Pharm drugs for TB

Which statement should the nurse include when teaching a patient about rifampin [Rifadin]?

A harmless side effect will be a red-orange discoloration of body fluids."

anti TB drugs

ALWAYS 2 or more drugs a. Decrease resistance, reduce relapse b. First line: isoniazid, rifamprin-most often** c. Rifapentine, rifabutin, and athambutol

primary directive of treat

ALWAYS treat TB with 2 or more drugs a. Decrease resistance and spontaneous mutation

phases of treatment regimen

Initiation: eliminate actively dividing tubercle bacilli i. Render sputum noninfectious ii. 2 months b. Continuation phase: eliminate intracellular persisters i. Not active, but still in body 4 months

if immune system fail to control primary infection

TB develops 1. necrosis and cavitation of lung tissue 2. severe destruction without treatment v. reactivation: renewal of dormant tubercle bacilli that have been dormant after control of primary infection

rifampin uses

TB, leprosy, haemophililus influenza, Legionelle a. Pulm TB and disseminated disease b. Use when complicated infection c. Always give with another anti-TB cuz resistance can develop rapidly if given alone

pyrazinamide

bacteralicidal to M. tuberculosis -Action: unknown -Use: TB -Use with INH and rifampin

ethambutol

bacteriostatic -Action: active only against mycobacteria -Uses: TB-When resistant to rifampin

TB

global epidemic a. Cases increasing outside of US i. Increase due to AIDS and multidrug resistant myocobacteria

pyrazinamide adverse effects

hepatotoxicity-jaundice a. Hyperuricemia b. GI disturb

prolong TB treatment

i. Drug toxicity and poor patient adherence ii. Promotes emergence of drug resistant mycobacteria

second line TB drugs info

i. Resistant to 1st line then use these ii. More expensive and more toxic, less effective 1. Lots of side effects iii. Injectable: capreomycin 1. PO iv. Kanamycin and amikacin

TB emergence due to drugs

i. Too short, too low doses, adherence, regimen has too few drugs

The nurse develops a care plan for a patient in the continuation phase of treatment for active tuberculosis (TB). The care plan includes teaching about which medication regimen?

if drug resistance is not a factor, treatment for active TB consists of a four-drug induction phase and a two-drug continuation phase. The continuation phase lasts at least 4 months, and therapy consists of two drugs—isoniazid and rifampin

TB diagnosis

indication for testing for pt with symptoms of TB, or + TB skin test 1. Definitive diagnosis: chest x ray a. Sputum culture-2 days to get results b. If + TB test, need chest x-ray to confirm it

A patient is taking rifampin [Rifadin] for active tuberculosis. Which assessment does the nurse identify as an adverse effect of the drug?

jaundice -toxic to liver

second line TB drugs

levofloxacin, moxifloxacin, kanamysin, amikacin, capreomycin, para-aminosalicylic acid, ethionamide and cycloserine, R207910

determine drug sensitivity

more selective, less suprainfection like other antibiotics

TB patho

myocobacteria tuberculosis 1. May be limited to lungs or disseminate 2. Norm in lung but can spread 3. Bacteria quiescent 4. No obvi symptoms-so by time diagnosed infected a lot of people

A patient who has an infection with Mycobacterium leprae (leprosy) has been prescribed rifampin [Rifadin]. The nurse identifies which dosing schedule as most effective for this drug?

once per month

Which statement by a patient taking ethambutol [Myambutol] indicates understanding of adverse effects of the drug?

optic neuritis, resulting in disturbance of color discrimination and blurred vision. -symptoms stop when med stopped

rifampin action

powerful inducer of cytochrome p450 enzymes and decrease levels of other drugs a. Inhibits bacterial DNA dependent RNA polymerase and suppresses RNA synthesis and protein synthesis b. Bactericidial

isoniazid

primary agent 1. Bactericidal

Multi drug resistance TB (MDR TB):

resistant to both isoniazid and rifampin v. Always treat with 2 drugs to prevent resistance

isoniazid action

suppresses bacterial growth by inhibiting synthesis of mycolic acid

ethambutol adverse effects

symptoms stop upon DC of drug a. Optic neuritis-hallucinations and blurred vision b. Allergy c. Hyperuricemia

