ISONIAZID, RIFAMPICIN, ETHAMBUTOL, PYRAZINAMIDE, and STREPTOMYCIN

ISONIAZID 

In 1952, isoniazid was first marketed. It is an anti-tubercular drug that is bactericidal.

Mechanism of Action

• It blocks the enzymes necessary for the production of mycolic acids and the cell walls of microorganisms.

Contraindication

• Liver disease brought on by drugs

Side Effect

• Peripheral neuritis
• Hepatotoxicity
• Convulsions
• Restlessness
• Fever
• Rash
• Psychosis
• Memory disorders
• Neurotoxicity
• Pellagra like syndrome
• Joint pains
• Agranulocytosis
• Acne
• Haemolysis in G6PD

Nursing Consideration

• At least one hour before or two hours after meals, the oral dose should be administered on an empty stomach.
• You should keep an eye out for any hepatic adverse effects as isoniazid may cause hepatic impairment.
• Isoniazid may induce peripheral neuropathy, which should be watched for, as well as neurological side effects as tingling and numbness in the extremities. Observe the patient's dietary compliance while they are on isoniazid. Tyramine-rich foods may interact with the medication and result in palpitations, flushing, and hypertension.
• Based on the severity of the disease condition and defined protocol, implement infection control measures.
• Create a healing environment to promote sufficient fluids, nutrition, and rest.

RIFAMPICIN

It works well to sterilize and prevent resistance. M. tuberculosis and numerous gram+ve and gram-ve bacteria are both bactericidal to it.

Mechanism of Action

• It strongly binds to DNA dependent RNA polymerase, which prevents bacteria from producing RNA.

Contraindication

• Hepatitis
• Pregnancy

Side Effect

• Hepatitis
• Hue of the faeces, urine, or sweat
• Drowsiness
• Headache
• Confusion
• Dizziness
• Purpura thrombocytopenic
• Leucopenia
• Anaemia.

Nursing Consideration

• Can be given without consideration to food.
• Regular uric acid and serum testing, sputum cultures, and chest x-rays.
• Obtain liver function tests before starting treatment and every 2-4 weeks while on it.
• Patients with porphyria, chronic gout, diabetes mellitus, or renal failure should use this medication with caution.
• Patients with a history of liver or kidney disease, diabetes, gout, a high blood uric acid level, drinking, pregnancy, or breastfeeding should use caution.
• Avoid drinking alcohol while taking this medicine.
• Avoid live vaccines while receiving treatment.

ETHAMBUTOL 

Synthetic, Heat-resistant, and Water-soluble substance. It is a synthetic medicine derived from isonicotinic acid. It is quite efficient against bacilli that grow quickly (bacteriostatic)

Mechanism of Action

• The interference with mycolic acid incorporation in cell walls and the inhibition of RNA synthesis are what cause the bactericidal action.

Contraindication

• Pregnancy
• Lactation
• Significant Renal Impairment
• Optic neuropathy

Side Effect

• Optic neuritis
• Blindness
• Hyperuricaemia
• Loss of visual acquity
• Colour blindness
• Anorexia
• Nausea
• Vomiting
• Abdominal pain.

Nursing Consideration

• If G irritation happens, oral dose should be administered with food.
• Perform ophthalmoscopic examinations before starting therapy and every month after that.
• It may make you feel lightheaded, disoriented, or sleepy, so you shouldn't drive or engage in other activities that call for alertness until you know how the drug affects you.
• Any changes in vision, numbness or tingling in the extremities, or persistent appetite loss should be reported to a doctor.
• Routinely monitor CBC, uric acid levels, and renal and hepatic functions.

PYRAZINAMIDE 

It shares a structure with isoniazid. It is a bactericidal medication that is derived from nicotinemid. It can get beyond the blood-brain barrier (BBB).

Mechanism of Action

• Unknown is the mechanism of action. It is a bactericidal drug because it kills bacteria.

Indication

• Tuberculosis
• Contraindication
• Hepatic Disease

Side Effects

• Hepatotoxicity
• Hyperuricaemia
• Arthritis and gout
• GI sensitivity
• Flushing
• Rashes
• Fever
• Loss of control over diabetes.

STREPTOMYCIN 

It was the first chemotherapeutic drug made available for the treatment of tuberculosis. It is offered as vials of dry powder, such as 1gm vials.

Mechanism of Action

• Because it binds to the isolated 30s ribosomal subunit of ribosomes and ribosomal protein synthesis by causing misreading of the m-RNA codons, interfering with the initiation complex of peptide formation, and breaking polysomes with non-functional monosomes, it is caused by the inhibition of protein synthesis inhibitors.

Indication

• Tuberculosis
• Bacterial endocarditis that is subacute

Contraindication

• Pregnancy
• Aminoglycoside hypersensitivity

Side Effect

• Ototoxicity
• Nephrotoxicity
• Vestibular poisoning
• Vertigo
• Rash
• Dermatitis that Exfoliates
• Rashes with Erythema
• Giddiness
• Ataxia

Nursing Consideration

• To reduce the risk of irritation, IM injections should be administered deeply into big muscle mass.
• Make sure you drink enough water both before and during the therapy.
• Watch for changes in your hearing.
• Inform your doctor if your hearing changes. woozyness and rash.