The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB?
A. Take the medication with antacids.
B. Double the dosage if a drug dose is forgotten.
C. Increase intake of dairy products.
D. Limit alcohol intake.
Correct Answer: D. Limit alcohol intake
INH and rifampin are hepatotoxic drugs. Clients should be warned to limit intake of alcohol during drug therapy. Liver function tests should be monitored routinely as rifampin, isoniazid, pyrazinamide, and ethambutol all may exert hepatotoxic effects. CBC also requires regular monitoring for patients taking rifampin, as it can cause thrombocytopenia and neutropenia.
Option A: Both drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after these drugs are administered. Rifampin also exerts its effects by inducing cytochrome P450(CYP450), which may cause unwanted drug interactions of medications that are metabolized by the CYP450 system and decrease their clinical efficacy.
Option B: Clients should not double the dosage of these drugs because of their potential toxicity. Isoniazid can cause pyridoxine deficiency that may lead to peripheral neuropathy in patients. All first-line antitubercular medications, rifampin, isoniazid, pyrazinamide, and ethambutol can exert hepatotoxic effects. A continual rise in liver functions test should prompt discontinuation of treatment.
Option C: Clients taking INH should avoid foods that are rich in tyramine, such as cheese and dairy products, or they may develop hypertension. All first-line antitubercular medications, rifampin, isoniazid, pyrazinamide, and ethambutol can exert hepatotoxic effects. A continual rise in liver functions test should prompt discontinuation of treatment.
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