By: Dr.Ayia Nathum

1. By the pharmacist Ayia nazum kamal بسم الله الرحمن الرحيم

2. Tuberculosis treatment

10. Mode of action & Recommended dose mg/kg 45 30 15 bacteriostatic Ethambutol 15 15 15 bactericidal streptomyicin 50 35 25 bactericidal pyrazinamide 10 10 10 bactericidal Rifampicin 15 10 5 bactericidal INH Twice/wk 3times/wk Daily dose mg/kg Mode of action Essential anti-tuberculosis drug

11. Pharmacokinetic renal Without hepatic metabolism 5-6hr streptomycin renal liver 9-10hr pyrazinamide renal liver 3-4 hr (increased in impaired renal function) Ethambutol urine (primarily), feces liver 0.5-1.6h (fast acetylators), 2-5h (slow acetylators) INH renal 15to 030% Faecal 60% Hepatic and intestinal wall 6 to 7 hours rifampicin Excretion Metabolism Half-life Drugs name

12. Adverse effect, caution ,contraindication & interaction of Essential anti-tuberculosis drugs

13. ↑ toxicity of these drugs ↑ INH hepatotoxicity INH effects ↓ *Carbamazepine & phynetoin *Carbamazepine *Antacids drug-induced liver disease *hepatic impairmet *renal impairment *epilepsy *alcohol dependence *breast-feeding *Nausea *vomiting *peripheral neuritis *Convulsion *psychotic episodes *allergic reactions *blood dyscrasias INH Results interaction contraindications cautions Adverse effects Drugs names

14. ↓ Effects of these drugs Phenytoin Digoxin Theophylline Oral anticoagulant Contraceptive b-blockers Sulphonylureas jaundice *hepatic impairment *pregnancy & breast-feeding, advise patients on hormonal contraceptive to use additional means, *discolours soft contact lenses GI disturbance, liver damage , influenza-like syndrome some times with thrombocytopenia, haemolytic anaemia, shock and renal failure (particularly with intermittent therapy) may coloure skin, urine, saliva & terars orange-red Rifampicin Results interaction contraindications cautions Adverse effects Drugs names

15. ↓ effect of Ethambutol Almunium hydroxide optic neuritis, poor vision reduce dose in renal impairment and if creatinine clearance less than 30 mL/minut *children under 6 years optic neuritis, red/green colour blindness, peripheral neuritis, rarely rash, pruritus, urticaria, thrombocytopenia Ethambutol Results interaction contraindications cautions Adverse effects Drugs names

16. antagonize effects of these drugs Probenecid Sulfinpyrazone Liver damage * diabetes *gout *renal dysfunction Liver damage, hyperuricemia, *GI disturbance, arthralgia, rash and occasionally photosensitivity pyrazinamide result interaction contraindications cautions Adverse effects Drugs names

18. Tuberculosis and other conditions