Name: ALCANTARA, NIKAH PAULINE F.

Group: 1
DRUG STUDY

Generic Name Brand Name/s Dosage Indication Contraindication Nursing Responsibilities

➤ isoniazid ➤ Isotamine Active Tuberculosis ➤ Treatment of ➤ Hypersensitivity to ➤ Baseline assessment
(in Combination with susceptible active isoniazid (including • Question for history of
One or More tuberculosis due to drug-induced hypersensitivity reactions,
Antituberculars) Mycobacterium hepatitis), acute hepatic hepatic injury or disease,
tuberculosis. disease, hepatic injury or sensitivity to nicotinic acid
➤ IM/PO: ADULTS, severe adverse reactions or chemically related
ELDERLY: 5 mg/kg once ➤ Treatment of latent with previous isoniazid medications.
daily. tuberculosis caused by therapy. • Ensure collection of
Usual dose: 300 mg. Mycobacterium specimens for culture,
tuberculosis. Cautions: Chronic hepatic sensitivity.
➤ CHILDREN disease, alcoholism, severe • Evaluate initial LFT.
WEIGHING LESS THAN renal impairment.
40 KG: 10–15 mg/kg Pregnancy, pts at risk for ➤ Intervention/evaluation
once daily. peripheral neuropathy, HIV • Monitor LFT, assess for
Maximum: 300 mg. infection, history of hepatitis: anorexia, nausea,
Note: Give isoniazid hypersensitivity reactions vomiting, weakness,
with rifAMPin, to latent TB infection fatigue, dark urine,
pyrazinamide, and with medications. jaundice (withhold
or without ethambutol concurrent INH therapy
for 8 wks, then give and inform physician
with rifAMPin for 18 promptly).
wks. • Assess for paresthesia of
extremities (pts esp. at risk
➤ Latent Tuberculosis for neuropathy may be
Note: Give for 9 mos. given pyridoxine
IM/PO: ADULTS, prophylactically:
ELDERLY: 5 mg/kg once malnourished, elderly,
daily (Maximum: 300 diabetics, pts with chronic
mg) or 15 hepatic disease [including
mg/kg twice weekly alcoholics]).
(Maximum: 900 mg). • Be alert for fever, skin
eruptions (hypersensitivity
➤ CHILDREN: 10–20 reaction).
mg/kg/day as a
single daily dose. ➤ Patient/family teaching
Maximum: 300 • Do not skip doses;
mg/day or 20–40 continue to take isoniazid
mg/kg 2 times/wk. for the full length of
Maximum: 900 therapy (6–24 mos).
mg/dose. • Take preferably 1 hr
before or 2 hrs following
Dosage in Renal meals (with food if GI
Impairment upset).
- No dose adjustment. • Avoid alcohol during
treatment.
Dosage in Hepatic • Do not take any other
Impairment medications, including
- Use caution. antacids, without
Contraindicated with consulting a physician.
acute hepatic disease. • Must take isoniazid at
least 1 hr before antacid.
• Avoid tuna, sauerkraut,
aged cheeses, smoked fish
(consult list of tyramine
containing foods), which
may cause hypertensive
reaction (red/itching skin,
palpitations,
light-headedness, hot or
clammy feeling, headache).
• Report any new
symptom, immediately for
vision difficulties, nausea/
vomiting, dark urine,
yellowing of skin/eyes
(jaundice), fatigue,
paresthesia of extremities.
Generic Name Brand Name/s Dosage Indication Contraindication Nursing Responsibilities
➤ rifampicin ➤ Rifadin Tuberculosis ➤In combination with ➤ Concomitant therapy ➤ Baseline assessment
Note: A four-drug other antitubercular with atazanavir, darunavir, • Obtain CBC, renal
regimen (ethambutol, agents for initial fosamprenavir, saquinavir, function test, LFT.
isoniazid,pyrazinamide, treatment, retreatment ritonavir, tipranavir; • Screen for concomitant
rifampin) is preferred of active tuberculosis. hypersensitivity to medications
for initial, empiric Eliminates meningococci rifAMPin, other rifamycins. known to cause
treatment. from nasopharynx of hepatotoxicity.
➤ PO, IV: ADULTS, asymptomatic carriers. Cautions: Hepatic • Question for
ELDERLY: 10 mg/kg/ impairment, active or hypersensitivity to
day. ➤ OFF-LABEL: Prophylaxis treated alcoholism, rifAMPin, rifamycins.
Maximum: of H. influenzae type B porphyria. Concurrent • Ensure collection of
600mg/day. infection, Legionella medications associated diagnostic specimens.
pneumonia, serious with hepatotoxicity.
➤ CHILDREN: 10–20 infections caused by ➤ Intervention/evaluation
mg/kg/day usually as a Staphylococcus • Assess IV site at least
single dose. spp. (in combination with hourly during infusion;
Maximum: 600 other agents). Treatment restart at another site at
mg/day. of prosthetic joint the first sign of irritation or
infection. inflammation.
Meningococcal Carrier • Monitor LFT, assess for
➤ PO, IV: ADULTS, hepatitis: jaundice,
ELDERLY: 600 mg twice anorexia, nausea, vomiting,
daily for 2 days. fatigue, weakness (hold
PO ONLY: CHILDREN 1 rifAMPin, inform physician
MO AND OLDER: 10 at once).
mg/kg/dose q12h for 2 • Report hypersensitivity
days. reactions promptly: any
Maximum: 600 type of skin eruption,
mg/dose. pruritus, flu-like syndrome
with high dosage.
➤ CHILDREN • Monitor daily pattern of
YOUNGER THAN 1 bowel activity, stool
MO: 5 mg/kg/ consistency (potential for
dose q12h for 2 days. antibiotic-associated
colitis).
Dosage in Renal/ • Monitor
Hepatic Impairment CBC results for blood
- No dose adjustment. dyscrasias; be alert for
infection (fever, sore
throat), unusual
bruising/bleeding, unusual
fatigue/weakness.

