DRUG STUDYDRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Actual:Dosage: 200 mgPreparation: 10 ml

Rifampicin Rifadin, RimactanceClassification: Anti-tubercularRoute and Dosage: PO, IV (Adults): 600 mg/day or 10mg/kg/day (up to 600mg/day) single dose; may also b given 2-3 times weekly PO, IV (Children): 10-20 mg/kg/day single dose (not to exceed 600 mg/day); may also be given 2-3 times weekly.Availability: Capsules: 150mg, 300mg Powder for injection: 600mg/vial In combination with: Isoniazid (rifamate); isoniazid and pyrazinamide

MECHANISM OF ACTION: Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms.ADVERSE EFFECTS: CNS: headache, drowsiness, confusion, fatigue, ataxia, weakness GI: nausea, vomiting, heartburn, abdominal pain, flatulence, diarrhea, hepatitis Hemat: hemolyticanemia, thrombocytopenia MS: myalgia, arthralgia Misc: flu-like syndrome, red discoloration of all body fluidsDRUG INTERACTIONS: Rifampin stimulates liver enzymes, which may increase metabolism and decrease the effectiveness of other drugs, including: (tocainide, oral contraceptive agents, estrogents etc.) Increased risk of hepatotoxicity with other hepatotoxic agents, including alcohol, and miconazoleINDICATION: Used in combination with other agents in the management of active tuberculosis Used to eliminate carriers of meningococcal diseaseCONTRAINDICATION: Contraindicated in hypersensitivity Use cautiously in history of liver disease Concurrent use of other hepatotoxic agents Pregnancy and lactation 10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluationAssessment: Mycobacterial studies and susceptibility test should be performed prior to and periodically throughout therapy. Assess lung sound and character and amount of sputum periodically throughout therapyLab test considerations: Renal function, CBC, and urinalysis Monitor hepatic function at least monthly during therapy May cause false-positive direct coombs test results May interfere with dexamethasone suppression test results May interfere with methods for determining serum Folate and vitamin B12 levels and with urine test based on color. May delay hepatic uptake and excretion of BSP during sulfobromophthalein uptake and excretion testImplementation: PO: administer medication on an empty stomach at least 1 hr before or 2 hr after meals with a full glass of water (240ml) Pharmacist can compound a syrup for patients unable to swallow solids Do not admix with other solutions or medicationsPatient/Family Teaching: Advise patient to take medication once daily (unless biweekly regimens are used) Advise patient to notify physician or other health care provider promptly if signs and symptoms of hepatitis, nausea, vomiting, anorexia, or thrombocytopenia occur. Advise patient to avoid use of alcoholEvaluation: Effectiveness of therapy can be demonstrated by: decreased fever and night sweats, diminished cough and sputum production and negative sputum cultures.

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Actual:Dosage: 200 mgPreparation: 5 mL

Isoniazid INH, Isotamine, Laniazid, Nydrazid, PMS IsoniazidClassification AntitubercularRoute and Dosage: PO, IM (adults): 5-10 mg/kg/day (usually 300 mg) or 15 mg/kg (up to 900 mg) 2-3 times weekly PO, IM (children): 10-20 mg/kg/day (up to 300 mg/day) or 10-20 mg/kg (up to 900 mg) 2-3 times weekly.Availability: Tablets: 50 mg, 100 mg, 300 mg Syrup: 50mg/5ml, 100 mg/ml

MECHANISM OF ACTION: Inhibits mycobacterial cell wall synthesis and interferes with metabolism.ADVERSE EFFECTS: CNS: peripheral neuropath, seizures, psychosis EENT: visual disturbances GI: nausea, vomiting, hepatitis Derm: rashes Endo: gynecomastia Hemat: blood dyscrasias Misc: feverDRUG INTERACTIONS: Additive CNS toxicity with other antituberculars BCG vaccine may not be effective during isoniazid therapy Isoniazid inhibits the metabolism of phenytoinINDICATION: Used as a first-line antitubercular in combination with other agents in the treatment of active disease Prevention of tuberculosis in patients exposed to active diseaseCONTRAINDICATION: Hypersensitivity Acute liver disease Previous hepatitis from isoniazid 10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluationAssessment: Mycobacterial studies and susceptibility should be performed prior to and periodically throughout therapy.Lab test consideration: May cause false-positive test results for copper sulfate urine glucose tests, Diabetic patient should test urine glucose with enzymatic test Hepatic function should be evaluated prior to and monthly throughout therapy If isoniazid overdosage occurs, treatment with pyridoxine in instituted.Implementation: PO: may be administered with foods or antacids. IM: medication may cause discomfort at injection site,Patient/Family Teaching: Advise patient to take medication exactly as directed. Advise patient to notify physician if signs and symptoms of hepatitis, nausea, vomiting, anorexia occurs. Instruct the patient to avoid the use of alcohol and ingestion of swiss or Cheshire cheeses, fish and tyramine-containing foods.Evaluation: Effectiveness of therapy can be demonstrated by: resolution of signs and symptoms of tuberculosis, negative sputum cultures, prevention of activation of tuberculosis in persons known to be exposed.

DRUGACTIONINDICATION/CONTRAINDICATIONNURSING RESPONSIBILITY

Actual:Dosage: 250mgPreparation: 10 mL

Pyrazinamide PMS Pyrazinamide, TebrazidClassification AntitubercularRoute and Dosage: PO (Adults and children): 15-30 mg/kg/day as single doseAvailability: Tablets: 500mgMECHANISM OF ACTION: Mechanism not knownADVERSE EFFECTS: GI: hepatotoxicity, nausea, vomiting, diarrhea, anorexia GU: dysuria Derm: itching, skin rash, photosensitivity, acne Hemat: anemia, thrombocytopenia Metab: hyperuricemia MS: gouty arthritis, arthralgiaDRUG INTERACTIONS: May decrease blood levels and effectiveness of cyclosporine May decrease the effectiveness of anti-gout agents.INDICATION: Management of simple or chronic constipation, particularly if associated with low-fiber diet Useful in situations where straining should be avoided (after myocardial infarction or rectal surgery, prolonged bed rest) Used in the management of chronic watery diarrheaCONTRAINDICATION: Hypersensitivity Abdominal pain, nausea, or vomiting (especially when associated with fever) Serious adhesions Dysphagia 10 Rights1. Right medication2. Right dosage3. Right patient4. Right route5. Right time and manner6. Right client education7. Right documentation8. Right to refuse medications9. Right assessment10. Right evaluationAssessment: Mycobacterial studies and susceptibility should be performed prior to and periodically throughout therapy.Lab test considerations: Hepatic function should be evaluated prior to and every 2-4 week during therapy Patients with impaired liver function should only receive pyrazinamide therapy if crucial to treatment. Monitor serum uric acid concentrations during therapyImplementation: General info: May be given concurrently with isoniazid and/or rifampinPatient/ Family Teaching: Advise patient to take medication exactly as directed, not to skip doses or double up on missed doses. Inform diabetic patients that pyrazinamide may interfere with urine ketone measurements. Advise patient to use sunscreen and protective clothing to prevent photosensitivity reactions.Evaluation: Effectiveness of therapy can be demonstrated by: Resolution of signs and symptoms of tuberculosis. Negative sputum cultures, thenia graves, reversal of non-depolarizing neuromuscular blockers.

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