A patient is taking streptomycin medicine for his active tubercular infection. Which of the following clinical finding suggest to adverse effects of streptomycin?

Appeared in: NORCET 3 - 2022 (Shift-2)

Explanation

Streptomycin is an aminoglycoside antibiotic, a class of drugs known for causing ototoxicity (damage to the ear) and nephrotoxicity (damage to the kidneys).
Ototoxicity specifically involves damage to the eighth cranial nerve (vestibulocochlear nerve).
This damage can manifest as cochlear toxicity, leading to tinnitus (ringing in the ears) and permanent sensorineural hearing loss.
It can also cause vestibular toxicity, leading to vertigo, dizziness, and ataxia (problems with balance and walking).
A decrease in hearing acuity is a direct and classic sign of cochlear ototoxicity from streptomycin.

Option A: Decreased visual acuity (optic neuritis) is the hallmark adverse effect of a different anti-tubercular drug, ethambutol.
Option C: While difficulty walking (ataxia) can result from the vestibular toxicity caused by streptomycin, it is a less direct answer. Hearing loss is a more specific and primary sign of ototoxicity.
Option D: A decreased sense of smell (anosmia) is not a recognized adverse effect of streptomycin.

Visual 1: Table - A comparative table showing the primary adverse effects of first-line anti-tuberculosis drugs (Isoniazid, Rifampin, Pyrazinamide, Ethambutol, Streptomycin) to help differentiate their toxicities.
Visual 2: Diagram - An illustration of the inner ear, highlighting the cochlea and vestibular apparatus, with an annotation showing where aminoglycosides like streptomycin cause damage.

Clinical Relevance

Nursing practice connection: Use the key finding related to Adverse effects of anti-tubercular drugs to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role is to monitor for and educate patients about potential drug toxicities. For a patient on streptomycin, this includes regular assessment for hearing changes, tinnitus, and vertigo.
Baseline and periodic audiometry (hearing tests) are essential for patients on long-term streptomycin therapy to detect early signs of ototoxicity.
Nurses must also monitor renal function (e.g., BUN, serum creatinine, urine output) because of the risk of nephrotoxicity, which can increase drug levels and worsen ototoxicity.

How to Approach the Question

First, identify the drug mentioned in the question: Streptomycin.
Recall the drug class for Streptomycin. It is an aminoglycoside antibiotic.
Access your knowledge about the major, hallmark toxicities of the aminoglycoside class. The two key toxicities are ototoxicity (ear toxicity) and nephrotoxicity (kidney toxicity).
Analyze the given options in the context of these toxicities.
Option A (visual) is linked to Ethambutol. Option B (hearing) directly matches ototoxicity. Option C (walking) is a secondary effect of vestibular ototoxicity. Option D (smelling) is unrelated.
Select the option that most directly and specifically represents a hallmark toxicity. 'Decrease hearing acuity' is a primary manifestation of ototoxicity.

Concept Tested & Keywords

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