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Antitubercular Agents




Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents

  • Tuberculosis, “TB”
  • Caused by Mycobacterium tuberculosis
  • Antitubercular agents treat all forms of
    mycobacterium




Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Mycobacterium Infections

  Common Infection Sites
  • lung (primary site)
  • brain
  • bone
  • liver
  • kidney



Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Mycobacterium Infections

  • Aerobic bacillus
  • Passed from infected:
        – Humans
        – Cows (bovine)
        – Birds (avian)




Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
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.



Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents

   Primary Agents                                         Secondary Agents
   isoniazid*                                             capreomycin
   ethambutol                                             cycloserine
   pyrazinamide (PZA)                                     ethionamide
   rifampin                                               kanamycin
   streptomycin                                           para-aminosalicyclic acid
                                                          (PSA)
   *most frequently used

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents:
  Mechanism of Action
  Three Groups
  • Protein wall synthesis inhibitors streptomycin,
    kanamycin, capreomycin, rifampin, rifabutin
  • Cell wall synthesis inhibitors cycloserine,
    ethionamide, isoniazid
  • Other mechanisms of action




Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents:
  Mechanism of Action isoniazid (INH)
  • Drug of choice for TB
  • Resistant strains of mycobacterium emerging
  • Metabolized in the liver through acetylation—
    watch for “slow acetylators”




Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents:
                  Therapeutic Uses
                        Used for the prophylaxis
                          or treatment of TB



Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Therapy

  Effectiveness depends upon:
  • Type of infection
  • Adequate dosing
  • Sufficient duration of treatment
  • Drug compliance
  • Selection of an effective drug combination



Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents: Side Effects

  • INH
    peripheral neuritis, hepatotoxicity
  • ethambutol
    retrobulbar neuritis, blindness
  • rifampin
    hepatitis, discoloration of urine, stools



Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents:
  Nursing Implications
  • Obtain a thorough medical history and assessment.
  • 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 the various agents,
    conditions for cautious use, and potential drug
    interactions.




Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents:
  Nursing Implications
  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.




Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents:
  Nursing Implications
  Patient education is CRITICAL:
  • Remind patients that they are contagious during
    the initial period of their illness—instruct in proper
    hygiene and prevention of the spread of infected
    droplets.
  • Emphasize to patients to take care of themselves,
    including adequate nutrition and rest.




Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents:
  Nursing Implications
  • Patients should not consume alcohol while on these
    medications nor take other medications, including
    OTC, unless they check with their physician.
  • Diabetic patients taking INH should monitor their
    blood glucose levels because hyperglycemia may
    occur.
  • INH and rifampin cause oral contraceptives to
    become ineffective; another form of birth control
    will be needed.


Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents:
  Nursing Implications
  • Patients who are taking rifampin should be told that
    their urine, stool, saliva, sputum, sweat, or tears may
    become reddish-orange; even contact lenses may be
    stained.
  • Vitamin B6 may is needed to combat peripheral
    neuritis associated with INH therapy.




Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents:
  Nursing Implications
  Monitor for side effects
  • Instruct patients on the side effects 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.




Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Antitubercular Agents:
  Nursing Implications
  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




Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

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Anti-tubercular agents

  • 1. Antitubercular Agents Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 2. Antitubercular Agents • Tuberculosis, “TB” • Caused by Mycobacterium tuberculosis • Antitubercular agents treat all forms of mycobacterium Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 3. Mycobacterium Infections Common Infection Sites • lung (primary site) • brain • bone • liver • kidney Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 4. Mycobacterium Infections • Aerobic bacillus • Passed from infected: – Humans – Cows (bovine) – Birds (avian) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 5. 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. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 6. Antitubercular Agents Primary Agents Secondary Agents isoniazid* capreomycin ethambutol cycloserine pyrazinamide (PZA) ethionamide rifampin kanamycin streptomycin para-aminosalicyclic acid (PSA) *most frequently used Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 7. Antitubercular Agents: Mechanism of Action Three Groups • Protein wall synthesis inhibitors streptomycin, kanamycin, capreomycin, rifampin, rifabutin • Cell wall synthesis inhibitors cycloserine, ethionamide, isoniazid • Other mechanisms of action Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 8. Antitubercular Agents: Mechanism of Action isoniazid (INH) • Drug of choice for TB • Resistant strains of mycobacterium emerging • Metabolized in the liver through acetylation— watch for “slow acetylators” Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 9. Antitubercular Agents: Therapeutic Uses Used for the prophylaxis or treatment of TB Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 10. Antitubercular Therapy Effectiveness depends upon: • Type of infection • Adequate dosing • Sufficient duration of treatment • Drug compliance • Selection of an effective drug combination Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 11. Antitubercular Agents: Side Effects • INH peripheral neuritis, hepatotoxicity • ethambutol retrobulbar neuritis, blindness • rifampin hepatitis, discoloration of urine, stools Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 12. Antitubercular Agents: Nursing Implications • Obtain a thorough medical history and assessment. • 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 the various agents, conditions for cautious use, and potential drug interactions. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 13. Antitubercular Agents: Nursing Implications 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. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 14. Antitubercular Agents: Nursing Implications Patient education is CRITICAL: • Remind patients that they are contagious during the initial period of their illness—instruct in proper hygiene and prevention of the spread of infected droplets. • Emphasize to patients to take care of themselves, including adequate nutrition and rest. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 15. Antitubercular Agents: Nursing Implications • Patients should not consume alcohol while on these medications nor take other medications, including OTC, unless they check with their physician. • Diabetic patients taking INH should monitor their blood glucose levels because hyperglycemia may occur. • INH and rifampin cause oral contraceptives to become ineffective; another form of birth control will be needed. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 16. Antitubercular Agents: Nursing Implications • Patients who are taking rifampin should be told that their urine, stool, saliva, sputum, sweat, or tears may become reddish-orange; even contact lenses may be stained. • Vitamin B6 may is needed to combat peripheral neuritis associated with INH therapy. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 17. Antitubercular Agents: Nursing Implications Monitor for side effects • Instruct patients on the side effects 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. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  • 18. Antitubercular Agents: Nursing Implications 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 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.