Antitubercular Drugs

ANTITUBERCULAR DRUGS

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·       Antitubercular drugs are medications used to treat tuberculosis (TB), an infectious disease caused by the bacterium Mycobacterium tuberculosis.

·       TB primarily affects the lungs but can also impact other parts of the body.

·       Antitubercular therapy typically involves a combination of drugs to ensure efficacy and prevent the development of drug resistance.

Definition

·       Antitubercular drugs are agents that specifically target and kill or inhibit the growth of Mycobacterium tuberculosis.

·       They are categorized into first-line and second-line drugs based on their efficacy, safety, and the likelihood of resistance.

Classification

First-line Antitubercular Drugs

1.     Isoniazid (INH)

2.     Rifampin (RIF)

3.     Pyrazinamide (PZA)

4.     Ethambutol (EMB)

5.     Streptomycin

Second-line Antitubercular Drugs

1.     Ethionamide

2.     Capreomycin

3.     Kanamycin

4.     Amikacin

5.     Cycloserine

6.     p-Aminosalicylic acid (PAS)

7.     Fluoroquinolones (e.g., Levofloxacin, Moxifloxacin)

Pharmacokinetics

Isoniazid (INH)

·        Absorption: Well absorbed orally

·        Distribution: Widely distributed in body fluids and tissues, including the cerebrospinal fluid

·        Metabolism: Metabolized in the liver by acetylation

·        Excretion: Excreted primarily in urine

Rifampin (RIF)

·        Absorption: Well absorbed orally

·        Distribution: Extensive distribution, including penetration into the cerebrospinal fluid

·        Metabolism: Metabolized in the liver

·        Excretion: Excreted mainly in bile and urine

Pyrazinamide (PZA)

·        Absorption: Well absorbed orally

·        Distribution: Widely distributed in body tissues

·        Metabolism: Metabolized in the liver

·        Excretion: Excreted in urine

Ethambutol (EMB)

·        Absorption: Well absorbed orally

·        Distribution: Widely distributed in body tissues, less penetration into cerebrospinal fluid

·        Metabolism: Partially metabolized in the liver

·        Excretion: Excreted in urine

Mechanism of Action

Isoniazid (INH)

·        Inhibits the synthesis of mycolic acids, essential components of the bacterial cell wall

Rifampin (RIF)

·        Inhibits bacterial DNA-dependent RNA polymerase, suppressing RNA synthesis

Pyrazinamide (PZA)

·        Disrupts mycobacterial cell membrane metabolism and transport functions

Ethambutol (EMB)

·        Inhibits the enzyme arabinosyl transferase, disrupting the formation of the cell wall

Uses

·        Pulmonary TB: All forms of TB involving the lungs

·        Extrapulmonary TB: TB affecting other parts of the body (e.g., lymph nodes, bones, joints, kidneys, central nervous system)

·        Latent TB infection: Preventing progression to active disease

Adverse Effects

Isoniazid (INH)

·        Hepatotoxicity

·        Peripheral neuropathy

·        Hepatitis

·        Rash

Rifampin (RIF)

·        Hepatotoxicity

·        Gastrointestinal disturbances

·        Orange discoloration of body fluids

·        Hypersensitivity reactions

Pyrazinamide (PZA)

·        Hepatotoxicity

·        Hyperuricemia

·        Arthralgia

·        Gastrointestinal disturbances

Ethambutol (EMB)

·        Optic neuritis

·        Red-green color blindness

·        Peripheral neuropathy

Contraindications

·        Liver disease: For drugs with hepatotoxic potential like INH, RIF, and PZA

·        Renal impairment: Dose adjustment may be necessary for drugs like EMB

·        Pregnancy: Some drugs may require caution or are contraindicated

Role of Nurse in Antitubercular Therapy

1.     Patient Education: Educate patients on the importance of adherence to the medication regimen, potential side effects, and the need for regular monitoring.

2.     Monitoring: Regularly monitor patients for adverse effects, liver function tests, and visual acuity tests (for those on EMB).

3.     Administration: Ensure proper administration of medications, including observing directly observed therapy (DOT) to enhance adherence.

4.     Support: Provide emotional and psychological support to patients undergoing long-term therapy.

5.     Coordination of Care: Collaborate with healthcare providers to ensure comprehensive care and management of TB.

6.     Infection Control: Educate patients on infection control practices to prevent the spread of TB

Video Description

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