Antituberculars NUR 210 Unit 8 PDF

Antituberculars NUR 210 Unit 8  Etiology Mycobacterium tuberculosis ◦ Acid-fast bacillus Transmission Person to person via droplets Tuberculosis ◦ Coughing, sneezing, talking...

Antituberculars NUR 210 Unit 8  Etiology Mycobacterium tuberculosis ◦ Acid-fast bacillus Transmission Person to person via droplets Tuberculosis ◦ Coughing, sneezing, talking clients at risk Immunocompromised Living or working in high-risk residential settings Injecting illegal drugs Health care workers with high-risk clients  Symptoms Cough Fever Night sweats Tuberculosis Anorexia Weight loss Chest pain Positive acid-fast bacilli in the sputum Bloody sputum  Drug combinations Antitubercular Single-drug therapy ◦ Not used as it is ineffective Drugs Multidrug therapy ◦ Decreases bacterial resistance to drug ◦ Treatment duration decreased  Treatment regimen Divided into 2 phases Phase 1 ◦ *Isoniazid, *rifampin, rifabutin, rifapentine, pyrazinamide, ethambutol, and streptomycin ◦ More effective than second-line Antitubercular ◦ Less toxic than second-line Drugs ◦ Duration: approximately 2 months Phase 2 ◦ Para-aminosalicylic acid, kanamycin, cycloserine, ethionamide, capreomycin, pyrazinamide, and others ◦ Less effective ◦ More toxic ◦ Duration: approximately 4 to 7 months ◦ * Need to know  Antitubercular Action Drugs: Inhibits bacterial cell-wall synthesis isoniazid & rifampin Uses Treat tuberculosis; prophylactic use against tuberculosis  Side effects Drowsiness Photosensitivity Dizziness Antitubercular GI upset Drugs: Ocular toxicity – isoniazid ◦ Photosensitivity and blurred vision isoniazid & rifampin Rifampin – turns secretions orange Adverse Reactions ◦ Hepatoxicity ◦ Nephrotoxicity ◦ Optic neuritis ◦ Isoniazid - Vitamin B6 deficiency – peripheral neuropathy  Contraindications Antitubercular Severe renal or hepatic disease Drugs: Alcoholism isoniazid & rifampin Diabetic retinopathy Interactions Alcohol Antacids  Antitubercular Assessment Drugs: Medication/medical history isoniazid & rifampin PPD results, signs and symptoms of TB Culture results Obtain baseline LFT’s, BUN, and creatinine  Interventions/teaching ◦ Administer isoniazid 1 hour before meals or 2 hours after meals. ◦ Must follow complete regimen Antitubercular ◦ Collect sputum specimen in early morning. Drugs: ◦ Check liver enzymes, kidney function isoniazid & rifampin ◦ Need frequent eye examinations. ◦ Take vitamin B6 to help prevent peripheral neuropathy. ◦ Teach sun precautions, to avoid antacids. ◦ Teach rifampin can turn urine, feces, saliva, sputum, sweat, and tears red-orange. Contact lenses and clothing can be stained  A client has developed active tuberculosis and is prescribed isoniazid and rifampin. Which information will the nurse include in teaching the client about taking this drug? (Select all that apply.) Practice A. Isoniazid should be given 1 hour before or 2 Question #1 hours after meals. 1 B. Have periodic eye examinations as ordered by the health care provider. C. Compliance with drug regimen is essential. D. Report numbness, tingling, and burning of hands and feet. E. Warn client that rifampin may turn body fluids a harmless green color.  Answer: A, B, C, D Rationale: Isoniazid should be given 1 hour before or 2 hours after meals for Practice better absorption. Periodic eye Question #1 examinations should be done as these 1 drugs may cause visual disturbances. Compliance with drug regimen is essential to prevent drug resistance. Numbness, tingling, or burning of hands and feet should be reported. Rifampin may turn body fluids a harmless reddish orange color.  A middle-aged adult is diagnosed with tuberculosis. Which is true of treatment for this diagnosis? Practice Question #2 A. Treatment may take about 10 days to 2 1 weeks. B. Usually two to three agents are needed. C. The bacteria is usually resistant to treatment therapy. D. Treatment for tuberculosis is usually without side effects.  Answer: B Practice Rationale: Single-drug therapy for TB is not effective. Usually two to three drugs are Question #2 needed. The total treatment plan is usually 6 to 1 9 months. Although unusual, resistance can occur. The client should be taught methods to prevent and report side effects and adverse reactions to therapy.  When teaching a client about isoniazid (INH) and rifampin drug therapy, which statement will the nurse include? Practice A. “Take isoniazid with meals.” Question #3 B. “Double the amount of vitamin C in your 1 diet to prevent the peripheral neuropathy associated with isoniazid therapy.” C. “Notify the primary health care provider immediately if your urine turns a red- orange color.” D. “Avoid exposure to direct sunlight.”  Answer: D Rationale: The client should be taught to Practice avoid direct sunlight. The client should be taught that INH should be administered 1 Question #3 hour before or 2 hours after meals. 1 Pyridoxine (vitamin B6) is used with INH therapy to decrease peripheral neuropathy. Rifampin use causes the urine to turn a red-orange color.