ANTITUBERCULAR

DRUGS
TUBERCULOSIS

 Is a major health problem throughout the world.

 People who are compromise immune systems, and
individuals with debilitative(weak) conditions are
especially susceptible to TB.
 Mycobacterium tuberculosis bacterium or known as
tubercle bacillus is the causative agent of TB.
 MODE OF TRANSMISSION

 Transmitted from one person to another by droplets dispersed in the air when
infected person cough or sneezes. And these droplet nuclei will be inhaled by non-
infected person.
 NOTE: it will not be transmitted through kissing (if the partner will not sneeze or
cough), it will not transmit through washed and sterilized utensils.
 It is not contagious if the person has started taking his medication religiously with-
in 2 weeks up until the last session.
 Early detection, go to DOTS (Directly Observed treatment short) and start the
medication.
 EXTRAPULMONARY (outside the lungs)

-when immune system is inadequate, the infection can spread from the
lungs to other organs of the body.
-such as Liver, kidney, spleen, uterus, and bones

*HIV (Human Immunodeficiency Virus) infection are at RISK of TB

because of their compromised immune systems**

In response to these, here are the : ANTITUBERCULAR DRUGS

 ANTITUBERCULAR DRUGS

 TB responds well to long term treatment with a combination of three or

more antitubercular drugs
 USED to TREAT active cases of TB.
 Alsoa prophylactic (preventative) therapy to prevent the spreading of
TB Bacilli.
 There are primary(first line) and secondary (second line) drugs in
treatment.
“do not cure, but they do render the patient noninfectious to others.”
 ACTIONS

 Are used to treat active TB.

For example:
* Isoniazid(INH), may be alone in preventive therapy
(prophylaxis).
- 6 months to 1 year medication with isoniazid
(INH)
 STANDARD TREATMENT

 2 PHASES OF STANDARD TREATMENT for TB

*initial phase – during this phase , drugs are used to kill the rapidly multiplying M.
tuberculosis and to prevent drug resistance.
--will last for 2 months
--DRUGS involved : (RIPE)
 Isoniazid (INH),
 Rifampin (Rifadin)
 Pyrazinamide along with
 Ethambutol (Myambutol)
 *continuing phase – used to kill the spreading of
bacteria and to prevent drug resistance.
--4 months or up to 7 months in special populations.
DRUG INVOLVED only :
Rifampin and isoniazid
 RETREATMENT

 When treatment fails, retreatment is NECESSARY

 There is the use of 4 or more antitubercular drugs
 Most often consists of drugs :

*ethionamide (Trecator), aminosalicylic acid (paser),

cycloserine (Seromycin), capreomycin (Capastat),
ofloxacin (Floxin) and ciprofloxacin (Cipro).
 ETHAMBUTOL

ADVERSE REACTIONS :
*Generalized reactions
 Dermatitis and pruritus
 Joint pain
 Anorexia
 Nausea and vomiting
SEVERE REACTIONS:
 Anaphylactoid reactions (exaggerated allergic reaction)
 Optic Neuritis ( decreased in visual acuity and changes in color perception)
 CONTRAINDICATIONS

 Ethambutol is not recommended for patients with history of

hypersensitivity to drug or children younger than 13 yrs.

PRECAUTIONS
 Used with caution during pregnancy category B
 In patients with hepatic and renal impairment
 With diabetic retinopathy or cataracts
 ISONIAZID

ADVERSE REACTIONS
*Generalized Reactions
 Nausea and vomiting
 Epigastric distress
 Fever
 Skin eruptions
 Hematologic changes
 Jaundice
 hypersensitivity
PRECAUTION
Toxicity
*peripheral neuropathy (numbness and tingling of extremities) is the most common symptoms of
toxicity.
CONTRAINDICATIONS
*Severe and sometimes fatal, hepatitis has been associated with isoniazid therapy and may appear
after many months of treatment.

-is contraindicated to patients with a history of hypersensitivityn to drug.

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

Interacting Drug Common Use Effect of interaction

Antacids containing aluminum salts Relief of heartburn and Reduced absorption of isoniazid
gastrointestinal upset

Anticoagulants Blood thinner Increased risk for bleeding

Phenytoin Antiseizure drug Increased serum levels pf phenytoin

Alcohol (in beverages) Calming effect Higher incidence of drug-related

hepatitis
 PYRAZINAMIDE

ADVERSE REACTIONS:
*Generalized Reactions
 Nausea and vomiting
 Diarrhea
 Myalgia (aches)
 Rashes
Hepatotoxicity
 jaundice
 CONTRAINDICATIONS

-Is contraindicated to patients with a history of hypersensitivity to

drugs, acute gout ( a metabolic disorder resulting in increased levels of
uric acid and causing severe joint pain)
-severe hepatic damage.

PRECAUTION
-should be used cautiously to pt. during pregnancy (category C) and
lactation and in patients with hepatic and renal impairment, HIV
infection, and diabetes mellitus.
INTERACTIONS

When pyrazinamide is administered

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

 ADVERSE REACTIONS
*Generalized Reactions
 Nausea and vomiting
 Epigastric distress, heart burn, fatigue
 Vertigo (dizziness)
 Rash
 Reddish-orange discoloration of body fluids (urine, tears, sweat, saliva and
sputum)
 CONTRAINDICATIONS

 Rifampinis contraindicated in patients with a history of

hypersensitivity to the drug.

PRECAUTIONS

 The drug is cautiously given to pregnant (category C) and

lactation and to pt. who has hepatic and renal impairment
INTERACTION
Interacting Drug Common Use Effect of Interaction
digoxin Management of cardiac problems Decreased serum levels of digoxin
Oral contraceptives Birth control Decreased contraceptive
effectiveness
isoniazid Antitubercular agent Higher risk of hepatotoxicity
Oral anticoagulants Blood thinner Increased risk for bleeding
Oral hypoglycemics Antidiabetic agent Decreased effectiveness of
hypoglycemic agent
chloramphenicol Anti-infective agent Increased risk for seizures
Phenytoin Antiseizure agent Decreased effectiveness of
phenytoin
verapamil Management of cardiac problems Decreased effectiveness of
and blood pressure verapami
 NURSING RESPONSIBILITIES

 Assess the family health history and history of contacts to person who has active TB.
 Nurse should observe for adverse effects daily when the pt is admitted.
 Monitor vital sign of the patient frequently or every 4 hours when admitted.
 The nurse should promote optimal response to therapy
 When drug is administered through parenteral route, the nurse is careful to rotate the injection.
 At the time of injection, the nurse should inspects previous injection sites for signs of swelling,
redness and tenderness.
 Ethambutol should be given at the same time daily and may be given without regard to food.
 Pyrazinamide may also be given with food
 The nurse should give other antitubercular drugs by oral route an on empty stomach , unless gastric upset
occurs.
 If a dose is missed, the nurse should tell the pt. not to double the dose the next day.
 The nurse teaches the pt. to minimize alcohol consumption because of increased hepatitis.
 In an DOTS, nurse should watches the pt. swallow each dose of medication.
 Explain further to the SO or to the family.
 Evaluate therapeutic effect