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Tuberculosis (TB)
Caused by an acid
fast-fast bacillus
Mycobacterium
tuberculosis
(tubercle bacillus)
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Mycobacterium Infections
Common Infection Sites
lung (primary site)
brain bone
liver
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Mycobacterium Infections
Tubercle bacilli are conveyed by
droplets.
Droplets are expelled by coughing or
sneezing, then gain entry into the body
by inhalation.
Tubercle bacilli then spread to other
body organs via blood and lymphatic
systems.
Tubercle bacilli may become dormant,
or walled off by calcified or fibrous
tissue.
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Anti tubercular Drugs
Streptomycin- the first drug used
to treat TB
Isoniazid (INH)- discovered in
1952, was the 1storal drug
preparation effective against thetubercle bacillus.
Pyridoxine ( Vit. B6)- usually given
in combination with INH to avoidpossible occurrence ofPeripheral
Neuropathy
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Prophylactic Therapy
Family Members of a TB patient are
usually given prophylactic doses of
INH for 6 months to 1 year.
Contraindication: Liver Disease
( may cause INH-induced liver
damage)
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Guide Question?
When a person is diagnosed with TB,the family members are usually
given prophylactic dose of what
antitubercular drug?
a. Streptomycin
b. Rifampicin
c. Pyrazinamided. INH
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Drug Combinations
( Duration of treatment is reducedfrom 2 years to 6-9 months)
INH + Rifampin
INH+Rifampin+ EthambutolINH+Rifampin+Pyrazinamide
(Rifampin & Ethambutol noteffective when given alone)
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Multidrug Therapy
EffectiveDivided into 2 phases:
Initial Phase ( 2 months)
Second Phase ( next 4-7 months)Multidrug Resistance persists:
Aminoglycosides (Streptomycin,
kanamycin, amikacin)
Fluoroquinolones (ciprofloxacin,
ofloxacin)
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Anti tubercular Agents
Primary Agents
Secondary Agents isoniazid* capreomycin
ethambutol cycloserine
pyrazinamide (PZA) ethionamide rifampin kanamycin
streptomycin para-aminosalicyclic
acid(PSA)
*most frequently used
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First-Line Drugs- are considered
more effective & less toxic than
second-line drugs.
Second-line Drugs- maybe used in
combination with first-line drugs,especially to treat disseminated
TB.
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Mechanism of Action
Protein wall synthesis inhibitors
streptomycin, kanamycin,
capreomycin, rifampin, rifabutin
Cell wall synthesis inhibitors
cycloserine, ethionamide,
isoniazid
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Mechanism of Action isoniazid (INH)
Drug of choice for TB
Resistant strains of
mycobacterium emerging
Metabolized in the liver through
acetylationwatch for slow
acetylators
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Side Effects
INH
peripheral neuritis,
hepatotoxicity
ethambutol
retrobulbar neuritis, blindness
rifampin
hepatitis, discoloration of urine,
stools
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Guide Question
A client who is taking rifampin (Rifadin) as part ofthe medication regimen for the treatment of
tuberculosis calls the clinic nurse and reports
that her urine is a red-orange color. The nurse
tells the client to:
a. Come to the clinic to provide a urine sample
b. Stop the medication until further instructions
are given by the physician
c. Take the medication dose with an antacid to
prevent this adverse effect
d. Expect a red-orange color in urine, feces, sweat,
sputum, and tears as a harmless side effect
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Antitubercular Therapy
Effectiveness depends upon
Type of infection
Adequate dosing
Sufficient duration of treatment
Drug compliance
Selection of an effective drugcombination
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Nursing Implications
Obtain a thorough medical history andassessment.
Perform liver function studies in patients
who are to receive isoniazid or
rifampin(especially in elderly patients or those
who use alcohol daily).
Assess for contraindications to thevarious agents, conditions for cautious
use, and potential drug interactions.
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Patient education is CRITICAL:
Therapy may last for up to 24 months.
Take medications exactly as ordered,at the same time every day.
Emphasize the importance of strict
compliance to regimen for
improvement of condition or cure.
Remind patients that they are
contagious during the initial period of
their illnessinstruct in proper
hygiene and prevention of the spread of
infected droplets.
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Emphasize to patients to take care
of themselves, including adequate
nutrition and rest.
Patients should not consume
alcohol while on these medications
nor take other medications,including OTC, unless they check
with their physician.
Diabetic patients taking INHshould monitor their blood glucose
levels because hyperglycemia may
occur.
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INH and rifampin cause oral
contraceptives to become ineffective;
another form of birth control will be
needed.
Patients who are taking rifampin
should be told that their urine, stool,
saliva, sputum, sweat, or tears maybecome reddish-orange; even contact
lenses may be stained.
Vitamin B6 may is needed to combat
peripheral neuritis associated with
INH therapy.
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Guide Questions
A client has been taken isoniazid (INH)for a month and a half. The client
complains to the nurse about
numbness, paresthesias, and tingling in
the extremities. The nurse interpretsthat the client is experiencing.
a. Small blood vessel spasm
b. Impaired peripheral circulationc. Hypercalcemia
d. Peripheral neuritis
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Monitor for side effects
Instruct patients on the sideeffects that should be reported
to the physician immediately.
These include fatigue, nausea,
vomiting, numbness and
tingling of the extremities, fever,
loss of appetite, depression,
jaundice
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Monitor for therapeutic effects
Decrease in symptoms of TB,such as cough
and fever
Lab studies (culture and
sensitivity tests)
and CXR should confirm clinical
findings
Watch for lack of clinical
response to therapy, indicating
possible drug resistance
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