Questions and Answers
What is the purpose of a Purified Protein Derivative (PPD) injection?
To detect exposure to the TB organism
What is a positive result indicated by in a PPD test?
Induration at the site of injection
What is the major effect of anti-Tubercular drug therapy?
Reduction of cough and reduction of infectiousness
What is a common adverse effect of INH therapy?
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What should patients be instructed to do while taking Rifampin?
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What should patients be monitored for during TB therapy?
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What should patients be informed about regarding their bodily fluids while taking certain TB medications?
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What is Isoniazid primarily used for?
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What laboratory tests should be monitored when administering Isoniazid?
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What is a common adverse effect of Rifabutin?
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What is the main concern regarding multidrug-resistant TB?
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What is the primary reason for the resurgence of TB in the United States in 1992?
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What is the definition of multidrug-resistant TB?
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Why is Ethambutol not recommended for pediatric patients younger than 13?
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What is the primary mechanism of NSAIDs' action in the body?
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Which of the following NSAIDs is NOT contraindicated in patients with a sulfa allergy?
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What is the primary indication for the use of allopurinol?
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What is the primary risk associated with the use of NSAIDs in patients with dehydration?
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Which of the following is a potential interaction between NSAIDs and other medications?
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What is the primary indication for the use of aspirin?
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What is the primary mechanism of action of probenecid?
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What is a crucial requirement for patients taking Lesinurad?
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What should patients be educated about when taking medications for gout?
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Why should salicylates not be given to children and teenagers?
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What laboratory studies should be performed before beginning therapy with NSAIDS?
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Why should NSAIDS be taken with food, milk, or an antacid?
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What is a condition that requires cautious use of NSAIDS?
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What is a therapeutic effect of NSAIDS in gout?
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How long may it take to see therapeutic effects of NSAIDS?
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What is an important aspect of nursing implications for NSAIDS?
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Patients with bleeding disorders are contraindicated to NSAIDS therapy.
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Sulfinpyrazone is a medication that requires good renal function.
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Lesinurad is a medication that can be used for long-term treatment of gout.
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Drinking at least 2 liters of fluid a day is recommended for patients taking NSAIDS.
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GI lesions or peptic ulcer disease are conditions that require cautious use of NSAIDS.
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Reye's Syndrome is a common adverse effect of NSAIDS in adults.
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NSAIDS are generally well-tolerated medications.
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Therapeutic effects of NSAIDS may be seen immediately after taking the medication.
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Monitor for a decrease in swelling, pain, stiffness, and tenderness of a joint or muscle area as a therapeutic effect of NSAIDS.
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Performing a medication history is not necessary before beginning NSAIDS therapy.
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Study Notes
Antitubercular Drugs
- First-line drugs:
- Isoniazid (INH): primary drug used, metabolized through the liver, contraindicated for patients with liver disease
- Rifapentine
- Ethambutol: first bacteriostatic drug used to treat TB, causes optic neuritis in pediatric patients
- Rifabutin: used to treat infections caused by non-TB mycobacterial species
- Pyrazinamide
- Rifampin
- Streptomycin
- Second-line drugs:
- Bedaquiline: used for multidrug-resistant TB
- Pretomanid: new drug used for only pulmonary multidrug-resistant TB
- Capreomycin
- Cycloserine
- Levofloxacin
- Ethionamide
- Oflaxacin
- Kanamycin
- Para-aminosalicycle (PAS)
TB Infection and Incidence
- Primary TB infection: first infectious episode
- Reinfection: can occur due to dormancy process
- Chronic form of the disease: may test positive for exposure but are not necessarily infectious
- Incidence:
- 1950s: TB incidence decreased in most years until about 1985
- 1985: TB incidence began to rise due to development of TB in patients coinfected with HIV
- 1992: Resurgence peak in the United States, but has decreased since then
- Current concern: increasing number of multidrug-resistant TB cases and nonadherence to prolonged treatment
PPD (Purified Protein Derivatives)
- Intradermal injection given in doses of 5 tuberculin units (0.1 ml) to detect exposure to TB organism
- Positive result indicated by induration (not erythema) at the site of injection
Anti-Tubercular Drug Therapy Considerations
- Patient cannot be sent home until medication regimen is determined to be working
