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anaphylactoid reactions

no prior exposure. The agent itself, rather than the antibodies mediates the reaction. Same S/S and TX as anaphylactic shock

directly observed therapy

DOT - administration of each dose of TB medication is done in the presence of an observer




Inflammation of joints due to the deposit of sodium urate crystals

Mycobacterium tuberculosis

cause of tuberculosis

optic neuritis

inflammation of optic nerve resulting in blindness

peripheral neuropathy

a painful condition of the nerves of the hands and feet due to damage to the peripheral nerves; also known as peripheral neuritis


remedy that prevents or slows the course of an illness or disease


causing no symptoms


an infectious disease that may affect almost any tissue of the body


an illness of dizziness

Nursing Alert (HIV)

Active TB in patients infected with HIV can be difficult to diagnose. X-ray studies, sputum analyses, or physical examinations may be needed to diagnose M. tuberculosis infection accurately in patients with HIV infection.

Certain fluoroquinolones such as ciprofloxacin, ofloxacinand levofloxacin

have proven effective against TB and are considered secondary drugs

Antitubercular Drugs Actions

Most antitubercular drugs are bacteriostatic against the M. tuberculosis bacillus.


Antitubercular drugs are used with other drugs to treat active TB. Isoniazid (INH), however, may be used alone in preventive therapy (prophylaxis).family members of the infected individual must be given prophylactic treatment with isoniazid for 6 months to 1 year.

Standard Treatment Standard treatment for TB (1)

is divided into two phases: the initial phase followed by a continuing phase. During the initial phase, drugs are used to kill the rapidly multiplying M. tuberculosis and to prevent drug resistance.(2 months )

Standard Treatment Standard treatment for TB is divided into two phases:(2)

second phase (4 mo) with the total treatment regimen lasting for 6 to 9 months, depending on the patient's response to therapy.


,if treatment fails 4 or more antitubercular drugs.

secondary drugs if treatment fails

thionamide (Trecator), aminosalicylic acid (Paser), cycloserine (Seromycin), and capreomycin (Capastat). Ofloxacin (Floxin) and ciprofloxacin (Cipro)

primary antitubercular drugs:

ethambutol, isoniazid, pyrazinamide, and rifampin.

Ethambutol Adverse Reactions Generalized Reactions

Dermatitis and pruritus Joint pain Anorexia Nausea and vomitingMore Severe Reactions Anaphylactoid reactions (unusual or exaggerated allergic reactions) * Optic neuritis (a decrease in visual acuity and changes in color perception); optic neuritis is dose related

Ethambutol Contraindications, Precautions, and Interactions

Ethambutol is not recommended for patients with a history of hypersensitivity to the drug or children younger than 13 years. The drug is used with caution during pregnancy (category B), in patients with hepatic or renal impairment, and in patients with diabetic retinopathy or cataracts.

Isoniazid Adverse Reactions

higher when larger doses of isoniazid are prescribed. Nausea and vomiting Epigastric distress Fever Skin eruptions Hematologic changes Jaundice * Hypersensitivity

Isoniazid Toxicity

Peripheral neuropathy (numbness and tingling of the extremities) is the most common symptom of toxicity. Severe, and sometimes fatal, hepatitis has been associated with isoniazid therapy and may appear after many months of treatment.

Contraindications and Precautions

is contraindicated in patients with a history of hypersensitivity to the drug. The drug is used with caution during pregnancy (category C) or lactation and in patients with hepatic and renal impairment.

Isoniazid Interactions

antacids containing aluminum salts,anticoagulants,phenytoin Antiseizure drug Increased serum levels of phenytoin,alcohol (in beverages)

When isoniazid is taken with foods containing tyramine, such as aged cheese and meats, bananas, yeast products, and alcohol,

sympathetic-type response can occur hypertension, increased heart rate, and palpitations).

Pyrazinamide Adverse Reactions

Generalized Reactions Nausea and vomiting Diarrhea Myalgia (aches) Rashes


Hepatotoxicity is the principal adverse reaction seen with pyrazinamide use.

pyrazinamide Contraindications and Precautions

acute gout (a metabolic disorder resulting in increased levels of uric acid and causing severe joint pain), or severe hepatic damage.hypersensitivity to the drug

pyrazinamide Interactions

allopurinol (Zyloprim), colchicine, or probenecid (Benemid), all antigout medications, its effectiveness decreases.

Rifampin Adverse Reactions

Nausea and vomiting Epigastric distress, heartburn, fatigue Vertigo (dizziness) Rash Reddish-orange discoloration of body fluids (urine, tears, saliva, sweat, and sputum) Hematologic changes, renal insufficiency

Contraindications and Precautions Rifampin

caution during pregnancy (category C) and lactation and in patients with hepatic or renal impairment.

Rifampin Interactions

digoxin Management of cardiac problems,isoniazid Antitubercular agent Higher risk of hepatotoxicity,oral contraceptives, oral anticoagulants,oral hypoglycemics Antidiabetic agent(reduces anti-c effect)chloramphenicol Anti-infective agent Increased risk for seizures,phenytoin Antiseizure agent Decreased effectiveness of phenytoin

Rifampin Interactions (verapamil)

verapamil Management of cardiac problems and blood pressure Decreased effectiveness of verapamil

Nursing Diagnoses Checklist

Acute Pain related to frequent injection of antitubercular drug Imbalanced Nutrition: Less than Body Requirements related to gastric upset and general poor health status Risk of Ineffective Therapeutic Regimen Management related to indifference, lack of knowledge, long-term treatment regimen, other factors

Acute Pain: Frequent Parenteral Injections

rotate the injection sites. At the time of each injection, the nurse inspects previous injection sites for signs of swelling, redness, and tenderness

Imbalanced Nutrition: Less than Body Requirements

Ethambutol (Myambutol) should be given at the same time daily and may be given without regard to food.

Bodily fluids from drugs

(urine, feces, saliva, sputum, sweat, and tears) may be colored reddish-orange

Gerontologic Alert (hepatitis)

if they consume alcohol on a regular basis.Two other antitubercular drugs, rifampin and pyrazinamide, can cause liver dysfunction in the older adult as well. Ca


directly observed therapy directly observed therapy (DOT) is used to administer these drugs. With DOT, the patient makes periodic visits to the office of the primary care provider or the health clinic, where the drug is taken in the presence of the nurse

Ineffective Therapeutic Regimen Management

becomes a problem and increases the risk of development of resistant strains of TB.

The nurse explains to the patient that to slow bacterial resistance to an antitubercular drug, the primary health care provider may prescribe

A. at least three antitubercular drugs

Which of the following drugs is the only antitubercular drug to be prescribed alone?


The nurse monitors the patient taking isoniazid for toxicity. The most common symptom of toxicity is

peripheral neuropathy

Which of the following is a dose-related adverse reaction to ethambutol?

optic neuritis

Which of the following antitubercular drugs is contraindicated in patients with gout?


A patient is prescribed isoniazid syrup 300 mg. The isoniazid is available as 50 mg/mL. The nurse should administer?

6 mL

Oral rifampin 600 mg is prescribed. The drug is available in 150-mg tablets. The nurse should administer ?

4 tablets

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