Which anti-tuberculin drug causes peripheral neuropathy?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Pharmacology

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Explanation

Isoniazid (INH), a first-line anti-tuberculosis agent, is known to cause peripheral neuropathy.
The mechanism involves INH-induced deficiency of pyridoxine (Vitamin B6), which is crucial for nerve health.
Symptoms typically include tingling, numbness, and burning sensations in the extremities (hands and feet).
This adverse effect is preventable and treatable with pyridoxine supplementation.

Option A: Rifampicin's most noted side effects are hepatotoxicity and a harmless orange-red discoloration of body fluids like urine, sweat, and tears. It is not primarily associated with peripheral neuropathy.
Option B: Streptomycin is an aminoglycoside antibiotic whose primary toxicities are ototoxicity (damage to the eighth cranial nerve, affecting hearing and balance) and nephrotoxicity (kidney damage).
Option D: Pyrazinamide is known for causing hepatotoxicity and hyperuricemia, which can lead to acute gouty arthritis. It is not a common cause of peripheral neuropathy.

Clinical Relevance

Nursing practice connection: Knowing Pharmacology: Adverse effects of anti-tuberculosis drugs helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing responsibility is to identify patients at high risk for INH-induced neuropathy (e.g., those with diabetes, malnutrition, alcoholism, or pregnancy) and ensure they receive prophylactic pyridoxine (Vitamin B6).
Nurses must educate patients on the importance of reporting early signs of neuropathy, such as tingling, numbness, or burning in the hands or feet, to their healthcare provider immediately.
What if? If a patient on a standard TB regimen without pyridoxine reports new-onset tingling in their feet, the nurse's priority is to assess the symptom thoroughly and notify the prescriber. This is a probable sign of INH-induced neuropathy, and delaying action could lead to permanent nerve damage. The nurse should anticipate an order to start pyridoxine.

How to Approach the Question

First, identify the keywords in the question: 'anti-tuberculin drug' and 'peripheral neuropathy'. This directs you to recall the side effect profiles of medications used to treat tuberculosis.
Systematically review the adverse effects of each option provided.
Recall that Isoniazid (INH) has a classic, well-documented association with peripheral neuropathy due to its effect on Vitamin B6.
Differentiate this from the other options by recalling their primary toxicities: Rifampicin (orange fluids, hepatotoxicity), Streptomycin (ototoxicity, nephrotoxicity), and Pyrazinamide (hepatotoxicity, hyperuricemia).
Select Isoniazid as the drug that directly matches the specific adverse effect mentioned in the question.

Concept Tested & Keywords

QOmcIWk-uU8yXDj13BGiEC

E6 Pharmacology Nurses Shanbhag 3e p. 312-314

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1834-1836

E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart B (pp 202-403 of 604) p. 27-29