2. Antitubercular Agents
โข Tuberculosis, โTBโ
โข Caused by Mycobacterium tuberculosis
โข Antitubercular agents treat all forms of
mycobacterium
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
3. Mycobacterium Infections
Common Infection Sites
โข lung (primary site)
โข brain
โข bone
โข liver
โข kidney
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
4. Mycobacterium Infections
โข Aerobic bacillus
โข Passed from infected:
โ Humans
โ Cows (bovine)
โ Birds (avian)
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
5. Mycobacterium Infections
โข Tubercle bacilli are conveyed by droplets.
โข Droplets are expelled by coughing or sneezing,
then gain entry into the body
by inhalation.
โข Tubercle bacilli then spread to other body organs
via blood and lymphatic systems.
โข Tubercle bacilli may become dormant, or walled
off by calcified or fibrous tissue.
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
7. Antitubercular Agents:
Mechanism of Action
Three Groups
โข Protein wall synthesis inhibitors streptomycin,
kanamycin, capreomycin, rifampin, rifabutin
โข Cell wall synthesis inhibitors cycloserine,
ethionamide, isoniazid
โข Other mechanisms of action
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
8. Antitubercular Agents:
Mechanism of Action isoniazid (INH)
โข Drug of choice for TB
โข Resistant strains of mycobacterium emerging
โข Metabolized in the liver through acetylationโ
watch for โslow acetylatorsโ
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
9. Antitubercular Agents:
Therapeutic Uses
Used for the prophylaxis
or treatment of TB
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
10. Antitubercular Therapy
Effectiveness depends upon:
โข Type of infection
โข Adequate dosing
โข Sufficient duration of treatment
โข Drug compliance
โข Selection of an effective drug combination
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
11. Antitubercular Agents: Side Effects
โข INH
peripheral neuritis, hepatotoxicity
โข ethambutol
retrobulbar neuritis, blindness
โข rifampin
hepatitis, discoloration of urine, stools
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
12. Antitubercular Agents:
Nursing Implications
โข Obtain a thorough medical history and assessment.
โข Perform liver function studies in patients
who are to receive isoniazid or rifampin
(especially in elderly patients or those who use
alcohol daily).
โข Assess for contraindications to the various agents,
conditions for cautious use, and potential drug
interactions.
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
13. Antitubercular Agents:
Nursing Implications
Patient education is CRITICAL:
โข Therapy may last for up to 24 months.
โข Take medications exactly as ordered,
at the same time every day.
โข Emphasize the importance of strict compliance
to regimen for improvement of condition or cure.
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
14. Antitubercular Agents:
Nursing Implications
Patient education is CRITICAL:
โข Remind patients that they are contagious during
the initial period of their illnessโinstruct in proper
hygiene and prevention of the spread of infected
droplets.
โข Emphasize to patients to take care of themselves,
including adequate nutrition and rest.
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
15. Antitubercular Agents:
Nursing Implications
โข Patients should not consume alcohol while on these
medications nor take other medications, including
OTC, unless they check with their physician.
โข Diabetic patients taking INH should monitor their
blood glucose levels because hyperglycemia may
occur.
โข INH and rifampin cause oral contraceptives to
become ineffective; another form of birth control
will be needed.
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
16. Antitubercular Agents:
Nursing Implications
โข 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.
โข Vitamin B6 may is needed to combat peripheral
neuritis associated with INH therapy.
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
17. Antitubercular Agents:
Nursing Implications
Monitor for side effects
โข Instruct patients on the side effects that should be
reported to the physician immediately.
โข These include fatigue, nausea, vomiting, numbness
and tingling of the extremities, fever, loss of appetite,
depression, jaundice.
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
18. Antitubercular Agents:
Nursing Implications
Monitor for therapeutic effects:
โข Decrease in symptoms of TB, such as cough
and fever
โข Lab studies (culture and sensitivity tests)
and CXR should confirm clinical findings
โข Watch for lack of clinical response to therapy,
indicating possible drug resistance
Copyright ยฉ 2002, 1998, Elsevier Science (USA). All rights reserved.
