Chapter 32
Antitubercular
Antitubercular Drugs: can be court ordered if violated can go to jail
Drug combinations
- Single-drug therapy
o Not used as it is ineffective
- Multidrug therapy
o Decreases bacterial resistance to drug
o Treatment duration decreased
Sometimes on medication for a year
o Minimum of 3-5 drugs used to treat
Treatment regimen
Divided into 2 phases
- Phase 1
o *Isoniazid, *rifampin, rifabutin, rifapentine, pyrazinamide, ethambutol, and
streptomycin
o More effective than second-line
o Less toxic than second-line
o Duration: approximately 2 months
Depends on Pt response, could be longer
- Phase 2
o Para-aminosalicylic acid, kanamycin, cycloserine, ethionamide, capreomycin,
pyrazinamide, and others
o Less effective
o More toxic
o Duration: approximately 4 to 7 months
In addition to the 2 months total 6-9 months
Antitubercular Drugs isoniazid & rifampin
Action
- Inhibits bacterial cell-wall synthesis
o Prevents the bacteria from growing
Uses
- Treat tuberculosis; prophylactic use against tuberculosis
Antitubercular Drugs isoniazid & rifampin
Side effects
- Drowsiness
- Photosensitivty
, - Dizziness
- GI upset
- Ocular toxicity
- Peripheral neuropathy
- Vitamin B6 deficiency
- Increased LFT’s – liver damage
- Can also injure kidneys
Rifampin – turns secretions orange sweat, saliva, semen, urine, feces
Contraindications
- Severe renal or hepatic disease
- Alcholism
- Diabetic retinopathy
Interactions
- Alcohol
- Antacids
- Isonasids still give, needed for tx.
Assessment
- Medication/medical history
- PPD results, signs and symptoms of TB
o Positive means exposed, not positive for it. Need chest xray to confirm pos or
neg for tb
- Obtain baseline LFT’s, BUN, and creatinine
- Same signs and symptoms as pneumonia except low grade fever
- TB can become encapsulated, if not symptomatic no tx needed
Interventions/teaching
- Administer isoniazid 1 hour before meals or 2 hours after meals.
o Give on empty stomach
- Must follow complete regimen
- Collect sputum specimen in early morning.
- Check liver enzymes, kidney function
- Need frequent eye examinations
- Report numbness, tingling, burning.
- Take pyridoxine (vitamin B6) to help prevent peripheral neuropathy.
- Teach sun precautions, to avoid antacids.
- Teach rifampin can turn urine, feces, saliva, sputum, sweat, and tears red-orange. Contact
lenses and clothing can be stained
- Pt wears mask if leaves room
Evaluation:
- Decreased symptoms
o Decreased cough and fever
- Sputum specimen neg x 3 = tx effective
, o First thing in the morning before breakfast
o Once 3 neg, can go into community
A patient has developed active tuberculosis and is prescribed isoniazid and rifampin. Which
information will the nurse include in teaching the patient about taking this drug? (Select all that
apply.)
Isoniazid should be given 1 hour before or 2 hours after meals.
Have periodic eye examinations as ordered by the health care provider.
Compliance with drug regimen is essential.
Report numbness, tingling, and burning of hands and feet.
Warn patient that rifampin may turn body fluids a harmless green color.
Answer: A, B, C, D
Rationale: Isoniazid should be given 1 hour before or 2 hours after meals for better absorption.
Periodic eye examinations should be done as these drugs may cause visual disturbances.
Compliance with drug regimen is essential to prevent drug resistance. Numbness, tingling, or
burning of hands and feet should be reported. Rifampin may turn body fluids a harmless
reddish orange color.
Practice Question
A middle-aged adult is diagnosed with tuberculosis. Which is true of treatment for this
diagnosis?
Treatment may take about 10 days to 2 weeks.
Usually two to three agents are needed.
The bacteria is usually resistant to treatment therapy.
Treatment for tuberculosis is usually without side effects.
Answer: B
Rationale: Single-drug therapy for TB is not effective. Usually two to three drugs are needed.
The total treatment plan is usually 6 to 9 months. Although unusual, resistance can occur. The
patient should be taught methods to prevent and report side effects and adverse reactions to
therapy.
Practice Question
When teaching a patient about isoniazid (INH) and rifampin drug therapy, which statement will
the nurse include?
“Take isoniazid with meals.”
“Double the amount of vitamin C in your diet to prevent the peripheral neuropathy associated
with isoniazid therapy.”
“Notify the primary health care provider immediately if your urine turns a red-orange color.”
“Avoid exposure to direct sunlight.”
