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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Pharmacology
Concepts Covered:
- Concepts of Pharmacology
- Test Taking Strategies
- Prefixes
- Suffixes
- Bipolar Disorders
- Immunological Disorders
- Medication Administration
- Learning Pharmacology
- Dosage Calculations
- Noninfectious Respiratory Disorder
- Anxiety Disorders
- Substance Abuse Disorders
- Adult
- Cardiac Disorders
- Cardiovascular Disorders
- Hematologic Disorders
- Central Nervous System Disorders – Brain
- Depressive Disorders
- Disorders of Pancreas
- Liver & Gallbladder Disorders
- Upper GI Disorders
- Urinary System
- Pregnancy Risks
- Microbiology
- Infectious Respiratory Disorder
- Respiratory Disorders
- Shock
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Personality Disorders
- Psychotic Disorders
- Nervous System
- Labor Complications
- Postpartum Complications
- Prenatal Concepts
- Newborn Care
- Musculoskeletal Trauma
- Intraoperative Nursing
- Vascular Disorders
- Disorders of the Posterior Pituitary Gland
- Oncology Disorders
- EENT Disorders
- Emergency Care of the Cardiac Patient
- Female Reproductive Disorders
- Gastrointestinal Disorders
- Lower GI Disorders
- Neurologic and Cognitive Disorders
- Acute & Chronic Renal Disorders
- Urinary Disorders
- Disorders of the Adrenal Gland
- Integumentary Disorders
- Neurological
- Postoperative Nursing
- Peripheral Nervous System Disorders
- Disorders of the Thyroid & Parathyroid Glands
- Cardiovascular
Study Plan Lessons
Pharmacology Course Introduction
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
Pharmacodynamics
Pharmacokinetics
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method – O
The SOCK Method – C
The SOCK Method – K
Basics of Calculations
Oral Medications
Injectable Medications
IV Infusions (Solutions)
Complex Calculations (Dosage Calculations/Med Math)
Interactive Pharmacology Practice
Interactive Practice Drip Calculations
Pediatric Dosage Calculations
Disease Specific Medications
Antianxiety Meds
Benzodiazepines
ACLS (Advanced cardiac life support) Drugs
Anti-Platelet Aggregate
NG Tube Medication Administration
Coumarins
Thrombin Inhibitors
Thrombolytics
Anticonvulsants
Antidepressants
MAOIs
SSRIs
TCAs
Antidiabetic Agents
Insulin
Insulin – Mixtures (70/30)
Histamine 1 Receptor Blockers
Histamine 2 Receptor Blockers
Renin Angiotensin Aldosterone System
Sympatholytics (Alpha & Beta Blockers)
ACE (angiotensin-converting enzyme) Inhibitors
Angiotensin Receptor Blockers
Calcium Channel Blockers
Cardiac Glycosides
Anti-Infective – Aminoglycosides
Anti-Infective – Antifungals
Anti-Infective – Antitubercular
Anti-Infective – Antivirals
Anti-Infective – Carbapenems
Anti-Infective – Fluoroquinolones
Anti-Infective – Glycopeptide
Anti-Infective – Lincosamide
Anti-Infective – Macrolides
Anti-Infective – Penicillins and Cephalosporins
Anti-Infective – Sulfonamides
Anti-Infective – Tetracyclines
Atypical Antipsychotics
Antipsychotics
Autonomic Nervous System (ANS)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Bronchodilators
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Proton Pump Inhibitors
Epoetin Alfa
HMG-CoA Reductase Inhibitors (Statins)
Magnesium Sulfate
Mood Stabilizers
NSAIDs
Tocolytics
Meds for Postpartum Hemorrhage (PPH)
Prostaglandins in Pregnancy
Rh Immune Globulin in Pregnancy
Lung Surfactant for Newborns
Eye Prophylaxis for Newborn
Phytonadione (Vitamin K) for Newborn
Opioids
Opioid Analgesics in Pregnancy
Sedatives-Hypnotics
Barbiturates
Anesthetic Agents
Corticosteroids
Betamethasone and Dexamethasone in Pregnancy
Hydralazine
Nitro Compounds
Vasopressin
ACLS (Advanced cardiac life support) Drugs
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
Anticonvulsants
Antidiabetic Agents
Sympatholytics (Alpha & Beta Blockers)
Anti-Infective – Antitubercular
Anti-Infective – Glycopeptide
Bronchodilators
Opioids
Barbiturates
Anesthetic Agents
Antineoplastics
Alkylating Agents
Antimetabolites
Anti Tumor Antibiotics
Plant Alkaloids Topoisomerase and Mitotic Inhibitors
Patient Controlled Analgesia (PCA)
Epidural
Insulin Drips
Acetaminophen (Tylenol) Nursing Considerations
Acyclovir (Zovirax) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
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Hepatitis B Vaccine for Newborns
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Procainamide (Pronestyl) Nursing Considerations
Promethazine (Phenergan) Nursing Considerations
Propofol (Diprivan) Nursing Considerations
Propranolol (Inderal) Nursing Considerations
Propylthiouracil (PTU) Nursing Considerations
Quetiapine (Seroquel) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
Rifampin (Rifadin) Nursing Considerations
Salmeterol (Serevent) Nursing Considerations
Selegiline (Eldepyrl) Nursing Considerations
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Streptokinase (Streptase) Nursing Considerations
Sucralfate (Carafate) Nursing Considerations
Terbutaline (Brethine) Nursing Considerations
Tetracycline (Panmycin) Nursing Considerations
Trimethoprim-Sulfamethoxazole (Bactrim) Nursing Considerations
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Vancomycin (Vancocin) Nursing Considerations
Vasopressin (Pitressin) Nursing Considerations
Verapamil (Calan) Nursing Considerations
Warfarin (Coumadin) Nursing Considerations
02.01 Hypertensive Crisis for CCRN Review