Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a client with TB. A nurse reviews the medical record of the client. Which of the following, if noted in the client’s history, would require physician notification?
A. Heart disease
B. Allergy to penicillin
C. Hepatitis B
D. Rheumatic fever
Correct Answer: C. Hepatitis B
Isoniazid and rifampin are contraindicated in clients with acute liver disease or a history of hepatic injury. In all adults preparing to begin isoniazid treatment, the clinician should order baseline measurements of aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, alkaline phosphatase, serum creatinine, and platelet count.
Option A: Regular monitoring of hepatic and renal function during treatment is not necessary unless the patient has abnormal baseline levels or is at increased risk for hepatotoxicity (alcohol abuse, hepatitis B or C infection, etc.). For those patients, serum transaminases should be measured again two to four weeks after treatment initiation.
Option B: 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. Aminoglycoside-induced nephrotoxicity is reversible when stopping the medication.
Option D: Renal toxicity depends on the patient if any underlying renal disease is present, and on the dose of the medication being administered. Renal insufficiency is avoidable in most patients. Liver function tests should be monitored routinely as rifampin, isoniazid, pyrazinamide, and ethambutol all may exert hepatotoxic effects.
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