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29.15 Anti-Infective – Antitubercular

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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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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.

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.

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.
Module 0 – Pharmacology Course Introduction
Module 3 – Disease Specific Medications

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