Drug Study - HRZE

St. Joseph College of Cavite Inc. Institute of Health Sciences

NAME: Juan Miguel AGE: 15 years old ADDRESS: Gilid Brgy Mayamot Summerville Antipolo City CHIEF COMPLAINT: Neck pain

Medication Generic Name: Rifampicin + Isoniazid + Pyrazinamide + Ethambutol HCl Brand Name:

Classification: Anti-infectives (systemic); Antituberculosis Route: Per Orem Dosage: 150 mg/ 75 mg/ 400 mg/ 275 mg Frequency: OD Form:

Color:

DRUG STUDY DRUG STUDY SEX: Male

RELIGION: Catholic ROOM NO: MTW DATE OF ADMISSION: May 21, 2014 DIAGNOSIS: Compression Fracture C4-C5 Secondary to Pott's Disease

Mechanism of Action

Specific Indication

Rifampicin Rifampicin, a semisynthetic antibiotic derivative of Rifamycin, suppresses bacterial RNA synthesis by binding to the b subunit of DNA-dependent RNA polymerase, thus inhibiting the attachment of the enzyme to DNA, blocking RNA transcription, elongation, and subsequent translation to protein. It does not inhibit the counterpart mammalian enzyme.

For the initial phase treatment of all forms of pulmonary and extrapulmonary tuberculosis.

Rifampicin has bactericidal action and potent sterilizing effect against both intracellular and extracellular tubercle bacilli. Cross resistance has been shown only with other rifamycin derivatives. Isoniazid Isoniazid kills actively growing tubercle bacilli by inhibiting the biosynthesis of mycolic acid which is the major component of the cell wall of Mycobacterium tuberculosis. It is active against susceptible bacteria only when they are undergoing cell division. Pyrazinamide Pyrazinamide is the pyrazine analog of nicotinamide. The precise mechanism of action of pyrazinamide is unknown. Its metabolite, pyrazinoic acid, which is less active in vitro, may possibly be

Contra-indication& Side effects

Nursing Responsibilities

Contraindications: Hypersensitivity to any ingredient in the product Jaundice or severe liver disease Acute gout Pre-existing optic neuritis from any cause Rifampicin High doses of rifampicin (>600 mg) given once or twice weekly have resulted in a high incidence of adverse reactions including: the “flu-like” syndrome (i.e., fever, chills, sometimes with headache, dizziness, and bone pain); hematopoietic reactions (i.e., leukopenia, thrombocytopenia, and acute hemolytic anemia); cutaneous; gastrointestinal and hepatic reactions; dyspnea, wheezing; shock; and acute renal failure. Hepatic: Elevations in serum concentrations of ALT, AST, bilirubin, and alkaline phosphatase, asymptomatic jaundice, and hepatitis. Rarely, hepatitis or shock-like syndrome with liver involvement and abnormal liver function test results. Dermatologic: Rash, pruritus, urticaria, acneiform eruptions, pemphigoid reaction, erythema multiforme including Stevens-Johnson syndrome, toxic epidermal necrolysis, vasculitis, exfoliative dermatitis, flushing, and rarely, anaphylaxis. Nervous system:Headache, drowsiness, fatigue, dizziness, inability to concentrate, mental confusion, behavioral changes, psychosis, and generalized

May cause reddish-orange discoloration of urine, saliva, tears, sweat and sputum. Instruct the patient that this is to be expected and not harmful. Monitor patient’s visual acuity, visual fields, and red-green discrimination regularly as reversible optic neuritis may be caused by Ethambutol. Instruct patients in proper oral hygiene, including caution in the use of regular toothbrushes, dental floss, and toothpicks. The leukopenic and thrombocytopenic effects of Rifampin may result in an increased incidence of certain microbial infections, delayed healing, and gingival bleeding. If leukopenia or thrombocytopenia occurs, dental work should be defined until blood counts have returned to normal. Rifampin may cause a hypersensitivity reaction of sores in mouth or tongue

Patient monitoring: Hepatic function determinations (ALT [SGPT], AST [SGOT], alkaline phosphatase, and serum bilirubin determinations may be

involved in pyrazinamide’s in vivo activity. Pyrazinamide is an effective bactericidal antituberculosis drug, and has a specific sterilizing action against Mycobacterium tuberculosis in the intracellular environment of macrophages. The acid environment presumably in some way makes Mycobacterium tuberculosis more susceptible to pyrazinamide, but this does not occur with Mycobacterium bovis which is resistant to the drug. As with other antituberculous drugs, resistance to pyrazinamide develops rapidly if it is used alone to treat human tuberculosis. Ethambutol HCl Ethambutol HCl diffuses into actively growing Mycobacteria cells such as tubercle bacilli. It inhibits the synthesis of one or more metabolites resulting in impaired cellular metabolism, arrested cell multiplication and cell death. It is active against susceptible bacteria only when they are undergoing cell division. No cross-resistance with other agents has been demonstrated.