➤ Patient/family teaching
• Preferably take on empty
stomach with 8 oz of water
1 hr before or 2 hrs after
meal (with food if GI
upset).
• Avoid alcohol.
• Do not take any other
medications without
consulting a physician,
including antacids; must
take rifAMPin at least 1 hr
before antacid.
• Urine, feces, sputum,
sweat, tears may become
red-orange; soft contact
lenses may be permanently
stained.
• Report any new symptom
immediately such as yellow
eyes/skin, fatigue,
weakness, nausea/
vomiting, sore throat, fever,
flu, unusual bruising/
bleeding.
• If taking oral
contraceptives, check with
a physician (reliability may
be affected).
Generic Name Brand Name/s Dosage Indication Contraindication Nursing Responsibilities
➤ pyrazinamide ➤ Tebrazid Tuberculosis (in ➤Treatment of clinical ➤ Hypersensitivity to ➤ Baseline assessment
Combination With tuberculosis in pyrazinamide. Acute gout, • Question for
Other Antituberculars) conjunction with other severe hepatic dysfunction. hypersensitivity to
➤ PO: ADULTS: Based antitubercular pyrazinamide, isoniazid,
on lean body weight. agents. Cautions: Diabetes, ethionamide, niacin.
40–55 KG: 1,000 mg porphyria, renal • Ensure collection of
daily; impairment, history of specimens for culture,
56–75 KG: 1,500 mg gout, history of alcoholism, sensitivity.
daily; concurrent medication • Obtain CBC, LFT, serum
76–90 KG: 2,000 mg associated with uric acid levels.
(maximum dose hepatotoxicity.
regardless of ➤ Intervention/evaluation
weight). • Monitor LFT results; be
alert for hepatic reactions:
➤ CHILDREN: 30-40 jaundice, malaise, fever,
mg/kg/dose once daily. abdominal (RUQ)
Maximum: 2 g/day. tenderness, anorexia,
nausea, vomiting (stop
Dosage in Renal/ drug, notify physician
Hepatic Impairment promptly).
- CrCl less than 30 • Check serum uric acid
mL/min or receiving levels; assess for hot,
HD: 25–35 mg/kg/dose painful, swollen joints, esp.
3 times/wk (given after big toe, ankle, knee (gout).
dialysis). • Evaluate serum blood
Contraindicated in glucose levels, diabetic
severe hepatic status carefully
impairment. (pyrazinamide makes
management difficult).
• Assess for rash, skin
eruptions.
• Monitor CBC for
thrombocytopenia,
anemia.

