Quadtab Drug Study

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					                                                                                DRUG STUDY – QUADTAB




Date &
                                                                              Route / Dosage /                                                             Precautions /
 Time       Brand Name             Indication             Drug Action                             Drug Interaction           Adverse Effect                                         Nursing Responsibilities
                                                                               Time Interval                                                             Contraindications
Ordered

                                                     Rifampicin:                                 Rifampicin:           Rifampicin:                   CONTRAINDICATION:             Observe for the 10
                            Intensive phase
                                                                                                                                                                                    rights of drug
                            treatment of all forms                              Per orem         Para amino licylic
                                                     It is a semisynthetic                                             High doses of rifampicin                                     administration
             Quadtab®       of pulmonary                                         3 tabs          acid, clofazimine                                    Hypersensitivity to
                                                     derivative of                                                     (>600 mg) given once or
                            and extrapulmonary                                  Once daily       and dapsone decr                                     rifampicin, isoniazid,
                                                     rifamycin, suppresses                                             twice weekly have
                            tuberculosis                                                         ease the effects of   resulted in a high             pyrazinamide and             Read the medication
                                                     bacterial RNA
                                                                                                 rifampicin.           incidence of adverse           ethambutol HCl, or any        label 3 times
                                                     synthesis by binding
                                                                                                 Rifampicin            reactions, including the       of the components
                                                     to the β-subunit of
                                                                                                 decreases the         flu-like syndrome (eg,         of Quadtab.                  Provide adequate
           Generic Name                              DNA-dependent RNA           Half-Life
                                                                                                 effects of            fever, chills and malaise);    Patients with severe
                                                     polymerase, thus                                                                                                               information about the
                                                                                                  paracetamol, oral    hematopoietic reactions        hepatic damage and
                                                     inhibiting the            Rifampicin                                                                                           drug
                                                                                                 anticoagulants,       (eg, leukopenia,               acute gout.
                                                     attachment of the
                                                                               2-5 hours         barbiturates,         thrombocytopenia and           Preexisting optic
                                                     enzyme to DNA,
                                                                                                 benzodiazepines,      acute hemolytic anemia);       neuritis from any            Assess for any possible
                                                     blocking RNA
January                                                                        Isoniazid         β-blockers,           cutaneous,                     cause.                        drug interaction
                                                     transcription and
21, 2010                                                                       1-6 hours         chloramphenicol,      gastrointestinal and
                                                     elongation. It does
                                                     not inhibit the                             clofibrate, oral      hepatic reactions;            PRECAUTION:                   Asses for any condition
 (take-                                                                        Pyrazinamide      contraceptives,       shortness of breath; shock;
                                                     counterpart                                                                                                                    which requires
 home                                                                          9-10 hours        corticosteroids, cy   and renal failure.
                                                     mammalian enzyme.                                                                                                              precaution or
 med)                                                                                            closporine, digitox   Hypersensitivity reactions,    Rifampicin:
            Rifampicin +                                                       Ethambutol        in, disopyramide,                                                                  contraindication
                                                     Rifampicin has a                                                  including rashes, urticaria
             Isoniazid +                             bactericidal action       3-4 hours         estrogens,            and pruritis have been         Thrombocytopenia has
           Pyrazinamide +                            and a potent                                hydantoins, metha     reported.                                                   Administer drug before
                                                                                                                                                      occurred primarily with
            Etahmbutol                               sterilizing effect                          done, mexiletine,                                                                  any meal to prevent
                                                                                                                                                      high-dose rifampicin
                                                     against both                                quinidine,                                                                         reduction in drug
                                                                                                                       Isoniazid:                     intermittent therapy,
                                                     intracellular and                           sulfones,
                                                                                                                                                      but has also been noted       efficacy
                                                     extracellular tubercle                      sulfonylureas, the
                                                                                                                                                      after resumption of
                                                     bacilli. Cross-                             ophylline,            Toxic effects are usually
                                                                                                                                                      interrupted treatment.       Instruct patient to
                                                     resistance has been                         tocainide and vera    encountered with higher
                                                                                                                                                      This effect is reversible     report any discomfort
                                                     shown only with other                       pamil.                doses of isoniazid; the
                                                                                                                                                      if the drug is
                                                     rifamycin derivatives.                                            most frequent are those                                      after taking the drug
                                                                                                                                                      discontinued as soon as
                                                                                                                       affecting the nervous
                                                                                                                                                      purpura occurs.
                                                     Isoniazid:                                  Isoniazid:            system and the liver                                        Encourage the patient
                                                                                                                                                      Cerebral hemorrhage
                                                                                                                       particularly disturbances
                                                                                                                                                                                    to take rest after taking

