Transcript Signs/symptoms

In The Name of God
Common Adverse Reactions to
Anti-TB Drugs
Caused by: Any drug
• Adverse reaction: Allergic reactions
• Signs/symptoms: Skin rash
Caused by: Ethambutol
Adverse reaction: Eye damage (optic neuritis)
Signs/symptoms: Blurred or changed
vision ; changed color vision .
Caused by: INH, PZA, RIF
Adverse reaction: Hepatitis
Signs/symptoms:
Abdominal pain,Abnormal LFTs,Dark urine
Lack of appetite,Nausea,Vomiting,Yellowish
skin or eyes.
Caused by: Isoniazid
Adverse reaction: Nervous system
damage
Signs/symptoms: Dizziness,
Tingling/numbness around mouth
• Adverse reaction: Peripheral neuropathy
• Signs/symptoms: Tingling/numbness
in hands and feet
Caused by: Pyrazinamide
Adverse reaction: Stomach upset
Signs/symptoms:
Vomiting , Lack of appetite
• Adverse reaction: Increased uric acid
• Signs/symptoms: Abnormal UA level
Joint aches , Gout (rare)
Caused by: Rifampin
Adverse reaction: GI upset
Signs/symptoms:
Anorexia,nausea,vomiting,diarrhea
• Adverse reaction: Discoloration of
body fluids
• Signs/symptoms: Orange urine, sweat, or
tears ,Stained soft contact lenses
• Adverse reaction: Drug interactions
• Signs/symptoms: Interferes with some
medications: BC pills,Anticoagulants,
Methadone,Anticonvulsants,Cardiac
glycosides,Oral hypoglycemics,…
• Hemolytic anemia,Thrombocytopenia,
Eosinophilia,Leukopenia
• Interstitial nephritis,Flushing,Edema
• Pruritus,urticaria,pemphigoid reactions
• Myalgia,weakness,osteomalacia
Caused by: Streptomycin
• Adverse reaction: Ear damage
• Signs/symptoms: Balance problems
Hearing loss, Ringing in the ears
• Adverse reaction: Kidney damage
• Signs/symptoms: Abnormal kidney
function test results
MANAGEMENT
MINOR SIDE EFFECTS
Minor side effects, such as gastrointestinal
intolerance, mild skin rash, pruritus or
flushing are best managed by reassurance and
symptomatic treatment and the patient should
be encouraged to continue anti tuberculosis
treatment.
Treatment with non steroidal anti inflammatory
drugs (NSAID)provide symptomatic relief of
pyrazinamide related arthralgia. Skin rashes
can usually be managed by withholding the
causative drug and if it is really necessary to
reintroduce the drug, the patient should undergo
desensitization.
MAJOR SIDE EFFECTS
Hepatitis:
Patients who develop jaundice or other signs of
liver dysfunction during therapy should have
treatment stopped immediately. Although
many patients with drug-induced hepatotoxicity
can be successfully rechallenged, this is best
done in a where liver function can be carefully
monitored.
Indications for stoping the hepatotoxic
anti-tuberculosis drugs
• 1- Clinical signs and/or symptoms
of hepatitis
• 2- Abnormal liver enzymes
• 3- Unexplained raised serum
bilirubin
If the period without drugs is
likely to be prolonged, and the
patient requires treatment, at
least two other drugs should be
given until it is determined
whether the offending drug can
be resumed.
The development of the following
conditons contraindicates further use
of the drug
*Thrombocytopenia ,hemolysis, shock and/or
renal failure due to rifampicin.
*Visual impairment due to ethambutol.
*Eighth nerve damage from streptomycin.
*Steven-Johnson syndrome.
THANK YOU