29.15 Anti-Infective – Antitubercular
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
Reference Links
Video 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.
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.
Tarang Patel, DNP-NA, RN, CCRN, RPh 
Nichole Weaver, MSN/Ed, RN, CCRN 
Miriam Wahrman, MSN/Ed, RNC-MNN 
Kara Tarr, BSN, RN 
Nacole Riccaboni, MSN, AGACNP-BC, FNP-BC, CCRN, CMC 