Chapter 41 Antitubercular Drugs

"Do not share any of your medications with anyone. Contact your son's HCP to discuss your concerns" -Medications of any kind should never be shared with any other person. In particular, anti-tubercular drugs are age specific. Assessment

A home care nurse is visiting a patient with a diagnosis of TB. The patient traveled abroad 2 months ago. He lives with his wife and 5 y/o son. The patient tells the nurse that he is concerned his son will also get TB, so he wants to share his pills with his son. What is the best response by the nurse?

The patient will receive the drug and supportive care to help him tolerate the anti-tubercular therapy. -it must be rexignized that the urgency of treating a potentially fatal infection may have to be balanced against any prevailing contraindications. In extreme cases, patients are sometimes given a drug to which they have some degree of allergy with supportive care that enables them at least to tolerate the medication. -examples: treatment with antipyretics (acetaminophen) antihistamines (diphenhydramine) corticosteriods (prednisone, methylprednisolone)

A patient has an extremely severe infection with a Mycobacterium that is resistant to all but one ant-tubercular drug; however the patient has had an allergic reaction to that drug in the past. What does the nurse anticipate as being order for this patient?

Vitamin B6 -Pyridoxine (Vitamine B6) may be indicated to prevent INH-precipitated peripheral neuropathies and numbness, tingling, or burning of the extremities

A patient is receiving INH for the treatment of TB. Which vitamin does the nurse anticipate administering with the INH to prevent INH-precipitated peripheral neuropathies?

In the morning -If the prescriber has ordered collection of a sputum specimen to test for acid-fast bacilli, it is best to obtain the sample early in the morning. Most common order is for three consecutive morning specimens, with a repeat specimen several weeks later.

A patient with TB has been taking antitubercular drugs. A sputum culture is ordered to test for acidfast bacilli. When is the best time for the nurse to obtain the sputum culture?

The dosage of INH may need to be lower to prevent INH accumulation. When INH is taken by slow acetylators, the INH accumulates because there are not enough liver enzymes to break down the INH. Therefore, the dosages of INH may need to be adjusted downward to prevent toxicity.

A patient with a diagnosis of TB will be taking INH as part of the anti-TB therapy. When reviewing the patient's chart, the nurse finds documentation that the patient is a "slow acetylator" This means that:

"I will take this with food"

Bedaquiline (Sirturo) is prescribed for a patient about the medication. Which statement by the patient indicates a correct understanding of the instructions?

This vitamin helps to prevent neurologic adverse effects

During anti-tubercular therapy with isoniazid, a patient received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for this second medication?

His infection may be resistant to the drug therapy ordered. -the nurse should not jump to conclusions that the patient is not taking his medication properly. An improvement should start to occur within 2 weeks of starting drug therapy, but this may not occur if the patient's TB is not sensitive to the prescribed drugs. An evaluation of the drug therapy will be needed.

Four weeks after being anti-tubercular drug therapy on an outpatient basis, the patient reports that he still experiences night sweats. What does the nurse identify as the main concern at this time?

You will need to switch to another form of birth control while you are taking the rifampin

The nurse is counseling a woman who is beginning anti-tubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse is most accurate regarding potential drug interactions?

-darkened urine -fatigue -jaundice

The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity include (select all that apply)

Reddish brown urine

The nurse is teaching a patient who is staring ant-tubercular therapy with rifampin. Which adverse effects would the nurse expect to see?

625 mg -this is not safe, the maximum dose is 300mg

The order for isoniazid (INH) reads: "Give 5 mg/kg Po daily". What is the amount per dose? Is this a safe dose?

PPD is a diagnostic injection given intradermally to detect exposure to the TB organism -PPD is a diagnostic injection given intradermally in doses of 5 tuberculin units (0.1mL) to detect exposure to the TB organism. A positive result is indicated by induration (not erythema) at the site of injection and is known as the Mantoux reaction, named for the physician who described it.

The patient tells the nurse, "I had a shot after I returned from my trip overseas. I thought that was supposed to stop me from getting a TB infection." What information regarding TB-related injections does the nurse identify as being true?

"I will take the medication for 1 week and then stop" -Anti-tubercular therapy is taken for long periods of time, often 24 months. Although this patient does not have an active infection at this time and is taking rifampin to prevent an infection, the nurse should further investigate the length of time the medication is ordered.

The patient's wife is taking rifampin to prevent her from developing a TB infection. Which statement by the wife indicates that further teaching is needed?

during the initial period of the illness and its diagnosis

When counseling a patient who has been newly diagnosed with TB, the nurse will make sure that the patient realizes that he or she is contagious____________?

-Oral contraceptives will not work while taking rifampin, use another for of birth control -Avoid prolonged exposer to the sun -Urine may turn a reddish color when taking rifampin

When using Rifampin keep in mind of the following?

There is a decrease in symptoms, along with improved chest x-ray and sputum culture results.

While monitoring a patient, the nurse knows that a therapeutic response to ant-tubercular drugs would be: