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Respiratory System Drugs

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Respiratory System Drugs Antitubercular Drugs Antitubercular Drugs Tuberculosis (TB) Caused by Mycobacterium tuberculosis Antitubercular drugs treat all forms of ... – PowerPoint PPT presentation

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Title: Respiratory System Drugs


1
Respiratory System Drugs
  • Antitubercular Drugs

2
Antitubercular Drugs
  • Tuberculosis (TB)
  • Caused by Mycobacterium tuberculosis
  • Antitubercular drugs treat all forms of
    Mycobacterium

3
Antitubercular 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

4
Antitubercular 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

5
Antitubercular 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

6
Antitubercular 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)

7
Antitubercular 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

8
Antitubercular 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

9
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10
Antitubercular Drugs
  • Second-Line Drugs
  • capreomycin amikacin
  • cycloserine levofloxacin
  • ethionamide ofloxacin
  • kanamycin
  • para-aminosalicyclic acid (PAS)

11
Antitubercular 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

12
Antitubercular Therapy
  • Effectiveness depends upon
  • Type of infection
  • Adequate dosing
  • Sufficient duration of treatment
  • Drug compliance
  • Selection of an effective drug combination

13
Antitubercular Therapy
  • Problems
  • Drug-resistant organisms
  • Drug toxicity
  • Patient noncompliance
  • Multidrug-resistant TB (MDR-TB)

14
Antitubercular 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

15
Antitubercular Drugs Adverse Effects
  • INH
  • Peripheral neuritis, hepatotoxicity
  • Ethambutol
  • Retrobulbar neuritis, blindness
  • Rifampin
  • Hepatitis, discoloration of urine, stools

16
Antitubercular 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

17
Antitubercular 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

18
Antitubercular 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

19
Antitubercular 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
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