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Unit 12_ Tuberculosis _TB_ Treatm

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					                                   Unit 12: Tuberculosis (TB) Treatment and Side Effects




Unit 12: Tuberculosis (TB)
Treatment and Side Effects
In this unit you will learn about the medicines used to treat TB patients
and the side effects that these medicines may cause. You will also learn
how to talk to members of your community about the importance of treat-
ment for TB.




           Objectives
 By the end of Unit 12 you will be able to:

      a . Explain to patients with inactive and active TB when to take
         tuberculosis medicine, how much, and how often.

      b . Explain what adherence to TB medicine means and why it is
         important.

      c . Explain what multidrug resistance is and why it is important.

      d . Explain the complications that arise when a patient has both
         HIV and TB.

      e . Describe the accompagnateur’s role in helping patients take
         their TB medicine.

      f . Recognize urgent side effects of TB medicines that need im-
         mediate medical attention at the clinic.

      g . Recognize non-urgent side effects of TB medicines that need
         medical attention at the clinic within a week.

      h . Recognize common side effects of TB medicines that do not
         need medical attention.



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      Unit 12: Tuberculosis (TB) Treatment and Side Effects




                    Key Points
              •	 People must take medicine for many months if they have TB.

              •	 TB can become resistant to medicine if patients do not take
                  it correctly. Patients should not miss any pills or stop taking
                  their medicine early.

              •	 Patients may experience side effects to TB medicine.

              •	 Ask your patients how they are feeling every day. Every week,
                  ask your patients if they are experiencing any side effects.

              •	 If patients have urgent side effects, they should go to the
                  clinic immediately.

              •	 If patients have non-urgent side effects, they should go to the
                  clinic within one week.




                    Key Vocabulary
        Adherence: to stick carefully to a plan; to take medicine carefully
        according to a doctor s directions

        Multidrug: more than one drug; multidrug resistance means that a
        disease can ght off several kinds of medicine

        Resistance: when a disease learns how to ght medicine




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Tuberculosis (TB) Treatment
Just like antiretroviral medicines (ARVs), TB medicines must be taken
with care. Some patients have to take multiple medicines every day.
Rifampicin, isoniazid, ethambutol, pyrazinamide and streptomycin are
drugs used to treat TB.




The abbreviation for rifampicin is (R).




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      The abbreviation for isoniazid is (H). There are 2 different kinds of
      isoniazid pills. The 300 mg pills have three times more medicine in them
      than the 100 mg pills do.




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Sometimes rifampicin and isoniazid are put together into one pill. This is
called a combination pill. There are 2 different kinds of combination
pills. The 300/150 mg pills have more medicine in them than the 150/100
mg pills.




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      Unit 12: Tuberculosis (TB) Treatment and Side Effects




      The abbreviation for ethambutol is (E).




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The abbreviation for pyrazinamide is (Z).




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      The abbreviation for streptomycin is (S). Only in special cases will people
      need injections of streptomycin to treat TB.




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Treating Inactive Tuberculosis (TB)




Patients with inactive TB have no symptoms. They are not contagious.


Patients with inactive TB should take isoniazid once a day for 9 months.


It is your job to make sure that your patients take all their medicines
every single day for all 9 months.




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      Treating Active TB




      Patients with active TB take medicine for 6 months.


      For the rst 2 months, patients take four different types of medicine
      (rifampicin, isoniazid, ethambutol, and pyrazinamide).


      For the last 4 months, patients take two different types of medicine
      (rifampicin and isoniazid).


      If the patient is taking a combination pill (rifampicin + isoniazid), he is
      still taking 4 different drugs but only swallowing 3 different pills.


      Patients treatments may be different if they have to take antiretrovirals
      (ARVs) and TB medicine at the same time. These medicines often interfere
      with each other. In some cases, this results in more side effects. In other
      cases, one medicine will make the other not work as well. A doctor will



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decide the best treatment for patients who have both HIV/AIDS and
TB. Be sure to speak with the doctor or nurse in these cases so you fully
understand what types of medicines the patient should be taking and how
often they should take them.


If patients stop taking their medicine before their treatment is nished,
they are not adhering to their treatment. If they do not adhere to
treatment, TB can come back. The medicines will stop working and the
patient will become sick again.




      Resistance happens when TB starts to fight the medicine

When TB becomes able to ght some of these medicines so that the
medicines do not work anymore, it is called multidrug resistance.
Multidrug resistance is very dangerous. When a person has multidrug-
resistant TB (MDR TB), doctors must add more and more different types
of medicine. MDR TB can be spread the same way as regular TB. This is
one of the many reasons why accompagnateurs are so important. You must
make sure your patients take their medicine every day for as long as
their doctors have prescribed it. This way, you are also making sure
that TB medicine keeps working for everyone.


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      People living with HIV/AIDS are more likely to have MDR TB than
      regular TB. This means that regular medicine will not work for them.
      If your patient continues to cough or lose weight after one month of TB
      medicine, he should visit the clinic again.