- Major effects of drug therapy: reduction of cough and infectiousness of the patient
- Successful treatment: sometimes lasts for up to 12-24 months due to noncompliance and environmental factors
Adverse Effects and Nursing Implications
- INH: peripheral neuropathy, hepatotoxicity
- Ethambutol: retrobulbar neuritis, blindness
- Rifampin: hepatitis, discoloration of urine, stools, and other body fluids
- Patient education is critical: therapy may last up to 12-24 months, take medications exactly as ordered, and emphasize strict adherence to regimen
NSAIDs and Gout
Common Uses for NSAIDs
- Pain relief for mild or moderate headaches, myalgia, neuralgia, and arthralgia
- Treatment of gout and hyperuricemia
Adverse Effects of NSAIDs
- GI: heartburn to severe GI bleeding
- Acute renal failure
- Noncardiogenic pulmonary edema
- Increased risk of MI and stroke
- Altered hemostasis
- Hepatotoxicity
- Skin eruption, sensitivity reaction
- Tinnitus, hearing loss
- Interactions: serious interactions can occur with anticoagulants, aspirin, corticosteroids, and other ulcerogenic drugs
Renal Function and Black-Box Warning
- Renal function depends partly on prostaglandins
- Disruption of prostaglandin function by NSAIDs can precipitate acute or chronic renal disease
- Black-box warning: all NSAIDs (except aspirin) share an increased risk of adverse cardiovascular thrombotic events, including fatal MI and stroke
Specific NSAIDs
- Acetic acid derivatives:
- Diclofenac sodium (Voltaren)
- Indomethacin
- Sulindac
- Tolmetin
- Etodolac
- Ketorolac
- Cyclooxygenase-2 (COX-2) inhibitors:
- Celecoxib (Celebrex): first and only remaining COX-2 inhibitor
- Enolic acid derivatives:
- Nabumetone (Relafen)
- Meloxicam (Mobic)
- Piroxicam (Feldene)
- Propionic acid derivatives:
- Fenoprofen (Nalfon)
- Flurbiprofen (Ansaid)
- Ibuprofen (Motrin, Advil)
- Ketoprofen (Orudis KT)
- Naproxen (Naprosyn, Aleve)
- Oxaprozin (Daypro)
- Aspirin:
- Good for heart health
- Used for headache, neuralgia, myalgia, and arthralgia
Gout and Hyperuricemia
- Gout: condition that results from inappropriate uric acid metabolism
- Hyperuricemia: underexcretion or overproduction of uric acid
- Antigout medications:
- Allopurinol
- Febuxostat
- Colchine
- Probenecid
- Lesinurad
- Sulfinpyrazone
Antitubercular Drugs
- First-line drugs:
- Isoniazid (INH): primary drug used, metabolized through the liver, contraindicated for patients with liver disease
- Rifapentine
- Ethambutol: first bacteriostatic drug used to treat TB, causes optic neuritis in pediatric patients
- Rifabutin: used to treat infections caused by non-TB mycobacterial species
- Pyrazinamide
- Rifampin
- Streptomycin
- Second-line drugs:
- Bedaquiline: used for multidrug-resistant TB
- Pretomanid: new drug used for only pulmonary multidrug-resistant TB
- Capreomycin
- Cycloserine
- Levofloxacin
- Ethionamide
- Oflaxacin
- Kanamycin
- Para-aminosalicycle (PAS)
TB Infection and Incidence
- Primary TB infection: first infectious episode
- Reinfection: can occur due to dormancy process
- Chronic form of the disease: may test positive for exposure but are not necessarily infectious
- Incidence:
- 1950s: TB incidence decreased in most years until about 1985
- 1985: TB incidence began to rise due to development of TB in patients coinfected with HIV
- 1992: Resurgence peak in the United States, but has decreased since then
- Current concern: increasing number of multidrug-resistant TB cases and nonadherence to prolonged treatment
PPD (Purified Protein Derivatives)
- Intradermal injection given in doses of 5 tuberculin units (0.1 ml) to detect exposure to TB organism
- Positive result indicated by induration (not erythema) at the site of injection
Anti-Tubercular Drug Therapy Considerations
- Patient cannot be sent home until medication regimen is determined to be working
- Major effects of drug therapy: reduction of cough and infectiousness of the patient
- Successful treatment: sometimes lasts for up to 12-24 months due to noncompliance and environmental factors
Adverse Effects and Nursing Implications
- INH: peripheral neuropathy, hepatotoxicity
- Ethambutol: retrobulbar neuritis, blindness
- Rifampin: hepatitis, discoloration of urine, stools, and other body fluids
- Patient education is critical: therapy may last up to 12-24 months, take medications exactly as ordered, and emphasize strict adherence to regimen
NSAIDs and Gout
Common Uses for NSAIDs
- Pain relief for mild or moderate headaches, myalgia, neuralgia, and arthralgia
- Treatment of gout and hyperuricemia
Adverse Effects of NSAIDs
- GI: heartburn to severe GI bleeding
- Acute renal failure
- Noncardiogenic pulmonary edema
- Increased risk of MI and stroke
- Altered hemostasis
- Hepatotoxicity
- Skin eruption, sensitivity reaction
- Tinnitus, hearing loss
- Interactions: serious interactions can occur with anticoagulants, aspirin, corticosteroids, and other ulcerogenic drugs
Renal Function and Black-Box Warning
- Renal function depends partly on prostaglandins
- Disruption of prostaglandin function by NSAIDs can precipitate acute or chronic renal disease
- Black-box warning: all NSAIDs (except aspirin) share an increased risk of adverse cardiovascular thrombotic events, including fatal MI and stroke
Specific NSAIDs
- Acetic acid derivatives:
- Diclofenac sodium (Voltaren)
- Indomethacin
- Sulindac
- Tolmetin
- Etodolac
- Ketorolac
- Cyclooxygenase-2 (COX-2) inhibitors:
- Celecoxib (Celebrex): first and only remaining COX-2 inhibitor
- Enolic acid derivatives:
- Nabumetone (Relafen)
- Meloxicam (Mobic)
- Piroxicam (Feldene)
- Propionic acid derivatives:
- Fenoprofen (Nalfon)
- Flurbiprofen (Ansaid)
- Ibuprofen (Motrin, Advil)
- Ketoprofen (Orudis KT)
- Naproxen (Naprosyn, Aleve)
- Oxaprozin (Daypro)
- Aspirin:
- Good for heart health
- Used for headache, neuralgia, myalgia, and arthralgia
Gout and Hyperuricemia
- Gout: condition that results from inappropriate uric acid metabolism
- Hyperuricemia: underexcretion or overproduction of uric acid
- Antigout medications:
- Allopurinol
- Febuxostat
- Colchine
- Probenecid
- Lesinurad
- Sulfinpyrazone
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Description
Learn about first line drugs used to treat tuberculosis, including Isoniazid, Rifapentine, Ethambutol, and Rifabutin. Understand their effects, contraindications, and monitoring requirements.
