Respiratory Agents - Tuberculosis

Tuberculosis

infectious disease of lungs can affect other body systems - major public health problem kills more worldwide than any other infection - multi-drug resistant strains d/t drug non-compliance

Resurgence of tuberculosis

‘85-’92 endemic among HIV+ patients, January 2024-present in Kansas City, KS (147 Dx)

Common infection sites of TB

lung (primary site), brain, bone, liver, kidney

Conveyance of TB

tubercle bacilli are conveyed by droplets expelled by coughing or sneezing, enter the body by inhalation, spread to other body organs via blood and lymphatics, may become dormant or walled off by calcified or fibrous tissue

S&S of TB

coughing with mucus or blood, chest pain, loss of appetite, chills, cough lasts more than 2 weeks, night sweats, weight loss, fever, fatigue

TB prevention

healthy diet, wash your hands after sneezing or coughing, stay away from coughing people, no smoking, no alcohol, wet house cleaning and ventilation, use personal utensils and cutlery

Active non-MDR disease treatment

treatment can last from 4 months for up to >2 years, outpatient unless severely ill/debilitated

Isoniazid (INH) - primary medication for TB

inhibits the synthesis of mycolic acids in bacterial cell wall

Other first line agents to INH

rifampin, pyrazinamide (PZA), streptomycin

Rifampin

inhibits bacterial DNA-dependent RNA polymerase

Pyrazinamide (PZA)

disrupts several essential bacterial processes

Streptomycin

inhibits protein synthesis in bacteria

INH + 2-3 combinations…

reduce MDR TB

Antitubercular therapy

monitor patient compliance closely (noncompliance increases MDR TB risk, directly observed therapy initiated if noncompliant), 12 month F/U to check for MDR TB (adjust drug regimen after test results), second line drugs (rifapentine, ethambutol, rifabutin)

INH - DOC

take on empty stomach (absorbs better), can inhibit cytochrome P450 pathway, add vitamin B6 (pyridoxine) - combats peripheral neuritis (neurologic ADRs)

Rifampin

oral contraceptives may not be effective, use an additional method of birth control, patient’s secretions may become reddish orange-urine, stool, saliva, sputum, sweat, tears (stains contact lenses)

Nursing implications for TB meds

do not drink alcohol, monitor LFTs, especially in liver disease, alcoholics, elderly

Nursing assessment implications from TB

obtain a thorough medical history and assessment, monitor LFTs in patients who take INH or rifampin (especially in liver disease, alcoholics, elderly), assess for contraindications to the various drugs, conditions for cautious use and potential drug interactions, monitor for therapeutic effects (clinical improvement, C&S and CXR improvement, negative sputum culture)

Patient teaching for TB

therapy may last longer than 24 months (take exactly as ordered at same time every day, proper hygiene and how to prevent spread, adequate nutrition and rest), contagious until 3 negative sputum cultures, immediately report to HCP fatigue, N&V, numbness/tingling of extremities, fever, loss of appetite, depression, jaundice, dark urine, check with primary HCP before taking other OTC meds, herbals or supplements, no alcohol