Only $35.99/year

Ch. 10 Antitubercular and Antifungal Drugs

Terms in this set (26)

Class
First Line Antitubercular Drugs
"Antimycobacterial"

isoniazid (INH)
MOA
- works by inhibiting several enzymes important to mycobacteria metabolism and reproduction
Notes
- Most common
- Bactericidal

rifampin (RIF)
MOA
- Prevents reproduction of the TB organism by binding to the enzyme that allows RNA to be transcribed
Notes
- Bactericidal and bacteriostatic

Pyrazinamide (PZA)
MOA
- Reduces the pH of the intracellular fluid of WBCs in which the TB bacillus resides
Notes
- Bacteriostatic at low doses
- Bactericidal at high doses

Ethambutol (EMB)
MOA
- Suppresses bacterial reproduction
Notes
- Bacteriostatic - Rarely used alone due to bacteriostatic status

Rifater (RIF, PZA, INH)
- Combination Drug
- One pill with all three meds

-------------------------------------------

Indication
- Treat Tuberculosis

Contraindications
- None? Anyone with TB requires treatment?

Intended responses:
- Treat tuberculosis
- Symptom improvement
- Cough & sputum production is reduced
- Fatigue is reduced and weight is gained
- Eventually sputum culture is negative

Side Effects
General:
- Diarrhea, vomiting, difficulty sleeping, headaches
INH
- Breast tenderness or enlargement (typically in men)
- Loss of appetite and sore throat
RIF
- Abdominal Pain
- Urinary retention
- Any fluid can be tinged Orange
· Even tears are tinged orange - staining contacts
- GI Upset - Diarrhea and vomiting
PZA
- Muscle aches
- Photosensitivity
PZA & EMB
- Increase in uric acid may lead to Gout

Adverse Effects
General
- Liver toxicity
· Alcohol & acetaminophen increases the risk
- Potential to interact with other drugs
· Especially Alcohol
Isoniazid
- can cause peripheral neuropathy with loss of sensation
- Can be prevented if pt increases B complex vitamins
Rifampin
- often causes anemia
Ethambutol
- At high doses can causes optic neuritis (vision changes)
· In some cases, pts lose ability to see color
- ANY VISION PROBLEMS is a medical emergency. STOP TAKING IMMEDIATELY
· If caught early, potential blindness can be avoided

Life Span Considerations
Pediatric
- Children of any age with active TB should take these drugs
- Can also take them in pre-exposure
Pregnancy and lactation
- Approved for treatment during pregnancy
- Higher risk of liver toxicity
- Require higher doses of B complex vitamins
Older adults
- Higher risk for liver toxicity
- Gout is more common

Administration
INH
- Weight based Drug
· Adults: 5 mg/kg (maximum 300 mg) orally daily or 15 mg/kg (maximum 900 mg) orally twice each week
· Frequency
· · Daily or 2x a week
· · Most MDs will want a daily basis for the sake of remembering
- Complete the Therapy!
- Watch for epigastric distress, jaundice, and peripheral neuritis
- Have liver function tests done
- Routes
· IM & PO
- Causes B6 deficiency (can cause the Peripheral neuritis and seizures)
- NO Alcohol intake

Check Before
- Make sure patient has no liver problems
- Ask males if they have enlarged prostate
- Ask all patients about urine retention
- Assess vision
Direct Observational Therapy
- Someone steps in and makes sure patient takes meds
- I.e Dementia, Homeless, non-compliant
- Used more when the health of the public becomes the priority
Rifampin
- Before starting, check for anemia
PZA & EMB
- Ask about gout

Check After
- Check vital signs and respiratory status every 15 minutes
- Check patient daily for yellowing of skin (Jaundice indicates liver failure)
- If a patient has diabetes, check blood glucose levels more frequently
- Ask the patient about any numbness, tingling, or pain in hands and feet (peripheral neuropathy)
- Check urine I&O
- A lot of teaching because most of this is outpatient

Patient Teaching
- Take drugs for 6 months
· Pt needs to understand length of treatment
- Avoid alcohol
- Notify prescriber about signs of liver toxicity
- Tell those with diabetes to check blood glucose frequently
- Avoid caffeine while taking isoniazid
· Has been known to increase BP
- For rifampin, expect it to stain skin
- Drink at least 8 oz. water when taking drugs
- Wear protective clothing and sunscreen