St. Joseph College of Cavite Inc.
Institute of Health Sciences
NAME: Juan Miguel AGE: 15 years old
ADDRESS: Gilid Brgy Mayamot Summerville Antipolo City
CHIEF COMPLAINT: Neck pain
Medication Mechanism of Action
Generic Name: Rifampicin
Rifampicin + Isoniazid + Rifampicin, a semisynthetic antibiotic
Pyrazinamide + derivative of Rifamycin, suppresses
Ethambutol HCl bacterial RNA synthesis by binding to
the b subunit of DNA-dependent RNA
Brand Name: polymerase, thus inhibiting the
attachment of the enzyme to DNA,
blocking RNA transcription, elongation,
Classification: and subsequent translation to protein.
Anti-infectives (systemic); It does not inhibit the counterpart
Antituberculosis mammalian enzyme.
Route: Rifampicin has bactericidal action and
Per Orem potent sterilizing effect against both
intracellular and extracellular tubercle
Dosage: bacilli. Cross resistance has been
150 mg/ 75 mg/ 400 mg/ shown only with other rifamycin
275 mg derivatives.
Frequency: Isoniazid
OD Isoniazid kills actively growing tubercle
bacilli by inhibiting the biosynthesis of
Form: mycolic acid which is the major
component of the cell wall of
Mycobacterium tuberculosis. It is active
Color: against susceptible bacteria only when
they are undergoing cell division.
Pyrazinamide
Pyrazinamide is the pyrazine analog of
nicotinamide. The precise mechanism
of action of pyrazinamide is unknown.
Its metabolite, pyrazinoic acid, which is
less active in vitro, may possibly be
DRUG STUDY
DRUG STUDY
SEX: Male RELIGION: Catholic ROOM NO: MTW
DATE OF ADMISSION: May 21, 2014
DIAGNOSIS: Compression Fracture C4-C5 Secondary to Pott's Disease
Specific Indication Contra-indication& Side effects Nursing Responsibilities
For the initial phase Contraindications:
treatment of all forms of May cause reddish-orange
pulmonary and Hypersensitivity to any ingredient in the product discoloration of urine, saliva, tears,
extrapulmonary Jaundice or severe liver disease sweat and sputum. Instruct the patient
tuberculosis. Acute gout that this is to be expected and not
Pre-existing optic neuritis from any cause harmful.
Rifampicin Monitor patient’s visual acuity, visual
fields, and red-green discrimination
High doses of rifampicin (>600 mg) given once or regularly as reversible optic neuritis
twice weekly have resulted in a high incidence of may be caused by Ethambutol.
adverse reactions including: the “flu-like” syndrome
(i.e., fever, chills, sometimes with headache, Instruct patients in proper oral
dizziness, and bone pain); hematopoietic reactions hygiene, including caution in the use
(i.e., leukopenia, thrombocytopenia, and acute of regular toothbrushes, dental floss,
hemolytic anemia); cutaneous; gastrointestinal and and toothpicks. The leukopenic and
hepatic reactions; dyspnea, wheezing; shock; and thrombocytopenic effects of Rifampin
acute renal failure. may result in an increased incidence
of certain microbial infections,
Hepatic: Elevations in serum concentrations of ALT, delayed healing, and gingival
AST, bilirubin, and alkaline phosphatase, bleeding. If leukopenia or
asymptomatic jaundice, and hepatitis. Rarely, thrombocytopenia occurs, dental work
hepatitis or shock-like syndrome with liver involvement should be defined until blood counts
and abnormal liver function test results. have returned to normal. Rifampin
may cause a hypersensitivity
Dermatologic: Rash, pruritus, urticaria, acneiform reaction of sores in mouth or tongue
eruptions, pemphigoid reaction, erythema multiforme
including Stevens-Johnson syndrome, toxic epidermal
necrolysis, vasculitis, exfoliative dermatitis, flushing, Patient monitoring:
and rarely, anaphylaxis.
Hepatic function determinations (ALT
Nervous system:Headache, drowsiness, fatigue, [SGPT], AST [SGOT], alkaline
dizziness, inability to concentrate, mental confusion, phosphatase, and
behavioral changes, psychosis, and generalized serum bilirubin determinations may be
involved in pyrazinamide’s in vivo numbness. indicated prior to and monthly or more
activity. frequently during
GI: Heartburn, epigastric distress, nausea, vomiting, treatment; however, elevated serum
Pyrazinamide is an effective anorexia, abdominal cramps, flatulence, diarrhea, enzyme values may not be predictive
bactericidal antituberculosis drug, and sore mouth and tongue, pseudomembranous colitis, of clinical hepatitis
has a specific sterilizing action against and pancreatic insufficiency. and may return to normal despite
Mycobacterium tuberculosis in the continued treatment; patients with
intracellular environment of Musculoskeletal: Ataxia, muscular weakness, impaired hepatic function
macrophages. The acid environment myopathy, and pain in muscles, joints and extremities. should not receive rifampin, isoniazid,
presumably in some way makes pyrazinamide, and ethambutol
Mycobacterium tuberculosis more Hematologic: Eosinophilia, leukopenia, purpura, combination unless it is crucial to
susceptible to pyrazinamide, but this hemolytic anemia, decreased hemoglobin therapy )
does not occur with Mycobacterium concentrations, hemolysis, thrombocytopenia,
bovis which is resistant to the drug. As disseminated intravascular dissemination, and Ophthalmologic examinations
with other antituberculous drugs, agranulocytosis. (symptoms of optic neuritis may occur
resistance to pyrazinamide develops either in adults or
rapidly if it is used alone to treat human Renal: Increased BUN and serum uric acid children during treatment due to
tuberculosis. concentrations, hemoglubinuria, light chain adverse effects of isoniazid and/or
proteinuria, hematuria, renal insufficiency, interstitial ethambutol
Ethambutol HCl nephritis, acute tubular necrosis, and acute renal
Ethambutol HCl diffuses into actively failure. Uric acid concentration
growing Mycobacteria cells such as (may be required during treatment,
tubercle bacilli. It inhibits the synthesis Endocrine: Precipitation of adrenocortical insufficiency since elevated serum uric acid
of one or more metabolites resulting in and menstrual disturbances. concentration frequently occur due
impaired cellular metabolism, arrested ethambutol and/or pyrazinamide,
cell multiplication and cell death. It is Opthalmologic: Visual disturbances and exudative possibly resulting
active against susceptible bacteria only conjunctivitis. in precipitation of acute gout
when they are undergoing cell division.
No cross-resistance with other agents Others: Fever, edema of face and extremities,
has been demonstrated. dyspnea, wheezing, hypotension, and shock.

