Key Terms Chapter Objectives
On completion of this chapter, the student will:
• Discuss the drugs used in the treatment of tuberculosis.
• Discuss the uses, general drug action, contraindications, precautions, interactions, and general adverse reactions associated with the administration of the antitubercular drugs.
• Discuss important preadministration and ongoing assessment activities the nurse should perform on the patient taking an antitubercular drug.
• List some nursing diagnoses particular to a patient taking an antitubercular drug.
• Explain directly observed therapy (DOT).
• Discuss ways to promote an optimal response to therapy, how to manage adverse reactions, and important points to keep in mind when educating patients about the use of the antitubercular drugs.
anaphylactoid reactions antitubercular drugs bacteriostatic circumoral extrapulmonary gout
Mycobacterium tuberculosis nephrotoxicity optic neuritis ototoxicity peripheral neuropathy prophylactic tinnitus tuberculosis vertigo
Tuberculosis is a major health problem throughout the world, infecting more than 8 million individuals each year. It is the world's leading cause of death from infectious disease. Individuals living in crowded conditions, those with compromised immune systems, and individuals with debilitative conditions are especially susceptible to tuberculosis.
Tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis bacillus. The pathogen is also referred to as the tubercle bacillus. The disease is transmitted from one person to another by droplets dispersed in the air when an infected person coughs or sneezes. These droplet nuclei are released into the air and inhaled by noninfected persons. Although tuberculosis primarily affects the lungs, other organs may also be affected. For example, if the immune system is poor, the infection can spread from the lungs to other organs of the body. Extrapulmonary (outside of the lungs) tuberculosis is the term used to distinguish tuberculosis affecting the lungs from infection with the M. tuberculosis bacillus in other organs of the body. Organs that can be affected include the liver, kidneys, spleen, and uterus. People with acquired immunodeficiency syndrome (AIDS) are at risk for tuberculosis because of their compromised immune systems. Tuberculosis responds well to long-term treatment with a combination of three or more antitubercular drugs.
Antitubercular drugs are used to treat active cases of tuberculosis and as a prophylactic to prevent the spread of tuberculosis. The drugs used to treat tuberculosis do not "cure" the disease, but they render the patient noninfectious to others. Antitubercular drugs are classified as primary and second-line drugs. Primary (first-line) drugs provide the foundation for treatment. Second-line or secondary drugs are less effective and more toxic than primary drugs. These drugs are used in various combinations to treat tuberculosis. Sensitivity testing may be done to determine the most effective combination treatment, especially in areas of the country showing resistance. Second-line drugs are used to treat extrapulmonary tuberculosis or drug-resistant organisms. The primary antitubercular drugs are discussed in this chapter. Both primary and second-line antitubercular drugs are listed in the Summary Drug Table: Antitubercular Drugs. Certain fluoroquinolones such as ciprofloxacin, ofloxacin, lev-ofloxacin, and sparfloxacin have proven effective against tuberculosis and are considered second-line drugs. See Chapter 10 for a discussion of the fluoroquinolones.
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