Questions and Answers
What is a primary reason for using combination therapy in the treatment of tuberculosis?
Mycobacteria grow faster than most other bacteria.
False
Name two first-line anti-tuberculosis drugs.
Isoniazid and Rifampicin
The treatment for tuberculosis often lasts for several ______.
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Match the following anti-tuberculosis drugs with their effects:
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Which of the following statements is true regarding the mycobacterial cell wall?
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Adverse effects monitoring is not necessary during anti-tuberculosis therapy.
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Explain why drug-resistant strains of Mycobacteria are a concern in tuberculosis treatment.
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What is the mechanism of action of Ethambutol?
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Rifampin can diminish the effectiveness of oral contraceptives.
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What are the common adverse effects associated with Ethambutol?
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Rifampin can increase the effectiveness of __________ medications, specifically protease inhibitors.
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Match the following nursing interventions with their related actions:
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What is a primary consequence of concurrent use of Rifampin with INH and pyrazinamide?
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Ethambutol should be used alone for treating tuberculosis due to its efficacy.
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What is an indication of effective tuberculosis treatment?
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What is the primary mechanism of action of Ethionamide?
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Streptomycin is safe to use for extended periods without any concerns for toxicity.
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List two common adverse effects of Streptomycin.
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Streptomycin should be limited to no more than ___ months to reduce toxicity.
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Under what circumstances are second-line drugs for tuberculosis typically considered?
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Match the following second-line drugs with their daily dosages:
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Isoniazid is a second-line drug for the treatment of tuberculosis.
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What should be monitored while administering Streptomycin due to its potential toxicity?
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Study Notes
Clinical Use in Tuberculosis
- Streptomycin sulfate is used for injectable treatment options and antibiotic-resistant infections.
- Typical dosage: 15 mg/kg/day intramuscularly or intravenously for adults, 20-40 mg/kg/day for children (max 1 g).
- Initial treatment phase lasts several weeks, then 15 mg/kg two or three times weekly for several months.
Adverse Reactions
- Streptomycin is known for ototoxicity and nephrotoxicity.
- Common adverse effects include vertigo and hearing loss, which may be permanent.
- Dose-related toxicity is particularly risky for the elderly.
- Dosage must be adjusted based on renal function and limited to 6 months to reduce toxicity.
First-line Anti-mycobacterial Agents
- Isoniazid: 300 mg/day
- Rifampin: 600 mg/day
- Pyrazinamide: 25 mg/kg/day
- Ethambutol: 15-25 mg/kg/day
- Weekly Streptomycin: 15 mg/kg/day
Second-line Drugs for Tuberculosis
- Utilized for resistance to first-line agents, clinical failure of conventional therapy, or serious adverse reactions.
- Requires expert guidance for managing toxic effects.
- Includes:
- Amikacin: 15 mg/kg/day
- Aminosalicylic acid: 8-12 g/day
- Bedaquiline: 400 mg/day
- Capreomycin: 15 mg/kg/day
- Clofazimine: 200 mg/day
- Cycloserine: 500-1000 mg/day (divided doses)
- Ethionamide: 500-750 mg/day
- Levofloxacin: 500-750 mg/day
- Linezolid: 600 mg/day
- Moxifloxacin: 400 mg/day
- Rifabutin: 300 mg/day
- Rifapentine: 600 mg
Ethionamide
- Related to isoniazid; inhibits mycolic acid synthesis.
- Poorly water-soluble; only available for oral use.
- Metabolized in the liver and hepatotoxic.
Introduction to Mycobacteria
- Mycobacteria show intrinsic resistance to most antibiotics and grow slowly, limiting effectiveness of rapid-action antibiotics.
- Mycobacterial cells can be dormant, presenting further resistance challenges.
- Their lipid-rich cell wall is impermeable, necessitating combination therapy to prevent resistance.
- Mycobacterial infections, such as tuberculosis and leprosy, require prolonged treatment, typically lasting months to years.
Principles of Anti-tuberculosis Treatment
- Combination therapy reduces the risk of developing resistance and quickly decreases bacterial load.
- Fixed-dose combination (FDC) tablets are common to prevent resistance emergence.
- First-line anti-TB drugs: isoniazid, ethambutol, rifampicin, pyrazinamide, and streptomycin.
- Mild gastrointestinal discomfort is a side effect but usually requires no intervention.
Contraindications/Precautions
- Use caution in patients with liver dysfunction; monitor liver function closely.
Drug Interactions and Client Education
- Rifampin can accelerate metabolism of warfarin, oral contraceptives, and certain HIV medications, potentially necessitating dosage adjustments.
- Recommend alternative birth control methods for clients on rifampin.
- Avoid alcohol consumption alongside hepatotoxic agents like INH and pyrazinamide; monitor liver function.
Nursing Evaluation of Medication Effectiveness
- Effectiveness can be noted through improved symptoms (e.g., clear breath sounds, increased appetite) and resolution of temperature elevations.
- Typically, achieving three negative sputum cultures for tuberculosis can take 3-6 months.
Ethambutol
- Water-soluble and heat-stable pharmacological agent.
- Inhibits mycobacterial arabinosyl transferases crucial for cell wall integrity.
- Rapid resistance develops if used as monotherapy.
- Well absorbed from the gastrointestinal tract, metabolized in the liver, and excreted via urine.
- Therapeutic levels reached in the central nervous system for tuberculosis treatment.
- Common adverse effect is optic neuritis, leading to visual disturbances, especially in those with renal function impairment.
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Description
This quiz covers the clinical use of streptomycin and other anti-mycobacterial agents in the treatment of tuberculosis. It discusses dosages, adverse effects, and the use of first and second-line drugs. Test your knowledge on the important aspects of tuberculosis therapy!