Isoniazid

Hepatic: Mild liver dysfunction, as evidenced by mild

and transient elevations in serum concentrations of
ALT, AST, and bilirubin concentrations. Rarely,
progressive liver dysfunction, bilirubinuria, jaundice,
and severe and sometimes fatal hepatitis.

Dermatologic: Hypersensitivity reactions, including

fever, skin eruptions (morbilliform, maculopapular,
purpuric, or exfoliative), lymphadenopathy, vasculitis,
and, rarely, hypotension.

Nervous system: Seizures, convulsions, toxic

encephalopathy, stupor, euphoria, memory
impairment, separation of ideas and reality, loss of
self-control, dizziness, vertigo, and toxic psychosis.

Gastrointestinal: Nausea, vomiting, and epigastric

distress.

Musculoskeletal: Ataxia and muscle twitching.

Hematologic: Agranulocytosis, eosinophilia,

thrombocytopenia, methemoglobinemia, and
hemolytic, sideroblastic, or aplastic anemia.

Endocrine: Hyperglycemia and metabolic acidosis.

Opthalmologic: Optic neuritis and atrophy

Others: Tinnitus, peripheral neuritis usually preceded

by paresthesia of the feet and hands, dryness of the
mouth, pyridoxine deficiency, pellagra, hyperreflexia,
urinary retention, gynecomastia, systemic lupus
erythematosus-like syndrome, and rheumatic
syndrome with arthralgia.

Pyrazinamide

Hepatic: Hepatotoxicity appears to be dose-related,

and may appear at any time during therapy. Transient
increases in serum aminotransferase concentrations,
jaundice, hepatitis, liver tenderness, and
hepatomegaly have been reported.

Dermatologic: Hypersensitivity reactions, including

rash, urticaria and pruritus have been reported.
Rarely, maculopapular rash, acne, and
photosensitivity with reddish-brown discoloration of
exposed skin.

GI: Nausea, vomiting, and anorexia.

Hematologic: Rarely, porphyria, thrombocytopenia

and sideroblastic anemia with erythroid hyperplasia,
vacuolation of erythrocytes, increased serum iron
concentration, and adverse effects on blood clotting
mechanisms.

Renal: Dysuria and interstitial nephritis.

 Others: Fever, splenomegaly, malaise, and frequently
mild arthralgia and myalgia. Hyperuricaemia
commonly occurs and may lead to attacks of gout.

Ethambutol HCl

Hepatic: Hepatotoxicity appears to be dose-related,

and may appear at any time during therapy.
Cholestatic jaundice, which appeared to be caused by
ethambutol, has been reported in at least one patient
who received the drug both alone and in combination
with streptomycin. Transient impairment of liver
function, as indicated by abnormal liver function tests,
and jaundice have been observed.

Dermatologic: Dermatitis and hypersensitivity

reactions, including rash, pruritus, and leukopenia
have been reported. Rarely, anaphylactoid reactions.

Nervous system:Headache, dizziness, mental

confusion, disorientation, possible hallucinations.

GI: Gastrointestinal upset, abdominal pain, nausea,

vomiting, and anorexia have occurred occasionally.

Hematologic: Thrombocytopenia and eosinophilia.

Others: Fever, joint pain, malaise, pulmonary

infiltrates, elevated serum uric acid levels,
precipitation of acute gout, and rarely, numbness and
tingling of the extremities due to peripheral neuritis.
Ethambutol may produce decreased visual acuity due
to optic neuritis. This effect appears to be related to
dose and duration of treatment.

Reference:
http://www.unilab.com.ph/consumers/products/quadtab