Name of drug Generic (Brand)

Isoniazid (Isoniazid,Isotamine, Nydrazide,PMS, INH)

Classification
Pharmacotherapeutic: Isonicotinic acid derivative. Clinical: Antitubercular

Dose Frequency Route

Tuberculosis( Treatment) PO/IM: Adults, Elderly: 5mg/kg/day as single dose. Maximum 300mg/day. Children: 10-15 mg/kg/day as single dose. Maximum: 300 mg/day Tuberculosis( Prevention) PO/IM: Adults, Elderly: 300mg/day as single dose. Children: 10mg/kg/day as single dose. Maximum: 300 mg/day

Mechanism of action
Inhibits mycolic acid synthesis. Active only during cell division. TherapeuticEffect: Causes disruption of bacterial cell wall, loss of acid-fast properties in susceptible mycobacteria. Bactericidal

Specific Indication
Drug of choice in tuberculosis prophylaxis. Used in combination with one or more other antitubercular agents for treatment of all forms of active tuberculosis

Side Effects
FREQUENT: Nausea, vomiting, diarrhea, abdominal pain. RARE: Pain at injection site, hypersensitivity

Nursing Implication
Baseline Assessment Question for history of hypersensitivity reaction, hepatic injury from isoniazid , sensitivity to nicotinic acid/ chemically related medications. Ensure collection of specimens for culture, sensitivity. Evaluate initial hepatic function results. Intervention/Evaluation Monitor hepatic function test results and assess for hepatitis: anorexia, nausea, vomiting, weakness, fatigue, dark urine, jaundice(hold INH and inform physician promptly). Assess for tingling, numbness, burning of extremities( those esp. at risk for neuropathy may be given pyridoxine prophylactically: malnourished, elderly, diabetics, pts with chronic liver disease[ including alcoholics]). Be alert for fever, skin eruptions( hypersensitivity reaction) Patient/Family Teaching Do not skip doses; continue taking isoniazid for full length of therapy(6-24 mos.). Take preferably 1 hr prior to or 2 hrs following meals (with food if GI upset). Avoid alcohol during treatment. Do not take any other medications including antacids without consulting physician. Must take isoniazid at least 1 hr before antacid. Avoid tuna, sauerkraut, aged cheeses, smoked fish(provide list of tyramine-coating foods) that may cause reaction such as red/itching skin, pounding heartbeat, lightheadedness, hot/clammy feeling, headache; contact physician of any new symptom, immediately for vision difficulties, nausea/vomiting, dark urine,

Name of drug Generic (Brand)

Classification

Dose Frequency Route

Mechanism of action

Specific Indication

Side Effects

Nursing Implication
yellowing of skin/eyes, fatigue, numbness/tingling of hands/feet. Baseline Assessment Question for history of hypersensitivity to rifampin, rifamycins. Ensure collection of specimens for culture, sensitivity. Evaluate initial hepatic function results, CBC results. Intervention/Evaluation Monitor hepatic function test results and assess for hepatitis: anorexia, nausea, vomiting, weakness, fatigue, jaundice(hold rifampin and inform physician at once). Report hypersensitivity reactions promptly: any type of skin eruption, pruritus, flulike syndrome with high dosage. Monitor frequency,consistency of stools. Monitor CBC results for blood dyscrasias, be alert for infection (fever, sore throat) bleeding/bruising, unusual tiredness/weakness. Patient/Family Teaching Preferably take on empty stomach with 8 oz. water 1 h before or 2 hrs after meal. Avoid alcohol during treatment. Do not take any other medications including antacids without consulting physician. Must take rifampin at least 1 hr before antacid. Urine, feces, sputum, sweat, tears may become red orange; soft contact lenses may be permanently stained. Notify physician of any new symptom, immediately for yellow eyes/skin, fatigue, weakness, nausea/vomiting, sore throat, fever, flu, unusual bruising/bleeding. If taking oral contraceptives, check with physician.

Rifampin (Rifadin, Rimactane, Rofact)

Pharmacotherapeutic: Antitubercular

Tuberculosis( Treatment) IV/PO: Adults, Elderly: 10mg/kg/day. Maximum 600mg/day. Children: 10-20 mg/kg/day in divided doses q12-24h.