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It kills actively          Halothane and iso      of hepatic function.           and fatalities have       the drug
growing tubercle           niazid when co-        Occasional neurotoxic          occurred when
bacilli by inhibiting      administered with      effects include                rifampicin
the biosynthesis of        rifampicin may         convulsions, optic neuritis    administration was
mycolic acids, which       result in a higher     and atrophy, memory            continued or resumed
are the major              rate of                impairment and toxic           after the appearance of
components of the          hepatotoxicity         psychosis.                     purpura.
bacterial cell wall        than with either
of Mycobacterium           agent alone. If
                                                  In rare cases, hepatitis and
tuberculosis.              alterations in liver
                                                  peripheral neuropathy
                           function tests
                                                  have been observed.            Isoniazid:
Pyrazinamide:              occur, consider
                                                  Other possible side effects
                           discontinuation of
                                                  are nausea, vomiting,
                           1 or both drugs.                                      Periodic
Pyrazinamide, an                                  abdominal discomfort,
                           Isoniazid inhibits                                    ophthalmologic
antituberculous drug,                             fever, skin eruptions,
                           the metabolism of                                     examinations during
the precise                                       rheumatic syndrome and
                           anticonvulsants,                                      isoniazid therapy are
mechanism of action                               systemic lupus
                           benzodiazepines,                                      recommended even
of pyrazinamide is not                            erythematosus-like
                           haloperidol, ketoc                                    when visual symptoms
known. Its metabolite,                            syndrome.
                           onazole,theophylli                                    do not occur.
pyrazinoic acid, which
is less active in          ne and warfarin.
                           Corticosteroids        Pyrazinamide:
vitro may possibly, be
                           may decrease the                                      Pyrazinamide:
involved in the in
vivo activity of           serum                  Pyrazinamide inhibits renal
pyrazinamide.              concentrations of      excretion of urates,           Pyrazinamide inhibits
                           isoniazid by           frequently resulting in        renal excretion of
Ethambutol:                increasing             hyperuricemia, which is        urates, frequency
                           acetylation rate       usually asymptomatic           resulting in
Ethambutol diffuses        and/or renal                                          hyperuricemia, which is
slowly into actively       clearance. Para-                                      usually asymptomatic.
                           aminosalicylic         Ethambutol:
growing Mycobacteria                                                             If hyperuricemia is
cells eg, tubercle         acid may increase                                     accompanied by acute
bacilli. It inhibits the   the plasma             Ethambutol may produce         gouty arthritis,
synthesis of 1 or more     concentration and      decreased visual acuity        pyrazinamide should be
metabolites, thus          elimination half-      due to optic neuritis. This    discontinued.
causing impaired cell      life of isoniazid by   effect appears to be
metabolism, arrest         competition of         related to dose and
cell multiplication and    acetylating            duration of treatment.         Ethambutol:
induce cell death. No      enzymes. Isoniazid     Other adverse reactions
cross-resistance with      may produce            reported include joint
                           hypoglycemia and                                      Ethambutol may
other agents has been                             pain, anaphylactoid
                                                                                 damage vision. Test
demonstrated.              lead to loss of        reactions, dermatitis,
                           glucose control in                                    vision before and
                                                  pruritus, anorexia, nausea,
                                                                                 regularly during
                           patients on oral       vomiting, gastrointestinal
                                                                                 administration.
                           hypoglycemics.         upset and abdominal pain.
                           Fast acetylation of                                   Ethambutol may
                                                  Fever, malaise, headache,
                                                                                 produce optic neuritis,
                           isoniazid may

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                                     produce high           dizziness, mental              which causes eye pain,
                                     concentrations of      confusion, disorientation      decreased visual acuity,
                                     hydrazine, which       and possible hallucinations    general loss of vision,
                                     facilitate             have also been reported.       central and peripheral
                                     defluorination                                        constriction of visual
                                     ofenflurane.                                          fields, and loss of
                                                            General:
                                                                                           red/green color
                                     Pyrazinamide:                                         perception. If the
                                                            Quadtab may cause a
                                                                                           patient has any
                                                            reddish-orange
                                                                                           indication that the
                                      Pyrazinamide          discoloration of urine,
                                                                                           perception of color or
                                     interferes with        stools, saliva, tears, sweat
                                                                                           the sight is
                                     oral antidiabetics     and sputum. This is to be
                                                                                           deteriorating,
                                     or with medicines      expected and is not
                                                                                           treatment must be
                                     taken for the          harmful. Soft contact lens
                                                                                           stopped immediately
                                     treatment of gout.     may be permanently
                                                                                           and the doctor
                                                            stained.
                                                                                           consulted. Do not give
                                     Ethambutol:                                           ethambutol to any
                                                                                           patient too young to
                                     Aluminum salts                                        understand this
                                     found in antacids                                     warning or who cannot
                                     may delay and                                         communicate any visual
                                                                                           problems (usually <6
                                     reduce the
                                                                                           years old).
                                     absorption of
                                     ethambutol.
                                     Separate their
                                     administration by
                                     several hours.



Classification     Absorption             Excretion

                 Rifampicin:         Rifampicin:

                                     30% of a 900mg
                 It is readily
                 absorbed from       dose may be
                 the                 excreted in the
 Anti-TB Drug                        urine, about half
                 gastrointestinal
                 tract               of it within 24 hrs.
                                     Rifampicin is
                                     excreted mainly
                 Isoniazid:          through the bile.

                 It is rapidly and

                                                                                                                      50 | P a g e
completely         Isoniazid:
absorbed orally
                   75% of a dose
                   appears in the
Pyrazina-mide:
                   urine in 24 hrs
                   mainly as
It is well         metabolites. Small
absorbed from      amounts of the
the                drug are also
gastrointestinal   excreted in the
tract.             feces.
Pyrazinamide is
widely             Pyrazinamide:
distributed in
body tissues       Approximately
and fluids,        70% of an oral
including the      dose is excreted in
liver, lungs and   urine, mainly by
CSF.               glomerular
                   filtration, within
Ethambutol:        24 hrs.

                   Ethambutol:
 About 80% of
an oral dose of    About 20% of the
ethambutol is      dose is excreted
absorbed from      unchanged in the
the                faeces. Marked
gastrointestinal   accumulation may
tract.             occur with renal
                   insufficiency.




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