ANTITUBCULAR DRUGS AND NURSING RESPONSIBLITY

2.  Ant tuberculosis drugs are medicines used to
treat tuberculosis, an infectious disease that can
affect the lungs and other organs.
 Tuberculosis management refers to the medical
treatment of the infectious
disease tuberculosis (TB).

6.  Bactericidal agents :
 Isoniazid
 Rifampicin
 Streptomycin
 Pyrazinamide
 Capreomycin
 Kanamycin
 Ciprofloxacin

7.  Ethambutol
 Ethionamide
 Thiacetazone
 Cycloserin
 Para-amino salicylic acid (PAS).

14.  Mechanism of action:
 bactericidal, may inhibit the synthesis of mycolic
acid,which are important component of
mycobacterial cell wall resulting in cell wall
disruption.

16.  Mechanism of action:
 It is a bactericidal drug, it inhibits DNA-
dependent RNA polymerase activity in bacterial
cells .
 Dose : 450-600 mg oral

17.  Mechanism of action:
 Same as Rifampicin
 Dose and route :
300 mg daily oral or 5-10mg/kg.

18.  Mechanism of action:
 Same as Rifampicin
 Weekly once
 -10-14 kg : 300mg
 >14-25 kg : 450 mg
 >25-32kg : 600mg
 >32-49.9 kg : 750 mg
 50kg or more : 900 mg maximum.

19.  Mechanism of action:
 Bactericidal drug, which inhibits the acid PH in
M. tuberculosis.
 Dose : 1,200-1,500 mg oral

21.  Mechanism of action:
 Bactericidal drug,
 Dose - 750-1,000 mg intramuscular ( IM)

22.  Mechanism of action:
 It is bacteriostatic, it inhibits the incorporation of
mycolic acids into the mycobacterial cell wall by
inhibiting certain enzymes ( arabinosyl
transferases ) involved it .
 Dose : 800-1,000 mg or 25mg/kg oral.

24.  Mechanism of action:
 It is bacteriostatic drug.
 Dose : 150 mg or 2.5 mg/kg oral.

25.  Mechanism of action:
 It inhibits mycolic acid synthesis, an essential
component of the bacterial cell wall.
 Dose: 10-20 mg/kg/day divided bid/tid oral
 No more than 1,000 mg/day.

26.  Mechanism of action:
 There are two mechanisms responsible for PAS
bacteriostatic action against M.tuberculosis.
 Firstly, PAS inhibits bacterial folic acid synthesis.
 Secondly, AS may inhibit the synthesis of the cell
wall component,
 Mycobactin, thus reducing iron uptake by
M.Tuberculosis.

27.  Dose : 200-300 mg/kg/day as devided in 2-4
equal doses,
 Not to exceed 10g/day.

28.  Mechanism of action:
 It inhibits alanine racemase and D-alanine.
 D-alanine ligase, both enzymes are essential in
the synthesis of peptidoglycan and subsequently
in cell wall biosynthesis and maintenance.
 Dose : 500-750 mg oral in 2-3 devided doses or
10-20 mg/kg/day.

29.  Mechanism of action:
 Inhibition of phospholipase and effects on
potassium transporters.
 Dose and route :
 50-100mg oral bd/od

30.  Mechanism of action:
 Inhibits mycobacterial adenosine 5-triphosphate
(ATP) synthase , an enzyme essential for the
generation of energy in mycobacterium
tuberculosis.

31.  Weeks 1-2: 400mg/day for 2 weeks.
 Weeks 3-24 : 200 mg 3 times / week for 22 weeks.

32.  Ciprofloxacin
 Ofloxacin
 Moxifloxacin
 Gatifloxacin
 Levofloxacin
 Sparfloxacin
 -used as second line tuberculosis drugs.

33.  Linezolid
 Amikacin
 Kanamycin
 Capreomycin

34. ANTITUBERCULAR DRUG SIDE EFFECT
Streptomycin Ototoxicity,Vestibular damage…..It contraindicate in
Pregnancy
Ethambutol E: Eye toxicity, T:Toxicity dose and duration dependent
(Ocular toxicity), H: Hyperuricemia, Others: Blurring and red
green colour blindness
Rifampicin R: Red discoloration of urine, I: Induction of liver enzymes, F:
Flue like symptoms, A:Abdominal
symptoms(Nausea,Vomitting,Saliva,Abdominal crams),M:
Malaise
Isoniazid I: Mental disturbance(Insanity), N: Neuritis , H: Hepatitis and
Others – Skin rashes, Pellagra like syndrome

35.  Pyrazinamide
Py: Problem in liver(Hepatitis)
R: Rashes
A: Arthralgia
I: Increased uric acid level

36.  The government of india along with world health
organization (WHO) and world bank has
reviewed national TB programme and has now
revised the strategy as Revised national
tuberculosis control programme ( RNTCP), which
was introduced in 1993.

37.  The directly observed treatment short - course
therapy (DOTS) has emerged as a possible
solution to the rising number of TB cases in
different parts of the world and has been
incorporated in india”s RNTCP

39.  For the treatment of drug - resistant , the current
TB drugs are grouped according their
effectiveness, experience of use and drug class
by WHO :

40.  PER
 Pyrazinamide
 Ethambutol
 Rifabutin

41.  KASC
 Kanamycin
 Amikacin
 Capreomycin
 Streptomycin

42.  MOL
 Levofloxacin
 Moxifloxacin
 Ofloxacin

43.  PCT-PT
 Para – aminosalicylic acid
 Cycloserine
 Terizidone
 Thionamide
 Protionamide

44.  Clofazimine
 Linezolid
 Amoxicillin/clavulanate
 Thioacetazone
 Imipenem / cilastatin
 High dose isoniazid
 Clarithromycin

45.  Drugs that are active against resistant forms of
TB are less potent, more toxic and need to be
taken for a long time > 18 months.

48.  Assess
 Signs of anemia ( Hb),fatigue,liver function
test,renal function test.
 Allergy to any of the drugs in the regimen
 Isolation of patients and barrier nursing.

49.  Isoniazid (INH) and Rifampicin 1 hour before
food.
 Other agents 2 hour after food.
 Antiemitics as prescribed if vomiting .

50.  Importance of compliance with dosage schedule,
duration if necessary.
 Rifampicin may colour the body fluids
red/orange.
 That scheduled follow up with prescriber should
be kept since relapse can occur.
 To avoid alcohol while taking the drug.

51.  To report flu-like symptoms : excessive fatigue,
anorexia,vomiting, sore throat, unusual
bleeding, and yellow discoloration of skin / eyes.

52.  To dispose of sputum carefully and to wear mask
to prevent transmission.
 Advise the patient to take foods rich in vitamin
B6 other wise neuropathies can develop.