A patient has been taking isoniazid Nydrazid for 4 months for ...

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A patient has been taking isoniazid Nydrazid for 4 months for latent tuberculosis. The patient reports bilateral tingling and numbness of the hands and feet, as well as feeling clumsy. The nurse expects the provider to:
 
  a. discontinue the isoniazid.
  b. lower the isoniazid dose and add rifampin.
  c. order pyridoxine 100 mg per day.
  d. recheck the tuberculin skin test to see whether it worsens.

Question 2

A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol Zyloprim and colchicine. The nurse will include which statement when teaching the patient about this drug regimen?
 
  a. Allopurinol helps reduce the gastrointes-tinal side effects of colchicine.
  b. Allopurinol reduces the likelihood of gouty episodes that usually occur with initial colchicine therapy.
  c. The colchicine is given to enhance the effects of the allopurinol.
  d. You will take both drugs initially and then stop taking the colchicine.

[Liddy]

Answer to Question 1

C
Patients sometimes develop peripheral neuropathy, characterized by paresthesias, clumsiness, and muscle aches. If these occur, they may be reversed by administering pyridoxine (vitamin B6). It is not necessary to discontinue the isoniazid. Lowering the isoniazid dose and adding rifampin is not indicated. Rechecking the TST is not indicated.

Answer to Question 2

D
Colchicine is used for prophylaxis when urate-lowering drugs, such as allopurinol, are initiated, because gouty episodes have a tendency to increase during this time. Patients start with both drugs, and ultimately the colchicine is withdrawn. Allopurinol does not affect the GI side effects caused by colchicine. Allopurinol may precipitate an acute gouty attack when treatment is begun; colchicine is given to prevent a gouty episode. Colchicine does not enhance the effects of allopu-rinol.

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