Which one of the following is a second-line drug for Tuberculosis?

RRB Nsg. Superintendent-20 July 2019 (Shift-1)

Pharmacology

Easy

Appeared in: RRB Nsg. Superintendent-20 July 2019 (Shift-1)

Explanation

Amikacin is classified as a second-line antitubercular drug, used primarily for treating drug-resistant tuberculosis (DR-TB).
Second-line drugs are considered 'reserve' agents because they are often more toxic and sometimes less effective than first-line drugs.
Amikacin is an injectable aminoglycoside antibiotic, a class of drugs used for complicated or resistant infections.

Option A: Rifampicin is a core first-line antitubercular drug, known for its potent bactericidal activity. It is a standard component of the initial treatment regimen.
Option B: Ethambutol is a first-line antitubercular drug. It is included in the initial four-drug regimen primarily to prevent the development of drug resistance.
Option D: Isoniazid is the most essential first-line antitubercular drug. It is highly effective and used in both the treatment of active TB and for prophylaxis.

Visual 1: Chart: A two-column chart visually separating first-line antitubercular drugs (Isoniazid, Rifampin, Ethambutol, Pyrazinamide) from second-line drugs (Amikacin, Levofloxacin, etc.) to reinforce the classification.
Visual 2: Infographic: An infographic illustrating the standard 'RIPE' therapy for drug-susceptible TB, showing the four first-line drugs and the typical treatment timeline.

Clinical Relevance

Nursing practice connection: Knowing Classification of antitubercular drugs (first-line vs. second-line) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Understanding the difference between first-line and second-line TB drugs is critical for nurses to administer correct treatment regimens and anticipate potential adverse effects.
Second-line drugs like Amikacin carry a higher risk of toxicity, such as nephrotoxicity (kidney damage) and ototoxicity (hearing loss). Nurses must diligently monitor renal function tests (e.g., creatinine) and assess for hearing or balance changes.
Patient education on the importance of strict adherence to the long and complex drug regimens is a key nursing role to prevent the development of multidrug-resistant TB (MDR-TB), which necessitates the use of second-line agents.

How to Approach the Question

First, identify the core of the question, which is to distinguish a 'second-line' drug for 'Tuberculosis' from the given options.
This is a factual recall question based on pharmacological classification. Access your knowledge of antitubercular therapy.
Recall the standard first-line treatment regimen, often remembered by the mnemonic RIPE: Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol.
Scan the options: Rifampicin (R), Ethambutol (E), and Isoniazid (I) are all part of the RIPE regimen, identifying them as first-line drugs.
By elimination, Amikacin is the only option not in the standard first-line group, making it the correct second-line drug.

Concept Tested & Keywords

Concept Tested: Classification of antitubercular drugs (first-line vs. second-line)
Stem keywords: second-line drug, Tuberculosis
Lead-in keywords: Which one

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