The treatment plan for a patient newly diagnosed with tuberculosis is likely to include which of the following medication as initial treatment?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

The standard initial treatment for drug-susceptible tuberculosis is a multi-drug regimen to prevent the development of resistance.
This intensive phase typically includes four first-line drugs: Rifampin, Isoniazid (INH), Pyrazinamide, and Ethambutol (a mnemonic is RIPE).
The correct option includes two of these essential first-line medications, Isoniazid (INH) and Ethambutol.

Option B: Penicillin G is ineffective against Mycobacterium tuberculosis. Streptomycin is considered a second-line agent, typically reserved for cases of resistance to first-line drugs or specific clinical situations.
Option C: Tetracycline is a broad-spectrum antibiotic not used for treating tuberculosis. Thioridazine is an antipsychotic medication and has no role in TB treatment.
Option D: Pyridoxine (Vitamin B6) is a supplement given alongside Isoniazid to prevent peripheral neuropathy; it is not an antitubercular drug itself. Tetracycline is not used for TB.

Clinical Relevance

Nursing practice connection: Use the key finding related to First-line pharmacotherapy for Tuberculosis (TB) to guide bedside assessment, documentation, and the next nursing action.
Adherence to the multi-drug regimen is critical. Directly Observed Therapy (DOT) is a key strategy to ensure patients take all medications as prescribed, preventing the emergence of multidrug-resistant TB (MDR-TB).
Nurses must educate patients about potential side effects, such as hepatotoxicity (jaundice, fatigue), optic neuritis with Ethambutol (report vision changes immediately), and the harmless orange discoloration of body fluids with Rifampin.
What if the patient has pre-existing liver disease? The regimen may need to be modified. Hepatotoxic drugs like Pyrazinamide and Isoniazid might be replaced with second-line agents under specialist guidance, requiring even more stringent monitoring of liver function tests.

How to Approach the Question

Identify the core subject: The question asks for the initial drug treatment for tuberculosis (TB).
Recall the standard of care: Remember that TB requires a multi-drug approach to prevent resistance. The standard first-line regimen is known by the mnemonic RIPE.
Decode the mnemonic: RIPE stands for Rifampin, Isoniazid (INH), Pyrazinamide, and Ethambutol.
Evaluate the options: Check which option contains drugs from the RIPE regimen.
Select the best fit: The option containing Ethambutol and INH includes two drugs from the RIPE regimen, making it the correct choice for initial therapy.

Concept Tested & Keywords

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E6 Pharmacology Katzung 16e pp. 1309-1311, 1310-1312

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

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