A patient is receiving isoniazid and rifampicin therapy for tuberculosis treatment. Which of the following vitamin supplement would be given to prevent peripheral neuritis to the patient?

1. A

   Vitamin B₆

2. B

   Vitamin B₁₂

3. C

   Vitamin C

4. D

   Vitamin D

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)

Explanation

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• Isoniazid (INH), a primary anti-tubercular drug, directly interferes with the metabolism of Vitamin B₆ (pyridoxine).
• This interference leads to a functional deficiency of Vitamin B₆, which is essential for nerve health.
• A deficiency in Vitamin B₆ is a direct cause of peripheral neuritis, presenting as numbness, tingling, and burning sensations in the extremities.
• Prophylactic supplementation with pyridoxine (Vitamin B₆) is the standard of care to prevent this specific neurotoxic side effect of isoniazid therapy.

Why Other Options Were Wrong

• Option B: Vitamin B₁₂ deficiency is not a known side effect of isoniazid. Its deficiency causes a different set of problems, including megaloblastic anemia and subacute combined degeneration of the spinal cord.
• Option C: Vitamin C (ascorbic acid) is an antioxidant important for immune function and preventing scurvy. It does not play a role in preventing the specific peripheral neuritis caused by isoniazid.
• Option D: Vitamin D is essential for calcium absorption and bone health. It has no direct role in nerve function related to isoniazid toxicity.

Related Visual

• Visual 1: Table: Side effects of common anti-tubercular drugs and their management.
• Visual 2: Diagram: Illustrating how Isoniazid's chemical structure resembles Pyridoxine, leading to competitive inhibition of enzymes that activate Vitamin B6.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Pharmacological side effects and prophylactic treatment in tuberculosis therapy to guide bedside assessment, documentation, and the next nursing action.
• Nurses must educate patients on INH therapy about the early signs of peripheral neuritis (e.g., tingling, numbness in hands/feet) and stress the importance of taking their Vitamin B6 supplement as prescribed.
• Patient adherence to the full course of TB medication, including supplements, is critical for treatment success, preventing relapse, and minimizing the development of drug-resistant TB strains.
• What if? If the patient is also an alcoholic, pregnant, malnourished, or has diabetes, the risk for developing peripheral neuritis from isoniazid is significantly higher. In these cases, Vitamin B6 supplementation is not just recommended but essential.

How to Approach the Question

• First, identify the key drug mentioned in the question that is known for causing specific side effects: isoniazid (INH).
• Second, recall the most common and specific adverse effects associated with isoniazid. Peripheral neuritis is a classic, well-known side effect.
• Third, remember the standard prophylactic measure used to counteract this specific side effect. The prevention for INH-induced neuritis is Vitamin B6 (pyridoxine) supplementation.
• Finally, scan the options to find Vitamin B₆ and select it as the correct answer.

Concept Tested & Keywords

• Concept Tested: Pharmacological side effects and prophylactic treatment in tuberculosis therapy.
• Stem keywords: isoniazid, rifampicin, tuberculosis, peripheral neuritis, vitamin supplement
• Lead-in keywords: Which of the following
• Negative lead-in flag: false

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Q1H1l6V8saLDFWd8X3ZZOx

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