Pharm Exam #2 ch. 43

Ms. Ellis has been prescribed INH for the treatment of tuberculosis. You are teaching her about dietary restrictions while taking this medication. What is the most important instruction to give her about dietary restrictions?

"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur." Because INH has some monoamine oxidase inhibitor activity, interactions may occur with tyramine-containing foods. INH may also interact with foods containing histamine. Patients should refrain from excessive intake of foods rich in tyramine, which include cheese and dairy products, beef or chicken liver, beer and ale, red wine, avocados, bananas, figs, raisins, caffeine, and chocolates. Because most people consume these food items, the diet is difficult to maintain.

A patient is to receive rifampin. Which of the following would be most important for the nurse to include in the teaching plan for this patient?

"Your urine or sweat may become orange in color." This drug causes body fluids to turn orange. The patient needs to be informed of this to avoid being frightened when it occurs. Any drug can cause a hypersensitivity reaction. Although this information is important, it is not the priority. GI adverse effects are common. Although this instruction would be important, it would not be the priority. Headache and dizziness are common CNS effects of the drug that do not need to be reported.

A patient receiving isoniazid (INH) and rifampin (Rifadin) has a decreased urinary output and peripheral neuropathy. Which laboratory values should be assessed?

ALT/AST and creatinine Hepatotoxicity and nephrotoxicity are important adverse effects of isoniazid and rifampin. The ALT/AST will assess liver function and creatinine will assess renal function. The hematocrit and hemoglobin are not indicated with the described symptoms. Erythrocyte count and differential are not indicated with these symptoms.

A 20-year-old female is being treated with rifampin and INH. What method of birth control would the nurse recommend for this patient?

Any of the above Since rifampin decreases the effectiveness of oral contraceptives, a different type of contraception should be used during therapy.

Mr. James, 49 years old, is diagnosed with TB. He has a history of alcoholism but has been sober for 3 months now. He has been prescribed INH. What should the nurse ensure is obtained before initiating the therapy?

Baseline liver function test values For a TB patient, you should obtain baseline liver function test values and schedule serial liver function tests throughout therapy. In addition, a nurse should ensure a baseline A1C evaluation for patients who are diabetics, because INH may cause hyperglycemia. Patients with preexisting anemias should have a baseline complete blood count (CBC), because they are at risk for hematologic disorders. For patients with a history of seizures, perform a baseline neurologic examination. Also assess baseline visual acuity. All other assessments such as height, weight, serum glucose level, and bone mass are not applicable to INH therapy.

what does DOT stand for?

Directly Observed therapy

A patient being treated for tuberculosis is determined to be drug resistant. Which of the following medications will the patient be resistant to in the treatment of the tuberculosis?

Isoniazid (INH) and rifampin Isoniazid (INH) and rifampin are used to treat tuberculosis. In multidrug resistance, the most effective drugs the patient is resistant to are isoniazid and rifampin. Carbamazepine and phenytoin are used to control seizures. Dextroamphetamine and doxapram are central nervous system stimulants. Propranolol and sotalol are beta-adrenergic blocking agents.

When a person is diagnosed with tuberculosis, family members may be treated prophylactically with which antitubercular drug? (Choose one)

Isoniazid (Nydrazid) When a person is diagnosed with tuberculosis, family members may be treated prophylactically with isoniazid (Nydrazid).

A patient is administered rifampin (Rifadin). Which of the following factors should the patient be taught?

The urine, tears, sweat, and other body fluids will be a discolored red-orange. The urine, tears, sweat, and other body fluids will be a discolored red-orange. This adverse effect is harmless, but the patient should be instructed on this adverse effect. The administration of this medication with warfarin will decrease the anticoagulant effect. The medication increases hepatic cytochrome P 450 3A4 enzyme and decreases serum concentrations. The serum half-life of rifampin is shorter than that of the medication rifabutin.

Tuberculosis caused by drug-resistant organisms should be considered in which of the following clients? Select all that apply:

• Clients who have no response to therapy • Clients who have been treated in the past

A patient seen in the clinic has symptoms of persistent cough, fever, and night sweats. He recently entered the United States from the Philippines. From what condition is the patient suffering?

