therapy? Vitamin B6 – Pyridoxine (Say: Pire ruh DOCKS seen)
When would Isoniazid be indicated as sole treatment? prophylactically in individuals whose PPD (skin test) converts to positive – only works on active (growing) bacteria
What side effects will the nurse watch for when the patient is taking Rifampin (Rifadin)(HHFGPO)? Hepatitis, Hypersensitivity, Febrile reaction, GI disturbance, Peripheral neuropathy, Orange urine
Rifampin (Rifadin) causes what drug to be less effective? birth control pills
When is Ethambutol (Myambutol) utilized in the treatment of TB? Most often as a substitute drug if the patient experiences toxicity with Isoniazid (INH) or Rifampin (Rifadin).
What are the common side effects associated with Ethambutol (Myambutol) (SPOG)? Skin rash, Peripheral neuritis, Optic neuritis, GI disturbance
Discuss the nature of side effects associated with Ethambutol (Myambutol). Side effects are uncommon and reversible with discontinuation of the drug.
How is streptomycin administered to TB patients? Parenterally
Which patients require extra caution with Streptomycin therapy? Older adults, pregnant women, renal disease
What side effects will the nurse watch for while her patient is taking streptomycin? Nephrotoxicity, Ototoxicity, Hypersensitivity
Pyrazinamide is often used in combination with BLANK and BLANK. Streptomycin and Capreomycin
What are the side effects associated pyrazinamide? (FSHJ) Fever, Skin rash, Hyperuricemia, Jaundice (rare)
Name 5 second line drugs used for treating TB. (ET CC KK A PP CS) Ethionamide (Tecator, SC) (say: Ethy OWN amide), Capreomycin (Capastat) (say: CAP rio MY Sin), Kanamycin (Kantriex), Amikacin, Para-aminosalicylic acid (PAS), Cycloserin (Seromycin)
What are the common side effects of Ethionamide (Tecator, SC)? (GHH) GI disturbance, Hepatoxicity, Hypersensitivity
When is Ethionamide (Tecator, SC) especially useful? Valuable for treatment of resistant organisms
When is Ethionamide (Tecator, SC) contraindicated? Pregnancy
What are the side effects of CapreOmyciN (Capastat)? Ototoxicity, Nephrotoxicity
Which clients require extra caution when using Capreomycin (Capastat)? Older adults
What are the side effects of Kanamycin (Kantrex) and Amikacin? Ototoxicity and Nephrotoxicity
When are kanamycin (Kantrex) and Amickacin indicated? in selected cases for treatment of resistant strains
Which uncommonly used second line drug interferes with absorption of rifampin (Rifadin)? Para-aminosalicylic acid (PAS)
What are the side effects of para-aminosalicylic acid (PAS)? (GHH) GI disturbance (Common), Hypersensitivity, Hepatotoxicity
What are the side effects of Cycloserine (Seromycin)? (PPR) Personality changes, Psychosis, rash
When is Cycloserine (Seromycin) indicated? When is Cycloserine (Seromycin) contraindicated? Indicated for resistant strains; Contraindicated for individuals with history of psychosis
Why is teaching so important for the TB Client? Teaching is important because drug therapy is tedious and long (9-12 months), but strict adherence is important to reduce the bacteria’s ability to develop resistance, and because of the contagious nature of TB.
In addition to importance of compliance what other teaching points will the nurse address when the client in taking Rifampin (Rifadin)? Reduces effectiveness of oral contraceptives, Gives body fluids an orange tint, stains soft contact lenses
Isoniazid increases BLANK levels. Dilantin
What is Dilantin used for? What drug class? How does it work? Phenytoin (an anticonvulsant) is used to control certain type of seizures, to treat/prevent seizures that may begin during or after surgery to the brain or nervous system. It works by decreasing abnormal electrical activity in the brain.
What assessment should the patient taking Ethambutol (Myambutol) have before starting therapy and monthly thereafter? Vision check
How long might a patient be taking Ethambutol (Myambutol)? 1-2 years
It is the nurse’s responsibility to teach the TB patient the rationale for combination drug therapy. What is it? Resistance develops more slowly if several anti-TB drugs are given, rather than just one at a time. The drugs utilize different forms of attack that make it harder for the bacteria to fight back
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