PPT_Chapter_36.ppt - Antimycobacterial Drugs Chapter 36 Copyright \u00a9 2013 Wolters Kluwer Health | Lippincott Williams Wilkins Tuberculosis Infectious

PPT_Chapter_36.ppt - Antimycobacterial Drugs Chapter 36...

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Unformatted text preview: Antimycobacterial Drugs Chapter 36 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Tuberculosis Infectious disease caused by Mycobacterium tuberculosis bacillus Transmitted from person to person by droplets dispersed in the air when an infected person coughs or sneezes Primarily affects the lungs People with AIDS are at risk because of compromised immune system Responds well to long-term treatment with a combination of three or more antitubercular drugs Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Tuberculosis Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions of Antitubercular Drugs Most are bacteriostatic Usually inhibit bacterial cell wall synthesis Isoniazid is bactericidal Rifampin and streptomycin have some bactericidal activity Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Antitubercular Drugs Treat active cases and as a prophylactic to prevent the spread of tuberculosis Does not cure the disease, but renders the patient noninfectious to others Classified as primary and secondary drugs Sensitivity testing may be performed to determine the most effective combination treatment Isoniazid is only drug used alone Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Antitubercular Drugs Prophylaxis Household members Positive skin test in the past 2 years Positive skin test with radiographic findings At risk for tuberculosis Age < 35 with a positive skin test AIDS or HIV positive with positive skin test or negative skin test but history of previous significant reaction to purified protein derivatives Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Antitubercular Drugs • Standard treatment has two phases and lasts for 6–9 months depending on the patient’s response to therapy – Initial phase: kills rapidly multiply bacteria and prevents drug resistant; lasts approximately 2 months • Must contain three or more drugs – Continuing phase: lasts approximately 4 months Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Antitubercular Drugs Preferred regimen: Initial phase: isoniazid, rifampin, pyrazinamide, and ethambutol for 56 doses (8 weeks) Continuation phase: rifampin and isoniazid for 4 months (18 weeks) Retreatment Treatment fails because of noncompliance or inadequate initial drug treatment Usually includes 4 or more antitubercular drugs Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Antitubercular Drugs • Ethambutol – Optic neuritis – related to dose and duration of treatment • Usually disappears upon discontinuation – Dermatitis – Pruritus – Anaphylactoid reaction – Joint pain – Anorexia – Nausea and vomiting Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Antitubercular Drugs Isoniazid Higher with larger doses Hypersensitivity reactions Hematologic changes Jaundice Fever Skin eruptions Nausea and vomiting Epigastric distress Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Antitubercular Drugs Isoniazid Severe and sometimes fatal hepatitis Peripheral neuropathy is most common symptom of toxicity Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Antitubercular Drugs Pyrazinamide Hepatotoxicity Nausea Vomiting Diarrhea Myalgia Rashes Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Antitubercular Drugs Rifampin Nausea and vomiting Epigastric distress and heartburn Fatigue Dizziness Rash Hematologic changes Renal insufficiency Red-orange discoloration of body fluids Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Antitubercular Drugs Ethambutol Contraindications: hypersensitivity, children younger than 13 Precautions: lactation, hepatic and renal impairment, diabetic retinopathy, cataracts Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Antitubercular Drugs Isoniazid Contraindications: hypersensitivity Precautions: lactation Interactions: alcohol, aluminum salts, anticoagulants, phenytoin, foods containing tyramine Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Antitubercular Drugs Pyrazinamide Contraindications: hypersensitivity, acute gout, severe hepatic damage Precautions: lactation, liver or kidney impairment, pregnancy, patients with HIV, diabetes mellitus Interactions: allopurinol, colchicines, probenecid Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Antitubercular Drugs Rifampin Contraindications: hypersensitivity Precautions: lactation, liver or kidney impairment Interactions: digoxin, isoniazid, oral anticoagulants, oral hypoglycemics, oral contraceptives, chloramphenicol, phenytoin, verapamil Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Antitubercular Drugs Many laboratory and diagnostic tests may be necessary before starting antitubercular therapy. Family history and a history of contacts are needed. Compliance is critical and should be monitored. Directly observed therapy may be necessary. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Antitubercular Drugs Treatment regimens Ethambutol: once every 24 hours at the same time each day; with food to prevent GI upset Isoniazid: empty stomach; can be taken with food if GI upset occurs; minimize alcohol consumption Pyrazinamide: once daily with food Rifampin: daily on an empty stomach; may experience discoloration of urine, fees, saliva, sputum, sweat, and tears Alternative treatment regimens with isoniazid and pyrazinamide may increase compliance Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About Antitubercular Drugs Drugs are given for a long time Education about compliance must occur Close medical supervision is necessary Educate about dosage schedule and adverse reactions Results must be monitored Drugs must be taken exactly as prescribed Do not use OTCs Limit alcohol Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About Antitubercular Drugs Ethambutol Take once per day at the same time each day Do not double the dose if miss a dose Notify health care provider if experience vision changes or skin rash Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About Antitubercular Drugs Isoniazid Take 1 hour before or 2 hours after meals May take with food if GI upset occurs Notify health care provider if experience weakness, yellowing of skin, loss of appetite, darkening of urine, skin rashes, numbness or tingling of hands or feet Avoid tyramine-containing foods Take pyridoxine (vitamin B6) to prevent deficiency Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About Antitubercular Drugs Pyrazinamide Notify health care provider if experience nausea; vomiting; loss of appetite; fever; malaise; visual changes; yellow discoloration of your skin; severe pain in knees, feet, or wrists Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About Antitubercular Drugs Rifampin Take on an empty stomach Tears, sputum, urine, or sweat my become discolored red-brown or red-orange Soft contact lenses and clothing can become discolored Notify health care provider if experience yellow discoloration of skin, fever, chills, unusual bleeding or bruising, skin rash, or itching Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Leprosy Chronic, communicable disease spread by prolonged, intimate contact with an infected person Peripheral nerves and skin are affected Also referred to as Hansen disease caused by Mycobacterium leprae Rare in colder climes, may occur in tropical and subtropical zones Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions and Uses of Leprostatic Drugs Dapsone is only current therapy Bactericidal and bacteriostatic Used to treat leprosy and dermatitis herpetiformis Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Leprostatic Drugs Hemolysis Anemia Peripheral neuropathy Nausea and vomiting Anorexia Insomnia Blurred vision Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Leprostatic Drugs Contraindications: lactation Precautions: anemia Interactions: none significant Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Leprostatic Drugs Treatment may require years Patients will have long-term medical and drug therapy Patient may suffer from severe disfigurement Take orally with food Antitubercular drugs may be given concurrently during initial therapy to minimize bacterial resistance to the leprostatic drug Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About Leprostatic Drugs Educate about need for long-term compliance Educate about treatment regimen, dosage schedule, possible adverse reactions, importance of follow-up visits Changes in skin pigmentation may occur and may take months to years to reverse after the drug is discontinued Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ...
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