TB primary infection

transmitted person to person 1. Inhale infected, aeorsal sputum a. Cough, sneeze b. If think may possibly be TB always put mask on 2. Initial infection in lungs 3. Immunity usually develop in few weeks 4. 90% with normal immune system never develop symptoms or evidence of a. no evidence on chest x-ray

isoniazid uses

treat and prevent TB a. All pt infected with M. tuberculosis except those who cant tolerate drug b. Prophyalaxisis, most effective c. PO or IM

INH

treatment of choice, same as isoniazid 1. Drawbacks 2. Short course therapy: rifampin alone 3. Short course therapy: rifampin + pyrazinamide 4. Vaccination against TB

TB treat regimen

usually treat outpatient unless really sick

rifampin adverse effects

usually well tolerated a. hepatotoxicity/hepatitis-increases liver enzymes, do liver function tests b. Discoloration of body fluids-red orange in almost all people** c. GI disturbances-nausea

rifampin

broad spectrum antibiotic, just as important as isoniazid

When teaching a patient about tuberculosis, the nurse will include which statements?

-Most people infected are asymptomatic. -Most people infected harbor dormant bacteria for life if they do not receive drug therapy -ethambutol can cause optic neuritis

Which statements will the nurse include when teaching a patient about isoniazid therapy for the treatment of tuberculosis?

-Take the isoniazid on an empty stomach -Notify your healthcare provider if your skin starts to turn yellow

To promote treatment adherence in a patient with tuberculosis, the nurse will include which interventions? (Select all that apply.)

-Teach about intermittent-dose therapy. -Teach about need for long-term treatment -Directly watch the pt take medication

who should be tested for TB

1. People at high risk for having acquired infection recently or progressing from latent to active TB 2. HIV, people in congregations, family members with it

causes of drug resistance

1. Some infecting bacilli inherently resistant 2. Some develop resist over course of treat 3. Resistnace to one drug vs. many

test for latent TB

1. TB skin test (TST): positive and negative, symptoms x-ray, sputum 2. QuantiFERON-TB Gold 3. Type 4 reaction-intradermal 4. Red, puffy= + test

TB promote adherence

: direct observation therapy (DOT)-standard of care a. Pt nonadherence i. Don't take long enough, doesn't take med, not high enough dose b. Allows ongoing assessment of clinical signs c. Intermittent dosing: 2-3x week

A patient who has tuberculosis is treated with isoniazid. The nurse should monitor for which symptoms, which could indicate a vitamin B6 deficiency caused by the medication?

Dose-related peripheral neuropathy is the most common adverse effect of isoniazid. -results from a vitamin B6 deficiency, which is corrected by taking oral supplements.

overview TB treatment

a. Always treat 2 or more drugs to reduce emergence b. Direct observation of drug admin is considered standard i. Eliminate symptoms and prevent relapse c. Must kill tubercle that are actively dividing and "resting" i. Treatment effective when no mycobacteria in sputum and no colonies present

evaluating TB treatment

a. Bacteriologic eval of sputum-2 to 4 weeks b. Clinical eval: lungs, fever, anorexia, resolves in a few weeks c. Chest radiographs

infection with resistant TB due to

a. Contact with someone who harbors resistant bacteria b. Repeated ineffectual courses of drug therapy

rifampin interactions

a. Induces P450: can hasten drug metabolism b. Oral contraceptives-decreases effectiveness c. Warfarin d. Drugs for HIV infection

Extensively resistant TB (XDR TB)

a. Isoniazid and rifampin-less toxic more effective b. All fluoroquinolones c. At least one of the second line injectable drugs

duration and treat

a. Minimum 6 mo for drug sensitive TB b. Up to 24 months for MDR or HIV/AIDS c. Can be on up to 7 drugs

isoniazid adverse effects

a. Peripheral neuropathy-most common i. Reversed with pyridoxine b. Hepatotoxicity-do liver function tests c. Optic neuritis d. Anemia e. Do not use with alcohol

A patient who has active TB is to start a medication regimen that includes pyrazinamide. The nurse identifies a risk for complications if the patient also has which medical condition?

alcoholism, gout and liver dysfunction -liver tests every 2 weeks

isoniazid benefits

efficacy, toxicity, ease of use, pt acceptance and affordability