A first line medication for pulmonary tuberculosis:-

Appeared in: AIIMS Manglagiri NO - 2019

Explanation

Rifampicin is a core first-line antibiotic for treating all forms of tuberculosis.
It is a key component of the standard multi-drug short-course chemotherapy regimen, often remembered by the mnemonic RIPE (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol).
Its mechanism of action involves inhibiting the bacterial DNA-dependent RNA polymerase, which stops bacterial RNA synthesis and results in a bactericidal effect.

Option A: Capreomycin is a second-line injectable antibiotic, not a first-line oral agent.
Option B: Pyridoxine is Vitamin B6, not an anti-tubercular medication. It has no bactericidal or bacteriostatic effect on Mycobacterium tuberculosis.
Option D: Ethionamide is a second-line anti-TB drug with a higher toxicity profile and lower efficacy compared to first-line agents.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain First-line drug therapy for pulmonary tuberculosis as background academic context rather than a clinical decision trigger.
The use of combination therapy with at least four drugs in the initial phase is critical to prevent the emergence of drug-resistant strains of M. tuberculosis.
Nurses play a vital role in the Directly Observed Treatment, Short-course (DOTS) strategy by ensuring patients take their medication as prescribed, which improves adherence and treatment success rates.
Patient education is crucial. Nurses must inform patients about common side effects, such as the harmless orange-red discoloration of urine, sweat, and tears caused by Rifampicin, to prevent alarm and non-adherence.

How to Approach the Question

This is a factual recall question from pharmacology.
Identify the key concepts in the question stem: 'first line medication' and 'pulmonary tuberculosis'.
Recall the standard first-line anti-tubercular drugs. A common mnemonic is RIPE: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol.
Systematically evaluate each option against the RIPE mnemonic.
Option A (Capreomycin) and Option D (Ethionamide) are not in RIPE; they are second-line drugs.
Option B (Pyridoxine) is a vitamin supplement, not an anti-TB drug.

Concept Tested & Keywords

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E6 Pharmacology Katzung 16e p. 1310-1312

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1835-1837

Practise the full AIIMS Manglagiri NO - 2019

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