A 30 -year-old pregnant woman is diagnosed with pulmonary tuberculosis. Which of the following anti tuberculosis drug should not be given?

Appeared in: Chitranjjan National Cancer Institute Kolkata - 2021

Explanation

Streptomycin belongs to the aminoglycoside class of antibiotics.
This drug is contraindicated in pregnancy because it readily crosses the placenta.
The primary risk to the fetus is irreversible ototoxicity, which involves damage to the 8th cranial nerve, potentially causing permanent hearing loss or deafness.
Due to this significant fetal risk, Streptomycin is avoided in pregnant patients.

Option A: Isoniazid (INH) is a first-line antitubercular drug and is considered safe for use during pregnancy.
Option B: Rifampicin is another first-line antitubercular drug that is considered safe to use during pregnancy.
Option D: Ethambutol is a first-line antitubercular drug considered safe for use during pregnancy.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacological management of tuberculosis in pregnancy to guide bedside assessment, documentation, and the next nursing action.
Treating active TB in pregnancy is critical because the disease itself poses a significant risk of morbidity and mortality to both the mother and the fetus, far outweighing the risks of appropriate medication.
The nurse's role includes comprehensive patient education on medication adherence, recognizing and reporting side effects (e.g., jaundice, vision changes, dizziness), and the importance of regular follow-up appointments.
What if the patient had Multi-Drug Resistant TB (MDR-TB)? Treatment becomes significantly more complex and must be managed by a specialist. It would involve second-line drugs, carefully selected to balance the life-threatening risk to the mother against potential fetal toxicities. Oral agents like bedaquiline and linezolid might be considered over injectable agents.

How to Approach the Question

First, identify the key clinical information in the stem: the patient is pregnant and has pulmonary tuberculosis.
Next, note the negative framing of the question: 'Which...drug should not be given?'. This means you are looking for a contraindicated medication.
Recall the standard first-line drugs for tuberculosis: Isoniazid (INH), Rifampicin, Pyrazinamide, and Ethambutol (RIPE).
Consider the safety profile of each drug in pregnancy. Remember that most first-line drugs (INH, Rifampicin, Ethambutol) are generally safe.
Specifically, recall that aminoglycosides are a class of antibiotics known for fetal toxicity.
Identify Streptomycin as an aminoglycoside and recognize its well-known risk of causing fetal ototoxicity (hearing loss). This makes it the contraindicated drug among the choices.

Concept Tested & Keywords

Concept Tested: Pharmacological management of tuberculosis in pregnancy
Stem keywords: pregnant woman, pulmonary tuberculosis, anti tuberculosis drug
Lead-in keywords: should not be given
Clinical cues: The patient's pregnancy status is the most critical piece of information for determining drug safety.
Negative lead-in flag: The question asks to identify the contraindicated drug.

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E6 Pharmacology Nurses Shanbhag 3e p. 312-314

E6 Medicine Harrison 22e Part 1 p. 1467-1469

Practise the full Chitranjjan National Cancer Institute Kolkata - 2021

Attempt every question from this paper in a timed mock, then review the full solution for each one.