A 55-year-old man with newly diagnosed pulmonary tuberculosis (chest X-ray showing left upper lobe infiltrate) is started on isoniazid, rifampin, pyrazinamide, and ethambutol. Two weeks later, he presents with progressive painful peripheral neuropathy affecting his feet and hands. Vital signs: BP 128/82, HR 92, RR 16, Temp 37.2°C, SpO2 98% on room air. Serum vitamin B6 level is low. He denies visual changes. Which agent is responsible, and what intervention is recommended?
- A)Isoniazid-induced deficiency; add pyridoxine (vitamin B6)GABARITO
- B)Pyrazinamide hyperuricemia; increase hydration
- C)Drug-drug interaction; switch to alternative regimen
- D)Rifampin hepatotoxicity; check liver function tests
- E)Ethambutol-induced optic neuritis; discontinue the drug
Explicação
Isoniazid is a competitive antagonist of pyridoxine (vitamin B6) metabolism, causing peripheral neuropathy, especially in patients with poor nutritional status. Prophylactic pyridoxine (25-50 mg daily) is routinely coadministered with isoniazid to prevent this... Ver explicação completa e trilha adaptativa →