All the drugs are given orally under the DOTS program, except?

Appeared in: IGNOU PB Bsc Nsg Entrance-2017

Explanation

Viomycin is a second-line anti-tuberculosis drug used for treating drug-resistant strains of TB.
It is a polypeptide antibiotic that is not absorbed from the gastrointestinal tract.
Due to its poor oral bioavailability, Viomycin must be administered via intramuscular (IM) injection to achieve therapeutic levels in the body.

Option A: Isoniazid (H) is a primary first-line anti-TB drug that is well-absorbed by the gut and is a cornerstone of oral TB therapy.
Option B: Rifampicin (R) is another essential first-line anti-TB drug administered orally. It is a key component of the standard short-course chemotherapy regimen.
Option C: Ethambutol (E) is a first-line anti-TB drug included in the initial phase of treatment to prevent the emergence of drug resistance. It is administered orally.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacology: Route of Administration of Anti-Tuberculosis Drugs as background academic context rather than a clinical decision trigger.
The DOTS strategy is central to global TB control, aiming to ensure patient adherence. A nurse's role is critical in observing the patient taking oral medications and administering injectable drugs using the correct technique.
Nurses must educate patients about the different routes of administration for their specific regimen and the importance of completing the full course of treatment, even when it involves injections.
Patient safety requires nurses to be knowledgeable about which TB drugs are oral and which are injectable to prevent medication errors.

How to Approach the Question

First, identify the keyword 'except' in the question. This means you are looking for the option that does not fit with the others.
The question states that most drugs under the DOTS program are given orally. You need to find the drug that is NOT given orally.
Recall the standard first-line oral drugs for tuberculosis, often remembered by the mnemonic 'RIPE': Rifampicin, Isoniazid, Pyrazinamide, Ethambutol.
Compare the options to the 'RIPE' mnemonic. Isoniazid, Rifampicin, and Ethambutol are all part of this oral regimen.
Viomycin is the only option not in the standard first-line oral group, making it the likely exception.
Confirm this by recalling that some anti-TB drugs, especially second-line agents for resistant cases, are injectable. Viomycin falls into this category.

Concept Tested & Keywords

Concept Tested: Pharmacology: Route of Administration of Anti-Tuberculosis Drugs
Stem keywords: DOTS program, orally, drugs
Lead-in keywords: except
Negative lead-in flag: The question asks for the EXCEPTION to the rule.

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

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