➤ Patient/family teaching
• Do not skip doses;
complete the full length of
therapy (may be mos or
yrs).
• Office visits, lab tests are
an essential part of
treatment.
• Take with food to reduce
GI upset.
• Avoid excessive exposure
to sun, ultraviolet light until
photosensitivity is
determined.
• Report any new
symptom, immediately for
jaundice (yellowing sclera
of eyes/skin); unusual
fatigue; fever; loss of
appetite; hot, painful,
swollen joints.
Generic Name Brand Name/s Dosage Indication Contraindication Nursing Responsibilities
➤ ethambutol ➤ Etibi/Myambutol Tuberculosis ➤ In conjunction with ➤ Hypersensitivity to ➤ Baseline assessment
➤ PO: ADULTS, other antitubercular ethambutol. Optic neuritis • Evaluate baseline CBC,
ELDERLY: Initially, 15 agents for treatment of (risk-versus benefit renal function, LFT, and
mg/kg once daily. pulmonary tuberculosis. decision). Use in young monitor periodically. •
(maximum: 1.5 g/day). children, unconscious pts, Obtain baseline visual
Retreatment: 25 OFF-LABEL: Treatment of or anyone unable to acuity.
mg/kg once daily atypical mycobacterial report visual changes.
(maximum: 2.5 g/day) infections ➤ Intervention/evaluation
for 60 days or until (e.g., Mycobacterium Cautions: Renal/hepatic • Assess for vision changes
bacteriologic smears/ avium complex [MAC]). dysfunction, ocular defects (altered color perception,
cultures become (diabetic retinopathy, decreased visual acuity
negative, then 15 cataracts), recurrent ocular may be first signs).
mg/kg once daily. inflammatory conditions. • Give with food if GI
Not recommended for distress occurs.
CHILDREN: (HIV children 13 yrs and younger • Monitor serum uric acid.
negative): 15–20 (unless benefit outweighs Assess for hot, painful,
mg/kg/day (maximum: risk). swollen joints, esp. great
1 g/day) or 50 mg/kg toe, ankle, knee (gout).
twice weekly • Report numbness,
(maximum: 2.5 tingling, burning of
g/dose). extremities (peripheral
(HIV exposed/ neuritis).
infected): 15–25
mg/kg/day. ➤ Patient/family teaching
Maximum: 2.5 g/day. • Do not skip doses; take
for the full length of
Dosage in Renal therapy (may take mos or
Impairment yrs).
- Dosage interval is • Immediately report any
modified based on visual changes (visual
creatinine clearance. effects generally reversible
Creatinine Clearance with discontinuation of
(a)10–50 mL/min ethambutol but in rare
(b)Less than 10 mL/min cases may take up to 1 yr to
(c)Hemodialysis disappear
(d)Peritoneal dialysis or may be permanent).
(e)Continuous renal • Promptly report swelling
replacement therapy or pain of joints, numbness
Dosage or tingling/burning of
(a)q24–36h extremities, fever, chills.
(b)q48h
(c)Administer post HD
(d)Administer q48h
(e)Administer q24–36h

Dosage in Hepatic
Impairment
- Use caution.
Generic Name Brand Name/s Dosage Indication Contraindication Nursing Responsibilities
➤ streptomycin ➤ Streptomycin ➤ IM: ADULTS: ➤ Streptomycin is ➤ A history of clinically ➤ Baseline Assessment &
Daily: 15 mg/kg indicated for the significant hypersensitivity Drug Effects
(maximum: 1 g) treatment of individuals to streptomycin is a • Lab tests: Obtain C&S
Twice Weekly: 25-30 with moderate to severe contraindication to its use. tests prior to and
mg/kg infections caused by periodically during the
(maximum: 1.5 g) susceptible strains of ➤ Clinically significant course of therapy. In
microorganisms in the hypersensitivity to other patients with impaired
➤ IM: CHILDREN: specific conditions aminoglycosides may kidney function, frequent
Daily: 20-40mg /kg (Mycobacterium contraindicate the use of determinations of serum
(maximum: 1 g) tuberculosis). streptomycin because of drug concentrations and
Twice Weekly: 25-30 the known cross-sensitivity periodic kidney and liver
mg/kg ➤ In combination with of patients to drugs in this function tests are advised
(maximum: 1.5 g) other agents in the class. (serum concentrations
management of active should not exceed 25
➤ IM: GERIATRIC: 10 tuberculosis. mcg/mL in these patients).
mg/kg • Be alert for and
(maximum: 750 mg/d) ➤ In combination with immediately report
other agents in the symptoms of ototoxicity
➤ IM: INFANT: 10–15 management of serious (see Appendix F).
mg/kg q12h enterococcal or Symptoms are most likely
gram-negative infections. to occur in patients with
➤ IM: NEONATE: impaired kidney function,
10–20 mg/kg q24h patients receiving high
doses (1.8–2 g/d) or other
ototoxic or neurotoxic
drugs, and older adults.
Irreversible damage may
occur if the drug is not
discontinued promptly.
• Early damage to the
vestibular portion of the
eighth cranial nerve (higher
incidence than auditory
toxicity) is initially
manifested by moderately
severe headache, nausea,
vomiting, vertigo in upright
position, difficulty in
reading, unsteadiness, and
positive Romberg sign.
• Be aware that auditory
nerve damage is usually
preceded by vestibular
symptoms and
high-pitched tinnitus,
roaring noises, impaired
hearing (especially to
high-pitched sounds), and a
sense of fullness in ears.
Audiometric tests should
be done if these symptoms
appear, and drugs should
be discontinued. Hearing
loss can be permanent if
damage is extensive.
Tinnitus may persist several
days to weeks after the
drug is stopped.
• Monitor I&O. Report
oliguria or changes in I&O
ratio (possible signs of
diminishing kidney
function). Sufficient fluids
to maintain urinary output
of 1500 mL/24 h are
generally advised. Consult
a physician.

➤ Patient/family teaching
• Report any unusual
symptoms. Review adverse
reactions with physicians
periodically, especially with
prolonged therapy.
• Be aware of the
possibility of ototoxicity
and its symptoms (see
Appendix F).
• Report to physician
immediately any of the
following: Nausea,
vomiting, vertigo,
incoordination, tinnitus,
fullness in ears, impaired
hearing.
• Do not breastfeed while
taking this drug.