Interfere with bacterial RNA synthesis by binding to DNAdependent RNA polymerase, preventing attachment of the enzyme to DNA, thereby blocking RNA transcription. TherapeuticEffect: Bactericidal activity occurs in susceptible microorganisms.

In conjunction with at least one other antitubercular agent for initial treatment and retreatment of clinical tuberculosis. Eliminates Neisseria meningoccoci from the nasopharynx of asymptomatic carrier in situations with high risk of meningococcal meningitis (prophylaxis, not cure). Recommended by WHO as andjunctive therapy with dapsone for leprosy

EXPECTED: redorange/red-brown discoloration of urine, feces, saliva, skin, sputum, sweat, tears. OCCASIONAL (1%-5%): Hypersensitivity reaction (pruritus, flushing, rash). RARE(1%-2%): Diarrhea, dyspepsia, nausea, fungal overgrowth (sore mouth/tounge).

Name of drug Generic (Brand)

Pyrazinamide ( Pyrazinamide, Tebrazid)

Classification
Pharmacotherapeutic: Antitubercular

Dose Frequency Route

Tuberculosis( Treatment) IV/PO: Adults, Elderly: 10mg/kg/day. Maximum 600mg/day. Children: 10-20 mg/kg/day in divided doses q12-24h.

Mechanism of action
Exact mechanism unknown TherapeuticEffect: Is either bacteriostatic or bactericidal depending on its concentration at infection site and susceptibility of infecting bacteria.

Specific Indication
In conjunction with at least one other antitubercular agent in treatment of clinical tuberculosis after failure of primary agents(isoniazid, rifampin)

Side Effects
FREQUENT: Arthrlagia, myalgia (usually mild and selflimiting). RARE: Hypersensitivity ( rash, urticaria, pruritus), photosensitivity.

Nursing Implication
Baseline Assessment Question for history of hypersensitivity to rifampin, rifamycins. Ensure collection of specimens for culture, sensitivity. Evaluate results of initial CBC, hepatic function tests, uric acid levels. Intervention/Evaluation Monitor hepatic function test results; be alert for hepatic reaction; jaundice, malaise,fever, liver tenderness. Anorexia/nausea/vomiting (stop drug, notify physician promptly). Check serum uric acid levels; assess for hot, painful, swollen joints, esp. big toe, ankle, knee. Evaluate blood sugar levels, diabetic status carefully (pyrazinamide makes management difficult). Assess for rash, skin eruption. Monitor CBC for thrombocytopenia, anemia Patient/Family Teaching Do not skip doses; take for full length of therapy. Office visits, lab tests are essential part of treatment. Take with food to reduce GI upset. Avoid excessive exposure to sun, ultraviolet light until photosensitivity is determined. Notify physician of any new symptom, immediately for yellow eyes/skin; unusual tiredness; fever; loss of appetite; hot, painful, swollen joints.

Name of drug Generic (Brand)

Ethambutol (Etibi, Myambutol)

Classification
Pharmacotherapeutic: Isonicotinic acid derivative. Clinical: Antitubercular

Dose Frequency Route

Tuberculosis( Treatment) PO: Adults, Elderly, Children: 15-25mg/kg/day as single doseor 50mg/kg 2times/wk. Maximum 2.5g/dose.

Mechanism of action
Interferes with RNA synthesis. Therapeutic Effect: Suppresses mycobacterial multiplication

Specific Indication
In conjunction with at least one other antitubercular agent for initial treatment and retreatment clinical tuberculosis. Unlabeled: Treatment of atypical mycobacterial infections

Side Effects
OCCASIONAL: Acute gouty arthritis, confusion, abdominal pain, nausea, vomiting, anorexia, headache. RARE: Rash, fever, blurred vision, eye, pain, red-green color blindness

Nursing Implication
Baseline Assessment Evaluate initial CBC, renal/hepatic test results. Intervention/Evaluation Assess for vision changes. Discontinue drug and notify physician immediately. Give with food if GI distress occurs. Monitor serum uric acid. Assess for hot/painful/swollen joints, esp. big toe, ankle, knee. Report numbness, tingling, burning of extremities. Patient/Family Teaching Do not skip doses; take for full length of therapy. Notify physician immediately of any visual problem . promptly report any swelling/pain of joints, numbness/tingling/burning of hands/feet.

DRUG SUMMARY