Anti-Infective – Antitubercular
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Outline
Overview
I. Overview
A. Mycobacterium
B. Tuberculosis (TB) infections
1. Pulmonary
2. Extrapulmonary
II. Mechanism of Action
A. Inhibit protein synthesis
B. Inhibit cell wall synthesis
III. Types (RIPES)
A. Rifampin
B. Isoniazid
C. Pyrazinamide
D. Ethambutol
E. Streptomycin
IV. Indications
A. Mycobacterium
B. Tuberculosis (TB) infections
1. Pulmonary
2. Extrapulmonary
3. TB treatment failures / relapses
V. Contraindications
A. Liver disease
B. Kidney disease
VI. Side Effects
A. CNS
1. Ototoxicity
2. Seizures
3. Visual disturbances
4. Dizziness
5. Headache
Kidney / Liver
1. Nephrotoxicity
2. Hepatoxicity
B. * Rifampin / Isoniazid
1. Red-orange-brown colored bodily secretion
2. Urine
3. Sweat
4. Tears
5. Sputum
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Transcript
Welcome back and today we are going to discuss antitubercular medications.
Antitubercular medications treat mycobacterium and TB infections which are pulmonary and extrapulmonary (kidney, spine or brain). With the most common location is pulmonary.
The mechanisms of actions are the inhibition of protein synthesis (which work in RNA/DNA replication – how bacteria communicate) and cell wall synthesis (which provide structural support). There are many drugs in this drug class but each drug performs one of these actions. So this drug class stop the bacteria from being able to replicate and function. Antitubercular medications treat mycobacterium and TB infections which are pulmonary and extrapulmonary (kidney, spine or brain). With the most common location is pulmonary.
Now, the types of drugs in the antitubercular section include the following. An easy way to remember these is the word RIPES – with the top two being rifampin and isoniazid. Years ago, I had a patient (who visited Florida from Africa) on rifampin and isoniazid who had HIV. TB is a common cause of death in this patient population who reside in Africa.
Now, the indications are two-fold mycobacterium and TB. Mycobacterium comes in many forms, focus only on the word “mycobacterium” and you will be fine. If you see mycobacterium, I want to immediately think antitubercular medications. And TB is again pulmonary or extrapulmonary (kidney, spine, brain). Now these drugs aren’t medications a patient is going to get for a few days. These drugs are usually given for 6-9 months on strict regimen and require strict monitoring for compliance. Please refer to the tuberculous lesson in the respiratory course for more details.
Contraindications are based in the drug’s excretion route (kidney and liver). If you have liver or kidney failure, you will not properly dispose of the drug. I had a patient with liver disease, who was administered rifampin, that drug lingered their system for days, causing all kinds of havoc. The side effect profiles are CNS and liver/kidney based. In the CNS, think ears, brain and eyes. And the drugs cause kidney and liver toxicity, which explains the contraindications mentioned earlier.
Contraindications are based in the drug’s excretion route (kidney and liver). If you have liver or kidney failure, you will not properly dispose of the drug. I had a patient with liver disease, who was administered rifampin, that drug lingered their system for days, causing all kinds of havoc. The side effect profiles are CNS and liver/kidney based. In the CNS, think ears, brain and eyes. And the drugs cause kidney and liver toxicity, which explains the contraindications mentioned earlier.
Alright, rifampin and isoniazid both have a unique side effect of red-orange-brown colored bodily secretions. I had a patient with orange sputum once, it’s something you will not forget and something you must educate your patients as a possible side effect or they will be in in the hospital freaking out! As, rightfully so.
Priority nursing concepts for a patient taking antitubercular medications include: infection control and pharmacology.
Antitubercular medications treat mycobacterium and TB infections – pulmonary and extrapulmonary (kidney, spine or brain). Any easy way to remember the types is RIPES, with Contraindications are based in the drug’s excretion route (kidney and liver). Side effects focus on ears, brain and eyes. And a special note is isoniazid / rifampin’s ability to turn your bodily fluids red-orange-brown.
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Pharmocology
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Study Plan Lessons
12 Points to Answering Pharmacology Questions
54 Common Medication Prefixes and Suffixes
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Essential NCLEX Meds by Class
6 Rights of Medication Administration
Renin Angiotensin Aldosterone System
ACE (angiotensin-converting enzyme) Inhibitors
Angiotensin Receptor Blockers
Atypical Antipsychotics
Autonomic Nervous System (ANS)
Benzodiazepines
Cardiac Glycosides
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Epoetin Alfa
Histamine 1 Receptor Blockers
Histamine 2 Receptor Blockers
Hydralazine
HMG-CoA Reductase Inhibitors (Statins)
Insulin
Magnesium Sulfate
MAOIs
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Nitro Compounds
Nitro Compounds
Parasympatholytics (Anticholinergics) Nursing Considerations
Anti-Infective – Penicillins and Cephalosporins
Proton Pump Inhibitors
SSRIs
TCAs
Vasopressin
Disease Specific Medications
NG Tube Medication Administration
Pharmacodynamics
Pharmacokinetics
Basics of Calculations
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Oral Medications
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IV Infusions (Solutions)
Complex Calculations (Dosage Calculations/Med Math)
The SOCK Method – S
The SOCK Method – C
The SOCK Method – K
The SOCK Method – O
The SOCK Method – Overview
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
ACLS (Advanced cardiac life support) Drugs
Parasympathomimetics (Cholinergics) Nursing Considerations
Anti-Infective – Aminoglycosides
Anti-Infective – Carbapenems
Anti-Infective – Macrolides
Anti-Infective – Fluoroquinolones
Anti-Infective – Sulfonamides
Anti-Infective – Tetracyclines
Anti-Infective – Antifungals
Anti-Infective – Antivirals
Acyclovir (Zovirax) Nursing Considerations
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Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Meds for Postpartum Hemorrhage (PPH)
Opioid Analgesics in Pregnancy
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Anti-Infective – Antitubercular
Antidepressants
Thrombin Inhibitors
Hepatitis B Vaccine for Newborns
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Eye Prophylaxis for Newborn
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Prostaglandins in Pregnancy
Rh Immune Globulin in Pregnancy
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Thrombolytics
Antidiabetic Agents
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Anti-Infective – Aminoglycosides
Anti-Infective – Carbapenems
Anti-Infective – Macrolides
Anti-Infective – Fluoroquinolones
Anti-Infective – Sulfonamides
Anti-Infective – Tetracyclines
Anti-Infective – Antifungals
Anti-Infective – Antivirals
Anti-Infective – Lincosamide
Thrombolytics
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Anti-Infective – Antitubercular
Anti-Infective – Glycopeptide
Bronchodilators
Opioids
Barbiturates
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Epidural
Patient Controlled Analgesia (PCA)
Insulin Drips
Interactive Practice Drip Calculations
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Plant Alkaloids Topoisomerase and Mitotic Inhibitors
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Anti Tumor Antibiotics
Captopril (Capoten) Nursing Considerations
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