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Drug Mechanism ofAction Indication ContraIndication SpecialPrecaution AdverseReaction Nursing Responsibilities

Isoniazid(also calledisonicotinylhydrazineorINH) is a first-line antituberculous medication used in the prevention and treatment oftuberculosis. Isoniazid is never used on its own to treat active tuberculosisbecause resistance quic

ly develops.

Isoniazid is active againstM tuberculosis, M bovisand some strains ofM

ansasii. One of its main mechanisms appears to be mycolic acid synthesis inhibition resulting in loss of acid-fastness and bacterial cell wall disruption.Absorption:Absorbed readily from the GIT (oral) and after parenteral admin (IM);pea

plasma concentrations after 1-2 hr (oral). Rate and extent may be reduced by the presence of food.Distribution:Body tissues and fluids, CSF, crosses the placenta and enters breastmil .Metabolism:Hepatic and enteral; acetylation by N-acetyltransferase to acetylisoni

azid followed by hydrolysis to isonicotinic acid and monoacetylhydrazine, then conjugated with glycine to isonicotinyl glycine and monoacetylhydrazine is further acetylated to diacetylhydrazine.Excretion:Via urine (as metabolites), via faeces (smallamounts); 1-6 hr (elimination half-life), removed by dialysis.OralTuberculosisAdult:5 mg/ g daily. Max: 300 mg daily. For intermittent treatment: 10 mg/ g 3 times a w or 15 mg/ g twice w ly. Similar doses may also be given via IM admin. For latent tuberculosis: 300 mg daily for 6 mth; alternatively, 5 mg/ g daily or15 mg/ g twice w ly for 9 mth.Child:10-15 mg/ g/day in 1-2 divided doses (max: 300 mg/day). Alternatively, intermittent therapy can be given at 20-40 mg/ g (max: 900 mg) 2-3 times w ly. For l

atent tuberculosis: 10-20 mg/

g/day or 20-40 mg/

g twice w

ly for 9 mth. Max: 300 mg/dose for daily regimen and 900 mg/dose for intermittent regimens.Renal impairment:Reduce dose in severe renal impairment.OralNontuberculous mycobacterial infectionsAdult:5 mg/ g/day for at least 12 mth of culture-negative sputum; usually used with ethambutol and rifampin. Max: 300 mg/day. Similar doses may also be given viaIM admin.

Special Populations:Reduce dose in patients with hepatic impairment and moderateto severe renal impairment.

Isoniazid is contraindicated in patients who develop severe hypersensitivity reactions, including drug -induced hepatitis; previous isoniazid-associated hepaticinjury; severe adverse reactions to isoniazid such as drug fever, chills, arthritis; and acute liver disease of any etiology. Before ta ing isoniazid,tell your doctor and pharmacist if you are allergic to isoniazid or any other drugs.tell your doctor and pharmacist what prescription and nonprescription medications you are ta ing, especially acetaminophen (Tylenol), antacids, carbamazepine (Tegretol), disulfiram (Antabuse), etoconazole (Nizoral), phenytoin (Dilantin), theophylline (Theobid, Theo-Dur), valproic acid (Depa ene, Depa ote), and vitamin

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s.in addition to the conditions listed in the IMPORTANT WARNING section, tell yourdoctor if you have or have ever had idney disease; diabetes; tingling, burning, and pain in the fingers or toes (peripheral neuropathy); or human immunodeficiency virus (HIV).tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while ta ing isoniazid, call your doctor.be aware that you should not drin

alcoholic beverages while ta

ing this drug.diarrhea

vision problems

Rifampicin

rifampinis a bactericidalantibioticdrug of therifamycingroup.It is a semisynthetound derived fromAmycolatopsis rifamycinica(formerly

nown asAmycolatopsis mediterraneiandStreptomyces mediterranei)]Rifampicin may be abbreviatedR,RMP,RA,RF, orRRifampicin is typically used to treatMycobacteriuminfections, including tuberculosisand Hansen's disease.

Rifampin inhibits DNA-dependent RNA polymerase activity in susceptible cells. Rifampin interacts with bacterial RNA polymerase but does not inhibit the mammalian enzyme. At therapeutic levels, rifampin has demonstrated bactericidal activityagainst both intracellular and extracellularMycobacterium tuberculosisorganisms R

ifampin has also bactericidal activity against slow and intermittently growingM.tuberculosisorganisms. Rifampin cross resistance has been shown only with other rifamycins.

Rifampin is indicated for the initial treatment of active tuberculosis in adults and children when combined with other antituberculous agents.Rifampin eliminates bacteria that cause tuberculosis (TB). It is generally usedwith other drugs to treat tuberculosis or to eliminate Neisseria meningitidis (abacteria) and to prevent you from giving these infections to others. However, rifampin is not used to treat Neisseria meningitidis infection.

A pyrazine that is indicated therapeutically as an antitubercular agent.

Rifampin is contraindicated in persons:

- with acute gout.- with severe hepatic damage.- who have shown hypersensitivity to it. Rifampicin should be used duringpregnancy or lactation only if clearly needed.Alcohol can reduce the effectiveness of this medication and increase side effects. Minimize alcohol consumption while ta

ing rifampacin.Rifampacin can decrease the effectiveness of oral contraceptives. It should be used with caution in patients with liver problems.Rifampin side effects that you should report to your health care professional ordoctor as soon as possible:- bone pain;- chills;

- diarrhea;- fever;- headache;- heartburn;- muscle pain;- s in rash (hives);- sores on s

in or in the mouth;- stomach cramps;- upset stomach;- vomiting;

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- yellowing of the s in or eyes; Rifampin comes as a capsule to ta e by mouth. It usually is ta

en once a day. You will probably be ta

ing it for at least 3 months and possibly for up to 2 years. Rifampin wor s best on an empty stomach; ta e it 1 hour before or at least 2 hours after a meal. If you have difficulty swallowing the capsule, you may empty its contents into applesauce or jelly.

Rifampin ills or stops the growth of certain bacteria that cause tuberculosis (TB). It is used with other drugs to treat tuberculosis. It is a highly specificagent and is active only against Mycobacterium tuberculosis. In vitro and in vivo, the drug is active only at a slightly acid pH.