Tuberculosis (TB): First-line Drugs – Antimycobacterial Agents (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Okay, so let's look at the old standby isoniazid.

    00:03 It's used for active and latent TB, it's been around forever, it's effective, it's relatively safe and it's pretty cheap.

    00:11 It's a bactericidal - you know, it can either be bacteriostatic, which kind of suppresses growth or bactericidal that means it kills those bugs.

    00:20 This one, kills those bugs - but you've got to be on it for at least six months.

    00:25 Now that’s a really long time for anybody.

    00:28 Now the adverse effects are it might have some peripheral neuropathy, it's hepatotoxicity - meaning toxic to your liver.

    00:38 You can have some optic neuritis, that inflammation of that and anemia, a low red blood cell count.

    00:45 So it is relatively safe and inexpensive but it can have these adverse effects, none of those are we interested in but if the patient is on this medication, and if they have regular TB, odds are they're going to be on this medication, we wanna teach them to watch for any sign of these four adverse effects, so they can let us know immediately and we can work with their healthcare provider.

    01:08 Now, rifampin is a broad spectrum antibiotic.

    01:12 It's got some adverse effects that are similar.

    01:15 It can have hepatotoxic or can cause an inflammation of your liver.

    01:19 It will definitely discolor your body fluids.

    01:23 I'm only laughing because it is very unkind if you don’t let your patients know, hey, when you take this medication, the first time you pee, you're gonna be very scared when you're done and you turn around and look and everyone turns around and looks after they go to the bathroom - whether they admit it or not, but it is gonna be this funky, oranges color - so warn your patients so they don’t think something is going drastically wrong in their body, rifampin will just do that.

    01:53 And it kinda upset their stomach, but again, like we always say, any oral medication can upset your stomach.

    01:59 Now there's some others but they're not very common so I'm not gonna tie up your brain space with that.

    02:04 Drug interactions.

    02:05 Rifampin can induce the P450 in your liver and that can rip through some other drugs, so if you notice some changes in some other medications that you're taking, let your healthcare provider know so they can see if there's an adverse in drug interaction with your rifampin and P450.

    02:24 Okay, oral contraceptives. We've talk before in our video series that we used to say that all antibiotics will make oral contraceptives ineffective, but really what we found recently is that rifampin is the only one that for sure, who’ll mess with your oral contraceptives.

    02:41 So if someone is taking oral contraceptives and then you take rifampin, their oral contraceptives are not gonna be as effective so you need to counsel them about that.

    02:51 It can also mess with warfarin and drugs for IV infection.

    02:55 So you wanna do a very good patient history assessment, know what other medications that they're on, work with your pharmacists, collaborate with them and see if there's any drug to drug interactions which we're already aware of.

    03:08 Now, pyrazinamide, it’s bactericidal.

    03:11 I know you know what that is, I mean, it kills those bugs, so that’s cool but it also has an adverse effect of hepatotoxicity.

    03:19 Whoa, stop, for just a minute.

    03:22 We've talked about three drugs and they’ve had one adverse effect in common, what is it? Good call, its right there on the screen, hepatotoxicity.

    03:35 So these drugs are kinda hard on your liver.

    03:37 Any drug that’s hard on your liver doesn’t make you feel good so remember that.

    03:42 It’s difficult for patients to follow TB medications because some people just feel yucky, general malaise, when they're taking these medications, which is why it’s hard to convince them to keep taking those medications.

    03:56 Now we talked about pain, you can have non-gouty arthralgia’s, joint pain, and hyperuricemia which can lead to gouty joint pains so bambam -- that’s a double whammy.

    04:09 We're talking about what kinda upsets their stomach and it makes them photosensitive which meaning they should not be out in the sun without sunscreen which is actually a good role for everybody but you definitely know whether they're much more likely to burn when they're on a medication like this.

    04:26 Okay, ethambutol is active only against mycobacteria and nearly all strains of tuberculosis.

    04:33 Cool. They all still kind of remain sensitive.

    04:36 Hopefully, we can hang on to that edge.

    04:39 Now it’s active against tubercle bacilli that are resistant to isoniazid and rifampin, circle that.

    04:46 That’s super cool thing, that’s great that we have this weapon in our arsenal.

    04:51 Now the initial treatment of TB in treatment of patients who have received therapy previously, this one is likely to be included but it’s always used as a part of a multidrug regimen.

    05:02 Man, you gotta take that point away from you from this presentation.

    05:05 Multidrugs, multidrugs, multidrugs - usually more than two.

    05:10 You saw back on the CDC we talked about four when we started, right? And then you got it down to two but originally it started with at least four.

    05:18 So the adverse effects are optic neuritis, this comes with some other kinda mild ones but ethambutol, overall, has to be used with other medications.

    05:25 In optic neuritis it’s really the most serious one that it has.

    05:30 So now that we've got our patients, they're engaged, they're willing to take the therapy, they're continuing to take the therapy - we have to help them know how are we gonna know if this is working? Well, would you, bacteriologic evaluation of their sputum, where we talked about some of those, we’ll clinically evaluate them with their symptoms.

    05:47 Do they have a fever? Are they still coughing? Have they noticed anything weird in their sputum? Do they feel tired? How are they doing with - are they having any night sweats? We’ll ask for all those kind of symptoms that we look for and we’d do a chest radiograph which is just a fancy way to say, chest x-ray.

    06:06 So these are the three ways, we're gonna evaluate how that therapy is going.

    06:10 We'll look at their sputum, we’ll look at their clinical evaluation and symptoms and we’ll do a full assessment and we’ll look at a chest x-ray.

    About the Lecture

    The lecture Tuberculosis (TB): First-line Drugs – Antimycobacterial Agents (Nursing) by Rhonda Lawes, PhD, RN is from the course Anti-Infective Drugs in Nursing.

    Included Quiz Questions

    1. Peripheral neuropathy, hepatoxicity, optic neuritis, and anemia
    2. Peripheral neuropathy, hepatoxicity, hyperuricemia, and photosensitivity
    3. Peripheral neuropathy, ototoxicity, gastrointestinal disturbances, and anemia
    4. Peripheral neuropathy, ototoxicity, optic neuritis, and photosensitivity
    1. Non-gouty arthralgias, hepatoxicity, hyperuricemia, gastrointestinal disturbances, and photosensitivity
    2. Non-gouty arthralgias, ototoxicity, hypercalcemia, gastrointestinal disturbances, and optic neuritis
    3. Non-gouty arthralgias, hepatoxicity, hypercalcemia, gastrointestinal disturbances, and anemia
    4. Non-gouty arthralgias, ototoxicity, hyperuricemia, gastrointestinal disturbances, and optic neuritis
    1. Oral contraceptives
    2. Warfarin
    3. Drugs for HIV infection
    4. Loop diuretics
    5. Lithium

    Author of lecture Tuberculosis (TB): First-line Drugs – Antimycobacterial Agents (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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