Antitubercular
Antitubercular Drugs: can be court ordered if violated can go to jail
Drug combinations
- Single-drug therapy
o Not used as it is ineffective
- Multidrug therapy
o Decreases bacterial resistance to drug
o Treatment duration decreased
Sometimes on medication for a year
o Minimum of 3-5 drugs used to treat
Treatment regimen
Divided into 2 phases
- Phase 1
o *Isoniazid, *rifampin, rifabutin, rifapentine, pyrazinamide, ethambutol, and
streptomycin
o More effective than second-line
o Less toxic than second-line
o Duration: approximately 2 months
Depends on Pt response, could be longer
- Phase 2
o Para-aminosalicylic acid, kanamycin, cycloserine, ethionamide, capreomycin,
pyrazinamide, and others
o Less effective
o More toxic
o Duration: approximately 4 to 7 months
In addition to the 2 months total 6-9 months
Antitubercular Drugs isoniazid & rifampin
Action
- Inhibits bacterial cell-wall synthesis
o Prevents the bacteria from growing
Uses
- Treat tuberculosis; prophylactic use against tuberculosis
Antitubercular Drugs isoniazid & rifampin
Side effects
- Drowsiness
- Photosensitivty
, - Dizziness
- GI upset
- Ocular toxicity
- Peripheral neuropathy
- Vitamin B6 deficiency
- Increased LFT’s – liver damage
- Can also injure kidneys
Rifampin – turns secretions orange sweat, saliva, semen, urine, feces
Contraindications
- Severe renal or hepatic disease
- Alcholism
- Diabetic retinopathy
Interactions
- Alcohol
- Antacids
- Isonasids still give, needed for tx.
Assessment
- Medication/medical history
- PPD results, signs and symptoms of TB
o Positive means exposed, not positive for it. Need chest xray to confirm pos or
neg for tb
- Obtain baseline LFT’s, BUN, and creatinine
- Same signs and symptoms as pneumonia except low grade fever
- TB can become encapsulated, if not symptomatic no tx needed
Interventions/teaching
- Administer isoniazid 1 hour before meals or 2 hours after meals.
o Give on empty stomach
- Must follow complete regimen
- Collect sputum specimen in early morning.
- Check liver enzymes, kidney function
- Need frequent eye examinations
- Report numbness, tingling, burning.
- Take pyridoxine (vitamin B6) to help prevent peripheral neuropathy.
- Teach sun precautions, to avoid antacids.
- Teach rifampin can turn urine, feces, saliva, sputum, sweat, and tears red-orange. Contact
lenses and clothing can be stained
- Pt wears mask if leaves room
Evaluation:
- Decreased symptoms
o Decreased cough and fever
- Sputum specimen neg x 3 = tx effective
, o First thing in the morning before breakfast
o Once 3 neg, can go into community
A patient has developed active tuberculosis and is prescribed isoniazid and rifampin. Which
information will the nurse include in teaching the patient about taking this drug? (Select all that
apply.)
Isoniazid should be given 1 hour before or 2 hours after meals.
Have periodic eye examinations as ordered by the health care provider.
Compliance with drug regimen is essential.
Report numbness, tingling, and burning of hands and feet.
Warn patient that rifampin may turn body fluids a harmless green color.
Answer: A, B, C, D
Rationale: Isoniazid should be given 1 hour before or 2 hours after meals for better absorption.
Periodic eye examinations should be done as these drugs may cause visual disturbances.
Compliance with drug regimen is essential to prevent drug resistance. Numbness, tingling, or
burning of hands and feet should be reported. Rifampin may turn body fluids a harmless
reddish orange color.
Practice Question
A middle-aged adult is diagnosed with tuberculosis. Which is true of treatment for this
diagnosis?
Treatment may take about 10 days to 2 weeks.
Usually two to three agents are needed.
The bacteria is usually resistant to treatment therapy.
Treatment for tuberculosis is usually without side effects.
Answer: B
Rationale: Single-drug therapy for TB is not effective. Usually two to three drugs are needed.
The total treatment plan is usually 6 to 9 months. Although unusual, resistance can occur. The
patient should be taught methods to prevent and report side effects and adverse reactions to
therapy.
Practice Question
When teaching a patient about isoniazid (INH) and rifampin drug therapy, which statement will
the nurse include?
“Take isoniazid with meals.”
“Double the amount of vitamin C in your diet to prevent the peripheral neuropathy associated
with isoniazid therapy.”
“Notify the primary health care provider immediately if your urine turns a red-orange color.”
“Avoid exposure to direct sunlight.”