numbness. GI: Heartburn, epigastric distress, nausea, vomiting, anorexia, abdominal cramps, flatulence, diarrhea, sore mouth and tongue, pseudomembranous colitis, and pancreatic insufficiency. Musculoskeletal: Ataxia, muscular weakness, myopathy, and pain in muscles, joints and extremities. Hematologic: Eosinophilia, leukopenia, purpura, hemolytic anemia, decreased hemoglobin concentrations, hemolysis, thrombocytopenia, disseminated intravascular dissemination, and agranulocytosis. Renal: Increased BUN and serum uric acid concentrations, hemoglubinuria, light chain proteinuria, hematuria, renal insufficiency, interstitial nephritis, acute tubular necrosis, and acute renal failure. Endocrine: Precipitation of adrenocortical insufficiency and menstrual disturbances. Opthalmologic: Visual disturbances and exudative conjunctivitis. Others: Fever, edema of face and extremities, dyspnea, wheezing, hypotension, and shock. Isoniazid Hepatic: Mild liver dysfunction, as evidenced by mild and transient elevations in serum concentrations of ALT, AST, and bilirubin concentrations. Rarely, progressive liver dysfunction, bilirubinuria, jaundice, and severe and sometimes fatal hepatitis. Dermatologic: Hypersensitivity reactions, including fever, skin eruptions (morbilliform, maculopapular, purpuric, or exfoliative), lymphadenopathy, vasculitis, and, rarely, hypotension. Nervous system: Seizures, convulsions, toxic encephalopathy, stupor, euphoria, memory

indicated prior to and monthly or more frequently during treatment; however, elevated serum enzyme values may not be predictive of clinical hepatitis and may return to normal despite continued treatment; patients with impaired hepatic function should not receive rifampin, isoniazid, pyrazinamide, and ethambutol combination unless it is crucial to therapy ) Ophthalmologic examinations (symptoms of optic neuritis may occur either in adults or children during treatment due to adverse effects of isoniazid and/or ethambutol Uric acid concentration (may be required during treatment, since elevated serum uric acid concentration frequently occur due ethambutol and/or pyrazinamide, possibly resulting in precipitation of acute gout

impairment, separation of ideas and reality, loss of self-control, dizziness, vertigo, and toxic psychosis. Gastrointestinal: Nausea, vomiting, and epigastric distress. Musculoskeletal: Ataxia and muscle twitching. Hematologic: Agranulocytosis, eosinophilia, thrombocytopenia, methemoglobinemia, and hemolytic, sideroblastic, or aplastic anemia. Endocrine: Hyperglycemia and metabolic acidosis. Opthalmologic: Optic neuritis and atrophy Others: Tinnitus, peripheral neuritis usually preceded by paresthesia of the feet and hands, dryness of the mouth, pyridoxine deficiency, pellagra, hyperreflexia, urinary retention, gynecomastia, systemic lupus erythematosus-like syndrome, and rheumatic syndrome with arthralgia. Pyrazinamide Hepatic: Hepatotoxicity appears to be dose-related, and may appear at any time during therapy. Transient increases in serum aminotransferase concentrations, jaundice, hepatitis, liver tenderness, and hepatomegaly have been reported. Dermatologic: Hypersensitivity reactions, including rash, urticaria and pruritus have been reported. Rarely, maculopapular rash, acne, and photosensitivity with reddish-brown discoloration of exposed skin. GI: Nausea, vomiting, and anorexia. Hematologic: Rarely, porphyria, thrombocytopenia and sideroblastic anemia with erythroid hyperplasia, vacuolation of erythrocytes, increased serum iron concentration, and adverse effects on blood clotting mechanisms. Renal: Dysuria and interstitial nephritis.

Others: Fever, splenomegaly, malaise, and frequently mild arthralgia and myalgia. Hyperuricaemia commonly occurs and may lead to attacks of gout. Ethambutol HCl Hepatic: Hepatotoxicity appears to be dose-related, and may appear at any time during therapy. Cholestatic jaundice, which appeared to be caused by ethambutol, has been reported in at least one patient who received the drug both alone and in combination with streptomycin. Transient impairment of liver function, as indicated by abnormal liver function tests, and jaundice have been observed. Dermatologic: Dermatitis and hypersensitivity reactions, including rash, pruritus, and leukopenia have been reported. Rarely, anaphylactoid reactions. Nervous system:Headache, dizziness, mental confusion, disorientation, possible hallucinations. GI: Gastrointestinal upset, abdominal pain, nausea, vomiting, and anorexia have occurred occasionally. Hematologic: Thrombocytopenia and eosinophilia. Others: Fever, joint pain, malaise, pulmonary infiltrates, elevated serum uric acid levels, precipitation of acute gout, and rarely, numbness and tingling of the extremities due to peripheral neuritis. Ethambutol may produce decreased visual acuity due to optic neuritis. This effect appears to be related to dose and duration of treatment.

Reference: http://www.unilab.com.ph/consumers/products/quadtab