Name of Drug

Dosage/Route

Drug Action/Classificatio n CLASSIFICATION: Anti-TB Agents :

Indication

Contraindication

Adverse Effect

Nursing Responsibilities

Fixcom 4

FORMULATIO N: Each tablet contains: Rifampicin 150mg Isoniazid 75mg Pyrazinamide 400mg

ACTION Rifampicin: Bactericidal. Inhibits mycobacterial RNA synthesis by binding to DNA-dependent RNA polymerase, Ethambutol thereby blocking 275mg RNA synthesis and subsequent Dosage/Route translation to Anti-tuberculosis proteins. short course chemotherapy Isoniazid: recommended by Bactericidal. Inhibits World Health mycolic acid Organization synthesis resulting in (WHO) involves loss of acid-fastness an initial phase and bacterial cell using a wall disruption. combination of drugs to produce Pyrazinamide: rapid killing of Bactericidal. Inhibits the tubercle the growth of bacilli. For the Mycobacterium initial phase: tuberculosis by Rifampicin + decreasing its pH Isoniazid + level. Pyrazinamide + Ethambutol Ethambutol: (FIXCOM 4) is Bactericidal. given for 2 Interferes with RNA

Ethambutol: For the initial or Children less intensive than 6 years phase Children less treatment of than 13 years all forms of Patients with pulmonary Visual defects and & Optic extrapulmon Neuritis ary tuberculosis Pyrazinamide:

Rifampicin: Hepatitis, orangered urine, sweat and tears, GI disturbances, nausea & vomiting, rashes, fever, headache Isoniazid: Peripheral neuritis, hepatitis, fever, rash, visual disturbances Pyrazinamide: Hypersensitivity, Hepatitis, Fever, porphyria, dysuria, GI disturbances, Ethambutol: Retrolobular neuritis, visual field constriction, central or peripheral scotoma, green-

Liver Damage Acute gout or Hyperuricemia

Rifampicin Jaundice Liver damage

1. The tablets should be taken 1 hr before or 2 hrs after meals to facilitate absorption. 2. Monitor liver function test results before and every 2 to 4 weeks during therapy. Immediately report abnormalities. 3. Expect skin to discolor and body fluids reddish orange to reddish brown, nausea and vomiting, epigastric distress, skin rashes, drowsiness, fatigue. 4. Take this drug regularly; avoid missing any doses; do not discontinue this drug without consulting your health care provider. 5. Have periodic medical checkups, including eye examinations and

months. Below 55 kg - 3 tablets per day 55kg - 70kg - 4 tablets per day Above 70kg - 5 tablets per day The tablets should be taken one hour before or two hours after meals.

synthesis, causing suppression of Mycobac. multiplication. It acts on rapidly growing pathogens in cavity walls.

red color blindedness, fever, confusion, headache, rashes, GI disturbances

blood tests, to evaluate the drug effects. 6. Do not drink alcohol, or drink as little as possible. There is an increased risk of hepatitis. 7. Instruct patient to report darkened urine, fever, chills, nausea, severe pain in feet or toes, vomiting and yellowing of skin and eyes, muscle and bone pain, excessive tiredness or weakness, loss of appetite, unusual bleeding or bruising, changes in vision 1. Monitor I&O ratio and pattern in patients receiving the parenteral drug. If oliguria occurs, stop infusion promptly and notify physician. 2. Lab test:

Potasium chloride Kalium Durule

PO (Adults): 2040 mEq/day in 12divided doses; single dose should notexceed 20 mEq. Adult & elderly Prophylaxis 2 durulesdaily. Hypokalemia Adjust dosageaccording to serum K level. Suggesteddose: 2

CLASSIFICATION: electrolytic and water balance agent ACTION: Replace potassium and maintain potassium level and principal intracellular cation; essential for maintenance of intracellular isotonicity,

To prevent and treat potassium deficit secondary to diuretic or corticosteroi d therapy. Indicated when potassium is depleted by

Severe renal impairment; severe hemolytic reactions; Untreated Addisons disease; crush syndrome; Early postoperative oliguria (except during

GI:Nausea, vomiting, diarrhea, abdominal distension.

BodyWhole:Pain, mental confusion, irritability, listlessness, paresthesias of

durules bid or more until serum Kis restored to normal, then prophylactic dosage

transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscles, maintenance of normal kidney function, and for enzyme activity. Plays a prominent role in both formation and correction of imbalances in acid base metabolism.

severe vomiting, diarrhea; intestinal drainage, fistulas, or malabsorptio n Prolonged diuresis, diabetic acidosis. Effective in the treatment of hypokalemic alkalosis (chloride, not the gluconate).

GI drainage); adynamic ileus; Acute dehydration; heat cramps, hyperkalemia, patients receiving potassiumsparing diuretics, digitalis intoxication with AV conduction disturbance

extremities, muscl e weaknessand heaviness of limbs, difficulty in swallowing, flaccid paralysis.

Urogenital:Oligur ia, anuria. Hematologic:Hyp erkalemia.

Respiratory:Respi ratory distress. CV:Hypotension, bradycardia; cardiac depression, arrhythmias, or arrest; altered sensitivity to digitalis glycosides. ECG changes in hyperkalemia: Tenting (peaking) of T wave (especially in right precordial leads), lowering of R with deepening of S waves and

Frequent serum electrolytes are warranted. 3. Monitor for and report signs of GI ulceration (esophageal or epigastric pain or hematemesis). 4. Monitor patients receiving parenteral potassium closely with cardiac monitor. Irregular heartbeat is usually the earliest clinical indication of hyperkalemia. 5. Be alert for potassium intoxication (hyperkalemia, see S&S, Appendix F); may result from any therapeutic dosage, and the patient may be asymptomatic.

depression of RST; prolonged P-R interval, widened QRS complex, decreased amplitude and disappearance of P waves, prolonged Q-T interval, signs of right and left bundle block, deterioration of QRS contour and finally ventricular fibrillation and death.

6. Check for the risk of hyperkalemia with potassium supplement increases (1) in older adults because of decremental changes in kidney function associated with aging, (2) when dietary intake of potassium suddenly increases, and (3) when kidney function is significantly compromised. Use minimal doses for minimal periods; drug tolerance can occur with prolonged use. Prepare solution for inhalation by diluting 0.5 mL 0.5% solution with 2.5 mL normal saline;

Ipratropium + Salbutamol Duavent

Pulmoneb Adult, adolescent >12 yr & elderly Treatmen t of acute attacks 1-2 pulmoneb. Maintenance: 1 pulmoneb 6-8 hrly. Childn 2-12 yr 3 drops/kg/dose. Max: 2.5 mg of salbutamol 6-8

Ipratropium bromide: Anticholinergic, chemically related to atropine, which blocks vagally mediated reflexes by antagonizing the action of acetylcholine. Causes bronchodilation and

Relieve or prevention of bronchospasm in patients with reversible obstructive airway disease such as Bronchial Asthma

Hypersensitivi ty to any component of Duavent or to atropine

Headache, pain, influenza, chest pain; nausea. Bronchitis, dyspnea, coughing, pneumonia, bronchospasm, pharyngitis, sinusitis, rhinitis.

hrly. MDI Adult & childn >12 yr 2 actuations 6 hrly. Max: 12 actuations in 24 hr.

inhibits secretion from serous and seromucous glands lining the nasal mucosa.

deliver over 5-15 minutes by nebulization.

Salbutamol sulfate: In low doses, acts relatively selectively at beta-adrenergic receptors to cause bronchodilation and vasodilation; at higher doses, 2 selectivity Is lost, and drug acts at 2 receptors.