Which are the First Line Drugs used in the treatment of T.B.?

Appeared in: MP CHO-2020

Explanation

The combination of Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E), and Streptomycin (S) constitutes the standard first-line drug regimen for treating drug-susceptible tuberculosis.
This multi-drug approach, often remembered by the mnemonic 'RIPES' or 'HRZES', is essential to kill the bacteria effectively and prevent the development of drug resistance.
These drugs are chosen as the primary treatment due to their high bactericidal/bacteriostatic efficacy and a more favorable toxicity profile compared to second-line agents.

Option B: This option is incorrect because it includes Para-aminosalicylic acid (PAS) and Amikacin.
Option C: This option is incorrect because it includes Kanamycin.
Option D: This option is incorrect because it contains two second-line drugs: Kanamycin and Para-aminosalicylic acid (PAS).

Clinical Relevance

Nursing practice connection: Knowing First-line anti-tubercular drug regimen helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Patient education on strict adherence to the Directly Observed Treatment, Short-course (DOTS) strategy is the most critical nursing role to prevent the development of Multidrug-Resistant TB (MDR-TB).
Nurses must monitor for signs of hepatotoxicity (jaundice, anorexia, fatigue) as Isoniazid, Rifampicin, and Pyrazinamide are all potentially damaging to the liver.
What if? If a patient on Ethambutol reports blurred vision or difficulty distinguishing between red and green, the nurse must instruct the patient to stop the drug immediately and notify the physician. This indicates optic neuritis, a serious adverse effect that requires prompt intervention to prevent permanent vision loss.

How to Approach the Question

This is a factual recall question that tests your knowledge of standard pharmacological treatments.
First, recall the mnemonic for first-line TB drugs, such as 'RIPES' (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol, Streptomycin).
Carefully read each option and compare the listed drugs to the 'RIPES' mnemonic.
Identify any 'intruder' drugs in the options. Recognize that agents like PAS, Amikacin, and Kanamycin are second-line drugs.
Eliminate any option that includes a second-line drug. The correct option will consist exclusively of the standard first-line agents.

Concept Tested & Keywords

QptdCBhxrv_M6c_uvMnjz2

E6 Pharmacology Nursing Lilley 11e Part 3 p. 26-28

E6 Medicine Harrison 22e Part 1 p. 1436-1438

E6 Pharmacology Nurses Shanbhag 3e p. 312-314

Practise the full MP CHO-2020

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