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N211: Health Differences Across the Lifespan I of 148 substitute drug when toxicity occurs with INH or Rifampin. Client requires vision check before starting therapy and monthly thereafter. Streptomycin inhibits protein synthesis and is bactericidal. Side effects are ototoxicity, nephrotoxicity and hypersensitivity. Use cautiously with older clients and those with renal disease. Streptomycin is given parenterally. Pyrazinamide has a bactericidal effect. Side effects are fever, skin rash, hyperuricemia and rarely jaundice. Pyrazinamide has a high rate of effectiveness when used in combination with streptomycin or capreomycin. 2.12 Second Line Medications Ethionamide (Trecator) inhibits protein synthesis. Side effects are GI disturbance, hepatotoxicity and hypersensitivity. This is used to treat resistant organisms. Capreomycin (Capastat) inhibits protein synthesis and is bactericidal. Side effects are ototoxicity and nephrotoxicity. Use cautiously with older adults. Kanamycin (Kantrex) interferes with protein synthesis. Side effects are ototoxicity and nephrotoxicity. Used for select resistant strains. Para-aminosalicyclis acid (PAS) interferes with metabolism of tubercle bacillus. Side effects commonly are GI disturbance, hypersensitivity and hepatotoxicity. PAS interferes with the absorption of Rifampin. Not commonly used. Cycloserine (Seromycin) inhibits cell wall synthesis. Side effects include personality changes, rash and psychosis. Cycloserine is contraindicated in clients with histories of psychosis. Used to treat resistant strains. Drug therapy is long term (9 months or longer). The client must take the medication as prescribed for the entire time. Skipping doses or prematurely terminating drug therapy can result in a public health hazard. 2.13 Standard Regimen of Drug Treatment Initial phase: daily therapy for 2 months with INH, Rifampin, pyrazinamide and ethambutol. Ethambutol is later dropped if culture and sensitivity show strain is sensitive to first 3 drugs. Continuous phase: INH and Rifampin is given 2-3 times per week for 4 months. ©2012 Achieve Page 65