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Identifying Symptoms
Like antiretrovirals (ARVs), TB medicines can also cause side effects.


    •	 Some side effects are urgent. If a patient has an urgent side
         effect, she should go to the clinic immediately.
    •	   Some side effects are non-urgent. If a patient has non-urgent
         side effects, she should go to the clinic within a week.
    •	   Some side effects are completely normal. They do not require a
         visit to the clinic.
    •	   Every day, ask your patients how they are feeling. If your pa-
         tients say they are not feeling well, ask them what is wrong. If
         necessary tell them to go to the clinic.
    •	   Every week, ask about speci c side effects.
    •	   See the lists of questions you should ask under Ask the Patient.




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      Urgent Side Effects




                Difficulty breathing                                Chest pain




                          Rash                                       Vomiting




               Difficulty swallowing                                 Jaundice




                    Swollen eyes                                 Swollen tongue




                  Change in vision                                 Hearing loss



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 Urgent Side Effect               Ask the Patient

 Difficulty breathing             Are you having dif culty breathing?
 or chest pain                    Are you having chest pain?

                                  Do you have a rash anywhere on your
 Rash
                                  body?

                                  Have you been vomiting or felt
 Vomiting
                                  nauseous?


 Difficulty swallowing            Have you had trouble swallowing?



 Jaundice                         Has your skin changed color?



 Swollen eyes                     Have your eyes been swollen?



 Swollen tongue                   Has your tongue been swollen?


                                  Has your vision changed? Can you see as
 Changes in vision
                                  well as always?


 Hearing loss                     Can you hear as well as always?




If your patient is having an urgent side effect, he should go to the clinic
immediately.


If your patient needs help getting to the clinic, do your best to help him
get there.




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      Non-urgent side effects




                      Dizziness                                     Weakness




                    Muscle pain                         Burning or tingling feet or hands




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 Non-urgent Side Effect           Ask the Patient


 Loss of appetite                 Are you eating well?



 Dizziness                        Do you feel dizzy?



 Weakness                         Do you feel weak?



 Muscle pain                      Do you have muscle pain?


 Burning or tingling in           Do you feel burning or tingling in your
 hands or feet                    hands or feet?




If your patient is having a non-urgent side effect, she should go to the
clinic within one week.




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      Normal Side Effects
      Some TB medicines can turn urine a dark or orange color. This is normal
      and the patient does not need to go to the clinic.


      Also, TB medicine weakens birth control pills. Women can and should still
      use the birth control pills, but the doctor might have to change the dose.
      Remind your patient to ask her doctor about this if she is taking birth
      control pills.

      TB Patients Who Have HIV/AIDS
      People living with HIV/AIDS may have worse reactions to TB medicines if
      they are also taking ARVs. Watch your patients who are taking medicine
      for both HIV and TB very carefully.


      A person living with HIV/AIDS who takes ARVs and then starts taking
      TB medicine may get worse at rst. This is because his immune systems
      his body s defense systems are suddenly getting strong enough to ght
      off the TB. When his immune system is ghting off the TB, sometimes the
      body damages itself and a patient can experience more symptoms.


      If a patient is experiencing any urgent symptoms or side effects, like
      dif culty breathing, she should visit the clinic immediately .


      If a patient is experiencing a non-urgent side effect, he should visit the
      clinic within a week.


      If a patient is too sick to travel to the clinic alone, arrange a ride for the
      patient. If this is not possible, go to the clinic to notify the doctor or nurse,
      who will arrange for transportation.




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       Accompagnateur Checklist

■ Observe patients taking their medicine every day and encourage
  them to continue their medicine until their treatment is nished.

■ Every day, ask patients how they are feeling. Every week, ask
  patients if they are experiencing side effects.

■ Watch for allergic reactions and urgent side effects to TB
  medicines so you can help patients get to the clinic immediately.

■ Recommend that patients who are experiencing non-urgent side
  effects to visit the clinic within one week.

■ Reassure patients who are experiencing normal side effects.




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      Unit 12: Tuberculosis (TB) Treatment and Side Effects




                Notes and Questions




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Unit 12, Activity 2
Role-Plays


   •	 An accompagnateur is visiting a patient with TB who has been
      taking her medicine for over 4 months. When the accompagna-
      teur arrives, the patient appears sad.
   •	 When the accompagnateur asks the patient what is wrong, she
      says that she is feeling better and she wants to stop taking her
      medicine. She does not like swallowing pills and often the pills
      make her feel dizzy.
   •	 The accompagnateur should explain to the patient why it is
      important to continue taking her medicine. The accompagna-
      teur should try to understand the patient s feelings and offer
      her support.



   •	 An accompagnateur is visiting a patient s home to give him his
      TB medicine and his ARVs. The patient has both TB and HIV.
   •	 The accompagnateur questions the patient to see if he is feeling
      well or has had any side effects to the medicine.
   •	 The patient tells the accompagnateur that he is having trouble
      breathing.




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      Unit 12: Tuberculosis (TB) Treatment and Side Effects




                Notes and Questions




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