The physician prescribes a medical regimen of isoniazid, rifampin, and vitamin B6 for a tuberculosis client. The nurse instructs the client that B6 is given because it:

1. A

   Increases activity of isoniazid

2. B

   Increases activity of rifampicin

3. C

   Improves nutritional status

4. D

   Reduces peripheral neuropathy

Appeared in: NORCET 6 mains-2024

Explanation

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• Isoniazid (INH), a key anti-tuberculosis drug, is known to cause a deficiency of pyridoxine (Vitamin B6).
• This deficiency can lead to peripheral neuropathy, characterized by symptoms like tingling, numbness, and pain in the hands and feet.
• Administering Vitamin B6 concurrently with INH is a standard prophylactic measure to prevent this neurotoxicity.
• The supplementation with Vitamin B6 does not interfere with the therapeutic (antitubercular) effect of isoniazid.

Why Other Options Were Wrong

• Option A: Vitamin B6 does not increase the bactericidal or bacteriostatic activity of isoniazid. Its purpose is to manage a specific side effect.
• Option B: Vitamin B6 has no effect on the activity of rifampin. Rifampin's main side effects include hepatotoxicity and red-orange discoloration of body fluids, which are not managed by B6.
• Option C: While Vitamin B6 is a nutrient, its administration in this context is not for general nutritional improvement. It is a targeted intervention to prevent a specific, predictable adverse drug reaction.

Related Visual

• Visual 1: Table: A summary table of first-line anti-tuberculosis drugs, their mechanisms of action, and their primary side effects.
• Visual 2: Diagram: A simple flowchart showing Isoniazid intake leading to Vitamin B6 depletion, which in turn causes peripheral neuropathy, and how B6 supplementation breaks this chain.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Pharmacology of Anti-Tubercular Drugs and Management of Adverse Effects to guide bedside assessment, documentation, and the next nursing action.
• A key nursing responsibility is patient education regarding medication adherence and the management of side effects. Explaining that B6 prevents nerve damage encourages the patient to take it as prescribed.
• Nurses must assess for early signs of peripheral neuropathy (e.g., asking about tingling or numbness) in patients on isoniazid, especially if they are non-adherent with their B6 supplement.
• What if? If the patient has pre-existing risk factors for neuropathy, such as diabetes, alcoholism, malnutrition, or HIV, the need for Vitamin B6 supplementation is even more critical, and a higher prophylactic dose may be prescribed.

How to Approach the Question

• First, identify the key medications mentioned in the question: isoniazid, rifampin, and Vitamin B6.
• Recall the primary purpose and common side effects of each drug. Isoniazid is a potent anti-TB drug, but it is famous for causing peripheral neuropathy.
• Recognize that Vitamin B6 (pyridoxine) is an adjunctive medication given with a primary drug. Ask yourself what problem it is intended to solve.
• Connect the known side effect of isoniazid (peripheral neuropathy) with the adjunctive medication (Vitamin B6). The purpose of B6 is to prevent or treat this specific side effect.
• Evaluate the options. Option D directly states that B6 reduces peripheral neuropathy, which aligns with your pharmacological knowledge.
• Eliminate the other options: B6 does not boost the activity of the drugs, and while it is a vitamin, its specific role here is not general nutrition.

Concept Tested & Keywords

• Concept Tested: Pharmacology of Anti-Tubercular Drugs and Management of Adverse Effects
• Stem keywords: isoniazid, rifampin, vitamin B6, tuberculosis
• Lead-in keywords: given because
• Negative lead-in flag: false

Question ID

QWIbxO9yy7m8VStk1zxqj0

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