Active tuberculosis Immigration from countries where the disease occurs, such as the Philippines, places patient at risk for tuberculosis. Active tuberculosis is characterized by symptoms of cough, fever, and night sweats. Patients with latent tuberculosis exhibit no symptoms and do not feel sick. Bacterial pneumonia is not commonly noted with night sweats. Emphysema is not noted with fever.

A patient seen in the clinic has symptoms of persistent cough, fever, and night sweats. He recently entered the United States from the Philippines. From what condition is the patient suffering?

Active tuberculosis Immigration from countries where the disease occurs, such as the Philippines, places patient at risk for tuberculosis. Active tuberculosis is characterized by symptoms of cough, fever, and night sweats. Patients with latent tuberculosis exhibit no symptoms and do not feel sick. Bacterial pneumonia is not commonly noted with night sweats. Emphysema is not noted with fever.

You are caring for a 39-year-old client who is taking INH, rifampin, and pyrazinamide. The client calls you to report that her urine is red. What is the most likely cause of this discoloration?

Adverse effect of rifampin Rifampin causes a harmless red-orange discoloration of urine, tears, saliva, and other body secretions.

You are caring for a 39-year-old client who is taking INH, rifampin, and pyrazinamide. The client calls you to report that her urine is red. What is the most likely cause of this discoloration?

Adverse effect of rifampin Rifampin causes a harmless red-orange discoloration of urine, tears, saliva, and other body secretions.

A patient with TB has been admitted to a health care facility. When providing instructions for the patient teaching related to antitubercular drugs, which of the following instructions should the nurse provide in order to avoid complications in the patient's GI tract?

Avoid the consumption of alcohol. The nurse should instruct the patient to avoid the consumption of alcohol since alcoholism compounds patient's difficulties and complicates the general condition of the patient's gastrointestinal tract. The nurse should instruct the patient to take the prescribed dose of Ethambutol without regard to food and to take the prescribed Pyrazinamide along with food. The nurse should instruct the patient to avoid doubling the dose in case the earlier dose was missed.

Gary is a construction worker who is diagnosed with leprosy and is prescribed rifampin. Gary is married, an alcoholic, and wears contact lenses. At the time of initiating the therapy, what should the nurse instruct the patient about the drug therapy?

Inform him that he should wear glasses during the therapy. People going through rifampin therapy are prone to skin discoloration and discoloration of contact lenses. This is because rifampin can discolor bodily fluids, such as urine, saliva, tears, and sputum. People taking rifampin are not known to have decreased sexual urge or have blood pressure elevation. The patient should continue the rifampin therapy for the period suggested by the physician, which may or may not be a year.

Gary is a construction worker who is diagnosed with leprosy and is prescribed rifampin. Gary is married, an alcoholic, and wears contact lenses. At the time of initiating the therapy, what should the nurse instruct the patient about the drug therapy?

Inform him that he should wear glasses during the therapy. People going through rifampin therapy are prone to skin discoloration and discoloration of contact lenses. This is because rifampin can discolor bodily fluids, such as urine, saliva, tears, and sputum. People taking rifampin are not known to have decreased sexual urge or have blood pressure elevation. The patient should continue the rifampin therapy for the period suggested by the physician, which may or may not be a year.

A 28-year-old client taking INH, rifampin, and ethambutol arrives at the clinic complaining of numbness in her feet. What adjustment to the client's drug regimen is most likely to remedy the issue?

Instructing the client to take the medications with vitamin B6 Vitamin B6 is usually given along with the INH to prevent peripheral neuritis.

A 28-year-old client taking INH, rifampin, and ethambutol arrives at the clinic complaining of numbness in her feet. What adjustment to the client's drug regimen is most likely to remedy the issue?

Instructing the client to take the medications with vitamin B6 Vitamin B6 is usually given along with the INH to prevent peripheral neuritis.

A patient is administered isoniazid (INH) for latent tuberculosis. Which of the following factors will result in discontinuation of the medication?

Jaundice Potentially serious adverse effects include hepatotoxicity and peripheral neuropathy. Hepatotoxicity may be manifested by symptoms of hepatitis (e.g., anorexia, nausea, fatigue, malaise, jaundice) or elevated liver enzymes. Cachexia, fever, and thrombus are not the most known adverse effects of isoniazid (INH).

A college student has a TB test prior to starting college. The tuberculin test site is noted with a reddened, raised area. What condition will the student be diagnosed with if the chest radioagraph is negative?

