1 8 Managing the Side Eff
Mino
SIDE EFFECTS DRUG RESPONSIBLE MANAGEMENT
Anorexia, Nausea, Abdominal Pain PZA, Rifampicin, INH Give drug with small meals or at
bedtime
Joint pain {from hyperuricemia} PZA Give aspirin or NSAID
—2
Peripheral neuropathy INH Pyridoxine 100 mg daily for
treatment/ 10 mg daily for
prevention
Orange/ red-colored urine Rifampicin Reassure the patient
Drowsiness INH Reassure the patient and give the
drug at bed time
Flu-like symptoms Rifampicin Give antipyretic
o o = se = oc a oc oO
B Ci Managing the Side Effects
Major SE
SIDE EFFECTS DRUG RESPONSIBLE MANAGEMENT
Severe skin rash {hypersensitivity} Any drug especially streptomycin
Jaundice due to hepatitis Any drug especially INH,
rifampicin, PZA
Visual impairment {optic neuritis} Ethambutol
— ———_* Discontinue taking the
Deafness, tinnitus, and dizziness Streptomycin medications and refer to
the clinician urgently.
Decreased urine output Streptomycin, rifampicin
Psychosis and convulsion INH
Thrombocytopenia, anemia, shock Rifampicin
Sources: DOH, National Tuberculosis Control Program, Sth Edition, 2013 w {| f
,| @ First Line Age
* Rifampin
— Semisynthetic derivative of rifamycin
— MOA: inhibits DNA-dependent RNA polymerase
— Pkinetics: undergoes enterohepatic recycling and is
partially metabolized in the liver, orange-colored
— Can be used as the sole drug in treatment of latent TB
in INH-intolerant patients, PREVENT EMERGENCE OF
DRUG-RESISTANCE MYCOBACTERIA
— DAILY ADULT DOSE IS 10 MG/KG, MAX 600 MG
— S/E: light chain-proteinuria, impair antibody
responses, skin rashes, nephritis and liver dysfunction,
ORANGE URINE
° a oO o > ° o o 2
creen
| ® First Line Age
* Isoniazid
— Astructural congener of pyridoxine (Vit B6)
— MOA: inhibition of mycolic acid (component of cell
wall)
— Single most important drug used in TB
— Pkinetics: INH half-life
* Fast acetylators (Asian) = 60-90 mins
* Slow acetylators (European/African) = 3-4 hours
— DAILY ADULT DOSE 5 MG/ KG, MAX 400 MG
— S/E: Peripheral neuriti$, Hepatoxicity, Drug-induced SLE
— Combined with pyridoxine to prevent symptoms of
peripheral neuritis
,[ a a First Line Age
* Pyrazinamide
— MOA: which is believed to act by inhibiting energy
metabolism across the cell membrane, is a
pro-drug requiring acidic conditions for activation.
— Active form: Pyrazinoic Acid
— Effective against slow replicating bacilli.
— DAILY ADULT DOSE: 25 MG/KG, MAX 2 G*
— S/E: Hepatic dysfunction, myalgia, Gl irritation,
maculopopular rash, HYPERURICEMIA, porphyria
and photosensitivity reactions
, 8 First Line Age
* Ethambutol
— MOA: inhibits arabinosyl transferases (for the
synthesis of mycobacterial cell wall)
— Pkinetics: dose reduction for renal impairment
— Use: Higher dose is needed for TB Meningitis
~ DAILY ADULT DOSE IS 15 MG/ KG*
— S/E: RETROBULBAR NEURITIS (red-green color
blindness, optic neuritis, possible retinal damage)
, OUR LADY OF FATIMA UNIVERSITY
College of Pharmacy
DISPENSING 2 (PDIS 312)
POST LABORATORY
Mino
SIDE EFFECTS DRUG RESPONSIBLE MANAGEMENT
Anorexia, Nausea, Abdominal Pain PZA, Rifampicin, INH Give drug with small meals or at
bedtime
Joint pain {from hyperuricemia} PZA Give aspirin or NSAID
—2
Peripheral neuropathy INH Pyridoxine 100 mg daily for
treatment/ 10 mg daily for
prevention
Orange/ red-colored urine Rifampicin Reassure the patient
Drowsiness INH Reassure the patient and give the
drug at bed time
Flu-like symptoms Rifampicin Give antipyretic
o o = se = oc a oc oO
B Ci Managing the Side Effects
Major SE
SIDE EFFECTS DRUG RESPONSIBLE MANAGEMENT
Severe skin rash {hypersensitivity} Any drug especially streptomycin
Jaundice due to hepatitis Any drug especially INH,
rifampicin, PZA
Visual impairment {optic neuritis} Ethambutol
— ———_* Discontinue taking the
Deafness, tinnitus, and dizziness Streptomycin medications and refer to
the clinician urgently.
Decreased urine output Streptomycin, rifampicin
Psychosis and convulsion INH
Thrombocytopenia, anemia, shock Rifampicin
Sources: DOH, National Tuberculosis Control Program, Sth Edition, 2013 w {| f
,| @ First Line Age
* Rifampin
— Semisynthetic derivative of rifamycin
— MOA: inhibits DNA-dependent RNA polymerase
— Pkinetics: undergoes enterohepatic recycling and is
partially metabolized in the liver, orange-colored
— Can be used as the sole drug in treatment of latent TB
in INH-intolerant patients, PREVENT EMERGENCE OF
DRUG-RESISTANCE MYCOBACTERIA
— DAILY ADULT DOSE IS 10 MG/KG, MAX 600 MG
— S/E: light chain-proteinuria, impair antibody
responses, skin rashes, nephritis and liver dysfunction,
ORANGE URINE
° a oO o > ° o o 2
creen
| ® First Line Age
* Isoniazid
— Astructural congener of pyridoxine (Vit B6)
— MOA: inhibition of mycolic acid (component of cell
wall)
— Single most important drug used in TB
— Pkinetics: INH half-life
* Fast acetylators (Asian) = 60-90 mins
* Slow acetylators (European/African) = 3-4 hours
— DAILY ADULT DOSE 5 MG/ KG, MAX 400 MG
— S/E: Peripheral neuriti$, Hepatoxicity, Drug-induced SLE
— Combined with pyridoxine to prevent symptoms of
peripheral neuritis
,[ a a First Line Age
* Pyrazinamide
— MOA: which is believed to act by inhibiting energy
metabolism across the cell membrane, is a
pro-drug requiring acidic conditions for activation.
— Active form: Pyrazinoic Acid
— Effective against slow replicating bacilli.
— DAILY ADULT DOSE: 25 MG/KG, MAX 2 G*
— S/E: Hepatic dysfunction, myalgia, Gl irritation,
maculopopular rash, HYPERURICEMIA, porphyria
and photosensitivity reactions
, 8 First Line Age
* Ethambutol
— MOA: inhibits arabinosyl transferases (for the
synthesis of mycobacterial cell wall)
— Pkinetics: dose reduction for renal impairment
— Use: Higher dose is needed for TB Meningitis
~ DAILY ADULT DOSE IS 15 MG/ KG*
— S/E: RETROBULBAR NEURITIS (red-green color
blindness, optic neuritis, possible retinal damage)
, OUR LADY OF FATIMA UNIVERSITY
College of Pharmacy
DISPENSING 2 (PDIS 312)
POST LABORATORY
