::: TB "tuberculosis" nursinG :::
Which organism causes tuberculosis?
Tuberculosis is caused by mycobacterium tuberculosis
What makes tuberculosis difficult to treat ?
1-Intra-cellular ******** of mycobacterium
2 -The organism grows very slowly
3 -Rapid development of the resistance
4 -Patient compliance
Why is tuberculosis treated with multiple drugs ?
1 - ↑ Antimycobacterial activity
2 -? Resistance
What are the first –line drugs used for treatment of tuberculosis?
Isoniazid (INH)
Rifampin
Pyrazinamide
Ethambutol
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Isoniazid
How does this drug work?
It acts on mycobacterial cell wall to inhibit mycolic acid synthesis
What is the route of administration of INH?
Oral
What are the clinical uses of INH?
1 -Treatment of active tuberculosis with other drugs
2 -INH is used as the sole drug : For chemoprophylaxis for Close contacts of
pt. with active disease. It is given for 6-9 months
State isoniazid’s adverse effects?
Neurotoxicity
a. Peripheral neuritis
b. Restlessness
c. Muscle twitching
d. Insomania
Pyridoxine administration can prevent this problem
Hepatoxicity
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Rifampin
What is its mechanism of action ?
Inhibits RNA polymerase
What is route of administration of rifampin?
ORAL
What is the elimination of this drug?
****bolized in the liver
****bolites are eliminated mainly in the in the bile &eliminated in the urine
****bolites gives red orange color to both feces and urine
What are the clinical uses of Rifampin ?
1. Treatment of active tuberculosis with other drugs
2. Rifampin is used as the sole drug : For chemoprophylaxis for Close contacts of pt. with with INH- resistant strain.It is given for 6-9 months
State the adverse effects of rifampin ?
1 - Flu-like syndrome: Fever ,chills and myalgia
2 - CNS→ Headache, confusion & ataxia
Hepatoxicity
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Ethambutol
What is its mechanism of action?
Inhibit enzymes responsible for the formation of arabinogalactan
Arabinogalactan is a component of mycobacterial cell wall
What is the route of administration of ethambutol?
ORAL
What is the clinical use of this drug ?
Only tuberculosis: In combination with other drugs
What are the adverse effects
* Visual disturbances
1- ? Visual acuity
2 - Red –green color blindness
3 - Optic neuritis
Pts should try reading small print in newspapers with each eye separately
Ethambutol should be stopped immediately if he find any difficulties in reading & he must report to his physician
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Pyrazinamide
When is this drug used?
Only tuberculosis:In combination with other drugs
What are pyrazinamide’s adverse effects ?
Polyarthalagia :40% of pts.
Hyperuricemia :usually asymptomatic
Myalgia
Hepatic dysfunction
What is meant by D.O.T
Direct Observed Therapy
Drugs are taken under direct supervision in special clinics
Useful to insure patient compliance
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