Description of Antituberculosis
Session 8: Description of Antituberculosis
Total Session Time: 120 minutes
Prerequisites
By the end of this session students are expected to be able to:
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning tasks
Presentation/
2 20 minutes Indications of Antituberculosis
Buzzing
Presentation/
3 20 minutes Contraindications of Antituberculosis
Brainstorming
4 30 minutes Presentation Dose, Dosage and Course of Antituberculosis
Presentation/ Side Effects and Adverse Effects of
5 20 minutes
Brainstorming Antituberculosis
Interactions and Precautions of
6 15 minutes Presentation
Antituberculosis
7 05 minutes Presentation Key Points
8 05 minutes Presentation Evaluation
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STEP 1: Presentation of Session Title and Learning tasks (5 minutes)
READ or ASK students to read the learning objectives and clarify
ASK students if they have any questions before continuing.
STEP 2: Indications of Antituberculosis Drugs (20 minutes)
Activity: Buzzing (5 minutes)
ASK students to pair up and buzz on the following question for 2 minutes
ALLOW few pairs to respond and let other pairs to add on points not mentioned
WRITE their response on the flip chart/board
CLARIFY and SUMMARIZE by using the content below
mycobacterium resistance and toxicity
o Rifampicin symbolized by R
o Isoniazid symbolized by H
o Pyrazinamide symbolized by Z
o Ethambutol symbolized by E
o Streptomycin symbolized by S
o The initial phase; during this phase combination drugs are continued for 2 months
o Drugs used in initial phase are rifampicin, isoniazid, pyrazinamide and ethambutol
o These drugs should be continued until full susceptibility is confirmed, even if this is
for longer than 2 months
o Continuation phase; after the initial phase, treatment is continued for a further 4
months with isoniazid and rifampicin (preferably given as a combination preparation).
Longer treatment is necessary for meningitis, direct spinal cord involvement, and for
resistant organisms which may also require modification of the regimen
ethionamide and streptomycin
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STEP 3: Contraindications of Antituberculosis Drugs (20 minutes)
Activity: Brainstorming (5 minutes)
Ask students to brainstorm on the following question:
ALLOW few students to respond
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below
o Patients or their careers should be told how to recognize signs of liver disorder, and
advised to discontinue treatment and seek immediate medical attention if symptoms
such as persistent nausea, vomiting, malaise or jaundice develop
psychotic states, alcohol dependence and acute porphyria
STEP 4: Dose, Dosage and Course of Antituberculosis Drugs (30minutes)
isoniazid or other antituberculosis drugs to patients with active tuberculosis to prevent
emergence of drug-resistant mycobacteria
with other agents in some atypical mycobacterial infections and in leprosy
neuropathy, an adverse effect of isoniazid
o Isoniazid is usually given by mouth but can be given parenterally in the same dosage
PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide
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treatment regimens.
o Pyrazinamide is an important front-line drug used in conjunction with isoniazid and
rifampin in short-course (ie, 6-month) regimens as a "sterilizing" agent active against
residual intracellular organisms that may cause relapse
in combination with isoniazid or rifampin.
o The higher dose is recommended for treatment of tuberculous meningitis.
two or three times weekly for several months
STEP 5: Side Effects and Adverse Effects of Antituberculosis (20 minute)
Activity: Brainstorming (5 minutes)
Ask students to brainstorm on the following question:
What are the side effects and adverse effects of antituberculosis?
ALLOW few students to respond?
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below
Side effects and adverse effects of antituberculosis drugs include:
o Occasional adverse effects include rashes, thrombocytopenia, and nephritis. It may
cause cholestatic jaundice and occasionally hepatitis
o Rifampin commonly causes light-chain proteinuria
o They occur in high dose and may include nausea, vomiting, constipation, dry mouth;
peripheral neuritis with high doses (pyridoxine prophylaxis, see notes above), optic
neuritis, convulsions, psychotic episodes and vertigo
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o Major adverse effects of pyrazinamide include hepatotoxicity, nausea, vomiting, drug
fever, and hyperuricemia
o Hyperuricemia may provoke acute gouty arthritis
loss of visual acuity and red-green color blindness
o Vertigo and hearing loss are the most common side effects and may be permanent.
o Toxicity is dose-related, and the risk is increased in the elderly
o Toxicity can be reduced by limiting therapy to no more than 6 months whenever
possible
STEP 6: Interactions and Precautions of Antituberculosis (20minutes)
o There is no serious interaction between ant tuberculosis drugs and other drugs except
that rifampicin reduces plasma concentration of digoxin
o Absorption of isoniazid is reduced by antacids, Hepatotoxic of isoniazid is potentiated
by general anaesthesia and its CNS toxicity is increased by cycloserine
o Pyrazinamide antagonizes effect of probenecid
o Rifampicin should be given with care in hepatic impairment, renal impairment
pregnancy and breast-feeding
o Isoniazid should be given with care in hepatic impairment, renal impairment, slow
acetylator status, epilepsy and history of psychosis
o Pyrazinamide should be given with care in pregnancy, hepatic impairment, diabetes
and gout
o Ethambutol should be given with care in renal impairment, elderly and pregnancy
o Streptomycin should be given with care in pregnancy, renal impairment,neonates,
infants and elderly
STEP 7: Key points (5 minutes)
and minimize side effects
STEP 7: Assessment (5 minutes)
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References
Pharmacotherapy: a pathophysiologic approach (9th ed.). New York,
McGraw-Hill Education
Ministry Of Health and Social Welfare. 2013. Standard Treatment Guidelines &
National Essential Medicines List Tanzania Mainland (4th ed.). Dar es Sally
salaam, Tanzania government printers .
S.R, Jeanne C.S. 2000. Introductory Clinical Pharmacology (6th ed) New York,
Lippincott Williams and Wilkins
School of Pharmaceutical sciences. 2011. Tanzania Pharmaceutical Handbook
(2nd ed.). Dar es Salaam, ARDHI University press.
The Royal Pharmaceutical Society of Great Britain. 2007. Martindale, the Extra
Pharmacopoeia (5TH ed). London, pharmaceutical press.
The Royal Pharmaceutical Society of Great Britain. 2009. British National Formulary
(59th ed). London, BMJ Group and RPS Publishing.
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