PATIENT-CENTERED DRUG STUDY/ ANALYSIS

STUDENTS INFORMATION Name: DOMINO, NIKKI Y. Group: 1 (B) Agency/ Area: 5B WARD Inclusive Dates of Rotation: MARCH 3-5, 2014 Year and Section: 4 ACN Shift: 7AM-3PM Clinical Instructor: PROFESSOR CAYETANO

PATIENTS INFORMATION Name of Patient: PATIENT E6 Chief Complaint: Diagnosis: Age: Sex: M

DRUG INFORMATION Drug Classification: Anti-infectives, Anti-protozoals Generic Name: Metronidazole__________________ Dosage: Brand Name: Flagyl Route of Administration: PO MODE/ MECHANISM OF ACTION Disrupts DNA and protein synthesis in susceptible organisms Bactericidal, or amebicidal action

INDICATION
Amebicide in the management of amebic dysentery Hypersensitivity

CONTRAINDICATION

SIDE EFFECT AND ADVERSE REACTION

CNS: seizures, dizziness, headache GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting Hematologic: leukopenia Skin: rashes, urticaria

DRUG INTERACTIONS (Drug-Drug, Drug-Food, Drug-Laboratories)

Metronidazole has been reported to potentiate the anticoagulant effect of warfarin and other oral coumarin anticoagulants , resulting in a prolongation of prothrombin time. This possible drug interaction should be considered when Flagyl (metronidazole) is prescribed for patients on this type of anticoagulant therapy. The simultaneous administration of drugs that induce microsomal liver enzymes, such as phenytoin or phenobarbital, may accelerate the elimination of metronidazole, resulting in reduced plasma levels; impaired clearance of phenytoin has also been reported. The simultaneous administration of drugs that decrease microsomal liver enzyme activity, such as cimetidine, may prolong the half-life and decrease plasma clearance of metronidazole. In patients stabilized on relatively high doses of lithium, short-term Flagyl (metronidazole) therapy has been associated with elevation of serum lithium and, in a few cases, signs of lithium toxicity. Serum lithium and serum creatinine levels should be obtained several days after beginning metronidazole to detect any increase that may precede clinical symptoms of lithium intoxication. Alcoholic beverages should not be consumed during Flagyl (metronidazole) therapy and for at least one day afterward because abdominal cramps, nausea, vomiting, headaches, and flushing may occur. Psychotic reactions have been reported in alcoholic patients who are using metronidazole and disulfiram concurrently. Metronidazole should not be given to patients who have taken disulfiram within the last two weeks. Drug/Laboratory test interactions: Metronidazole may interfere with certain types of determinations of serum chemistry values, such as aspartate aminotransferase (AST, SGOT), alanine aminotransferase (ALT, SGPT), lactate dehydrogenase (LDH), triglycerides, and hexokinase glucose. Values of zero may be observed. All of the assays in which interference has been reported involve enzymatic + coupling of the assay to oxidation-reduction of nicotinamide adenine dinucleotide (NAD NADH). Interference is due to the similarity in absorbance peaks of NADH (340 nm) and metronidazole (322 nm) at pH 7.

NURSING CONSIDERATIONS/ HEALTH TEACHINGS Assessment & Drug Effects Discontinue therapy immediately if symptoms of CNS toxicity develop. Monitor especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities). Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a second course is necessary. Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of CHF. Monitor patients on lithium for elevated lithium levels. Report appearance of candidiasis or its becoming more prominent with therapy to physician promptly. Repeat feces examinations, usually up to 3 months, to ensure that amebae have been eliminated. Patient & Family Education Adhere closely to the established regimen without schedule interruption or changing the dose. Refrain from intercourse during therapy for trichomoniasis unless male partner wears a condom to prevent reinfection. Have sexual partners receive concurrent treatment. Asymptomatic trichomoniasis in the male is a frequent source of reinfection of the female. Prepared by: Evaluated by: Do not drink alcohol during therapy; may induce a disulfiram-type reaction Avoid alcohol or alcoholcontaining medications for at least 48 h after treatment is completed. Urine may appear dark or reddish brown (especially with higher than recommended doses). This appears to have no significance. Student Nuclinical rses Signature over Printed Name Clinical Instructors Signature over Printed Name DATE: DATE: Rating: Mode/ Mechanism of Action Indication and Contraindication Side Effect and Adverse Reaction Drug Interactions Nursing Considerations/ Health Teachings POINTS 15 15 15 15 40 SCORE

TOTAL: TRANSMUTED GRADE (60% Passing Score):