Title: Respiratory System Drugs
1Respiratory System Drugs
2Antitubercular Drugs
- Tuberculosis (TB)
- Caused by Mycobacterium tuberculosis
- Antitubercular drugs treat all forms of
Mycobacterium
3Antitubercular DrugsMycobacterium Infections
- Common infection sites
- Lung (primary site)
- Brain
- Bone
- Liver
- Kidney
- Aerobic bacillus
- Passed from infected
- Humans
- Cows (bovine) and birds (avian)
- Much less common
4Antitubercular DrugsMycobacterium Infections
- Tubercle bacilli are conveyed by droplets
- Droplets are expelled by coughing or sneezing,
then gain entry into the body by inhalation - Tubercle bacilli then spread to other body organs
via blood and lymphatic systems - Tubercle bacilli may become dormant, or walled
off by calcified or fibrous tissue
5Antitubercular DrugsTuberculosis -
Pathophysiology
- M. tuberculosis gram-positive, acid-fast
bacillus - Spread from person to person via airborne
droplets - Coughing, sneezing, speaking disperse organism
and can be inhaled - Not highly infectious requires close, frequent,
and prolonged exposure - Cannot be spread by hands, books, glasses,
dishes, or other fomites
6Antitubercular DrugsTuberculosis Clinical
Manifestations
- Early stages free of symptoms
- Many cases are found incidentally
- Systemic manifestations
- Fatigue, malaise, anorexia, weight loss,
low-grade fevers, night sweats - Weight loss occurs late
- Characteristic cough frequent produces mucoid
or mucopurulent sputum - Dull or tight chest pain
- Some cases acute high fever, chills, general
flulike symptoms, pleuritic pain, productive
cough - HIV Pt with TB Fever, cough, weight loss
- Pneumocystic carinii pneumonia (PCP)
7Antitubercular DrugsTuberculosis Diagnostic
Studies
- Tuberculin Skin Testing -- reaction 2-12 weeks
after the initial infection - PPD Purified protein derivative used to
detect delayed hypersensitivity response - Two-step testing health care workers
- 5mm gt induration Immunosuppressed patients
- 10 mmgt at risk populations health are workers
- 15 mmgt Low risk people
- Chest X-ray -- used in conjunction with skin
testing - Multinodular lymph node involvement with
cavitation in the upper lobes of the lungs - Calcification within several years after
infection - Bacteriologic Studies
- Sputum, gastric washings early morning specimens
for acid-fast bacillus -- three consecutive
cultures on different days - CSF or pus from an abscess
8Antitubercular DrugsTuberculosis Medical
Management
- May be treated as outpatient
- Depends on debility and severity of symptoms
- Mainstay of treatment drug therapy for active
disease - Five primary drugs
- Isoniazid (INH) (primary drug used)
- Rifampin
- Pyrazinamide
- Streptomycin
- Ethambutol
- Combination 4 drug therapy
- HIV patients cannot take rifampin interferes
with antiretroviral drug effectiveness
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10Antitubercular Drugs
- Second-Line Drugs
- capreomycin amikacin
- cycloserine levofloxacin
- ethionamide ofloxacin
- kanamycin
- para-aminosalicyclic acid (PAS)
11Antitubercular Drug TherapyConsiderations
- Perform drug-susceptibility testing on the first
Mycobacterium sp. that is isolated from a patient
specimen to prevent the development of
MDR-TB(Multidrug-resistant TB) - Even before the results of susceptibility tests
are known, begin a regimen with multiple
antitubercular drugs - Adjust drug regimen once the results of
susceptibility testing are known - Monitor patient compliance closely during therapy
- Problems with successful therapy
- patient nonadherence to drug therapy
- increased incidence of drug-resistant
12Antitubercular Therapy
- Effectiveness depends upon
- Type of infection
- Adequate dosing
- Sufficient duration of treatment
- Drug compliance
- Selection of an effective drug combination
13Antitubercular Therapy
- Problems
- Drug-resistant organisms
- Drug toxicity
- Patient noncompliance
- Multidrug-resistant TB (MDR-TB)
14Antitubercular Drugs Isoniazid (INH)
- Drug of choice for TB
- Resistant strains of Mycobacterium emerging
- Metabolized in the liver through
acetylationwatch for slow acetylators - Used alone or in combination with other drugs
- Used for the prophylaxis or treatment of TB
15Antitubercular Drugs Adverse Effects
- INH
- Peripheral neuritis, hepatotoxicity
- Ethambutol
- Retrobulbar neuritis, blindness
- Rifampin
- Hepatitis, discoloration of urine, stools
16Antitubercular DrugsNursing Implications
- Thorough medical history and physical assessment
- Perform liver function studies in patients who
are to receive isoniazid or rifampin (especially
in elderly patients or those who use alcohol
daily) - Assess for contraindications to the various
drugs, conditions for cautious use, and potential
drug interactions
17Antitubercular DrugsNursing Implications
- Monitor for therapeutic effects
- Decrease in symptoms of TB, such as cough and
fever - CS and CXR should confirm clinical findings
- Observe for lack of clinical response to therapy,
indicating possible drug resistance - Monitor for adverse effects
- Instruct patients on the adverse effects that
should be reported to the physician immediately - fatigue, nausea, vomiting, numbness and tingling
of the extremities, fever, loss of appetite,
depression, jaundice
18Antitubercular DrugsPatient Education
-
Patient education is critical - Therapy may last for up to 24 months
- Take medications exactly as ordered, the same
time every day - Emphasize the importance of strict adherence to
regimen for improvement of condition or cure - Remind patients that they are contagious during
the initial period of their illnessinstruct in
proper hygiene and prevention of the spread of
infected droplets - Emphasize to patients to take care of themselves,
including adequate nutrition and rest
19Antitubercular DrugsPatient Education
- Patients should not consume alcohol or take other
medications, including OTC -- check with their
physician - INH and rifampin cause oral contraceptives to
become ineffective another form of birth control
will be needed - Patients who are taking rifampin should be told
that their urine, stool, saliva, sputum, sweat,
or tears may become reddish orange even contact
lenses may be stained - Pyridoxine (Vitamin B6) may be needed to combat
neurologic adverse effects associated with INH
therapy - Oral preparations may be given with meals to
reduce GI upset, even though recommendations are
to take them 1 hour before or 2 hours after meals