Latent tuberculosis People with inactive or latent TB have no symptoms and do not feel sick. The transmission of the infection occurs when an uninfected person inhales infected airborne particles that are exhaled by an infected person. Primary infection occurs 6-8 weeks after exposure. The patient has a mild, pneumonia-like illness that often is undiagnosed. Active tuberculosis is a result from reactivation of a latent infection.

A major concern among public health authorities is an increase in drug-resistant TB infections. Traditionally, this has been attributed to patient lack of adherence to medication regimen. New evidence indicates that:

Many drug-resistant infections are new infections, especially in those who are immunosuppressed. When infected people receive antitubercular drugs, drug-resistant mutants are not killed or weakened by the drugs. Eventually, the majority of the TB bacilli in the body are drug-resistant. Drug-resistant strains can be spread from one person to another, and there is increasing evidence that many drug-resistant infections are new infections, especially in people whose immune systems are suppressed. Not all TB infections are drug-resistant, nor are drug-resistant infections decreasing.

A 72-year-old patient with TB is undergoing standard treatment in a health care facility. Which of the following nursing interventions should the nurse perform during ongoing assessment of the treatment?

Monitor for appearance of adverse reactions. The nurse should monitor for the appearance of adverse reactions in the patient during ongoing assessment of the treatment. The nurse should monitor vital signs of the patient every four hours and not every 24 hours when the patient is hospitalized. The nurse should assess the patient's history of contacts as part of the pre-administration assessment and not as part of the ongoing assessment. DOT can only be used by the nurse to administer antitubercular drugs when the patient is at home, at his place of employment, or in school. DOT is not used when the patient is hospitalized.

Mr. Marks is a 35-year-old man who is being treated with isoniazid (INH) for exposure to TB. He has the following medical history: diabetes mellitus type 2, hypertension, hyperlipidemia, and coronary artery disease. He drinks one to two glasses of wine on the weekend and smokes two packs of cigarettes per day. Which adverse reaction should you as the nurse alert Mr. Marks to report to his physician right away?

Numbness and tingling in his feet INH should also be given with caution to patients with diabetes mellitus, malnutrition, or alcoholism because its effects (antagonism or increased excretion) on pyridoxine (vitamin B6) can cause peripheral neuropathy in these patients. Pyridoxine may be given concurrently with INH to decrease the risk for this adverse effect. Another frequent adverse effect is peripheral neuropathy. This effect may cause paresthesias in the hands and feet. As previously mentioned, malnourished patients and those with diabetes and alcoholism have a higher risk for this adverse effect.

A patient is hospitalized due to noncompliance with an antitubercular drug treatment. Which of the following is most important for the nurse to do?

Observe the patient taking the medications Directly observed therapy in which a health care provider observes the patient taking each dose of anti-TB drugs is recommended for all drug regimens and is considered mandatory in this case. The medications are not administered parenterally. The family should be instructed on the medication regime, but this action is not imperative in maintaining compliance. The patient should not be taking her/his own medications.

A patient is hospitalized due to noncompliance with an antitubercular drug treatment. Which of the following is most important for the nurse to do?

Observe the patient taking the medications Directly observed therapy in which a health care provider observes the patient taking each dose of anti-TB drugs is recommended for all drug regimens and is considered mandatory in this case. The medications are not administered parenterally. The family should be instructed on the medication regime, but this action is not imperative in maintaining compliance. The patient should not be taking her/his own medications.

A patient is admitted to hospice with the diagnosis of XDR-TB. Knowing some of the contributing factors to this disease, the nurse understands this disease is a major indication of:

The failure to adequately diagnose, prevent, and treat MDR-TB. The development of XDR-TB indicates failure to adequately diagnose, prevent, and treat MDR-TB. The failure to adequately treat immunosuppressive diseases is not a direct corollary to developing TB. Additionally, patients receive treatment without notifying health authorities with their diagnosis. As with all treatment regimens, personal (not healthcare system) responsibility is the significant consideration in treatment adherence.

The nursing instructor is teaching students about drug regimens for tuberculosis (TB). He instructs them on the different prophylactic uses of isoniazid (INH), which include? (Select all that apply.)

• Those at risk for TB (such as those with Hodgkin's disease, leukemia, and other serious illnesses) • All patients younger than 35 years with a positive skin test • Those whose tuberculin skin test result has become positive in the last 2 years • Household members of those recently diagnosed with TB