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1.

Brand Name:Rifadin, Rimactane

Generic Name: rifampicin/rifampin

Drug Classification: Antibiotic, Antituberculotic (first line)

Mechanism of Action:

Rifampin inhibits DNA-dependent RNA polymerase activity in

susceptible Mycobacterium tuberculosis organisms.

Specifically, it interacts with bacterial RNA polymerase but does

not inhibit the mammalian enzyme.

Inhibits DNA-dependent RNA polymerase activity in susceptible

bacterial cells.

Rifampin, a semisynthetic broad-spectrum bactericidal

antibiotic, inhibits bacterial RNA synthesis by binding strongly to

the beta subunit of DNA-dependent RNA polymerase,preventing attachment of the enzyme to DNA, and thus blocking

initiation of RNA transcription

Indication: Treatment of Pulmonary TB in conjunction with atleast one other effective antituberculotic.

Neisseria meningitidis carriers, for asymptomaticcarriers to eliminate meningococci from nasopharynx; notfor treatment of meningitis.

Unlabeled uses: Infections causedby Staphylococcus aureus and Staphylococcus epidermis,usually in combination therapy; gram-negativebacteremia in infancy; Legionella pneumophilia, notresponsive to erythromycin; leprosy (in combination with

dapsone); prophylaxis of meningitis caused by Haemophilisinfluenzae.

This antibiotic treats only bacterial infections. It will notwork for viral infections (e.g., common cold, flu).

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Contraindication: Contraindicated with allergy to any rifamycin, acutehepatic disease, lactation.

Use cautiously with pregnancy (teratogenic effectshave been reported in preclinical studies; safestantituberculous regimen for use in pregnancy is condideredto be rifampin, isoniazid, and ethambutol).

Side Effects:Less serious side effects may include:

• tired feeling; or 

• red or orange colored urine, stools, tears, sweat, or saliva.

This is not a complete list of side effects and others may occur.Tell your doctor about any unusual or bothersome side effect.

Adverse Drug Effects: CNS: headache, drowsiness, fatigue, dizziness,

inability to concentrate, mental confusion, generalizednumbness, muscle weakness, visual disturbances.

Dermatologic: Rash, pruritus, urticaria, flushing,reddish discoloration of body fluids—tears, saliva, urine,sweat, sputum.

GI/ Hepatotoxic: heartburn, distress, anorexia,vomiting gas, cramps, diarrhea, hepatitis, pancreatitis,

 jaundice, liver failure in severe cases- nausea, vomiting,abdominal cramps with or without diarrhea

GU: hemoglobinuria, hematuria, renal insufficiency,acute renal failure, menstrual disturbances.

Hematologic: eosinophilia, thrombocytopenia,transient leucopenia, hemolytic anemia, decreased Hgb,hemolysis; Blood dyscrasias (sore throat; unusual

bleeding or bruising) Other: pain in extremities, osteomalacia, myopathy,fever, flulike symptoms.

Flu-like symptoms - with chills, fever,

headache, arthralgia, and malaise. Rifampin has good

penetration into the brain, and this may directly explain

some malaise and dysphoria in a minority of users.

Nursing Responsibilities: Administer on an empty stomach, 1 hr before or 2 hr 

after meals.

Administer in a single daily dose.

Consult pharmacist for rifamoin suspension for patients unable to swallow capsules.

Prepare patient for the reddish-orange coloring of bodyfluids (urine, sweat, sputum, tears, feces, saliva); softcontact lenses may be permanently stained; advise patientsnot to wear them during therapy.

Warning: arrange for follow-up visits for liver and renal

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function tests, CBC, and ophthalmic examinations.

Health Teachings

Teach client to take drug in a single daily dose. Takeon an empty stomach, 1 hr before or 2 hrs after meals.

Inform client to take this drug regularly; avoid missing

any doses; do not discontinue this drug without consultingthe health care provider.

Tell client to have periodic medical checkups, includingeye examinations and blood test, to evaluate the drugeffects.

Inform client that he may experience the drug’s sideeffects (especially the red colored secretion)

Instruct client to see his physician if he experiencefever, chills, muscle and bone pain, excessive tiredness or weakness, loss of appetite, N/V, yellowing of eyes/skin,unusual bleeding or bruising, skin rash or itching.

Instruct client to remove contact lenses as they maydiscolor 

Additional infos:

2.

Brand Name: Tebrazid (Canada)

Generic Name: pyrazinamide

Drug Classification: Antibacterial

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Mechanism of Action: Pyrazinamide is a prodrug that stops the growthof  Mycobacterium tuberculosis.M. tuberculosis has the enzyme pyrazinamidase which is onlyactive in acidic conditions.[6] Pyrazinamidase convertspyrazinamide to the active form, pyrazinoic acid whichaccumulates in the bacilli. Pyrazinoic acid was thought to inhibitthe enzyme fatty acid synthase (FAS) I, which is required by the

bacterium to synthesise fatty acids[7]

  although this has beendiscounted.[8] It was also suggested that the accumulation of pyrazinoic acid disrupts membrane potential and interferes withenergy production, necessary for survival of M. tuberculosis atan acidic site of infection. Further studies reproduced theresults of FAS I inhibition as the putative mechanism first inwhole cell assay of replicating M. tuberculosis bacilli which haveshown that pyrazinoic acid and its ester inhibit the synthesis of fatty acids.[9] This study was followed by in vitro assay of tuberculous FAS I enzyme that tested the activity withpyrazinamide, pyrazinoic acid and several classes of pyrazinamide analogs. Pyrazinamide and its analogs inhibitedthe activity of purified FAS I.[10]Mutations of the pyrazinamidasegene ( pncA) are responsible for pyrazinamide resistance in M.tuberculosis.

Indication: Pyrazinamide is used with other medications to

treat tuberculosis (TB). It is an antibiotic and works by stopping

the growth of bacteria.This antibiotic treats only bacterial

infections. It will not work for viral infections (such as common

cold, flu). Unnecessary use or misuse of any antibiotic can lead

to its decreased effectiveness.

Initial treatment of active tuberculosis in adults and selected

children when combined with other antituberculosis agents.

After treatment failure with other primary drugs in any form of 

active tuberculosis.

Contraindication: Pyrazinamide is contraindicated in conditions like Renal

diseases,  Hepatic disease. 

Side Effects: • an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

• a fever;

• unusual weakness or fatigue;

• nausea, vomiting, or loss of appetite;

•

yellow skin or eyes;• dark urine;

• difficult or painful urination;

• worsening gout;

• a rash; or 

• arthralgia

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Adverse Drug Effects:Dermatologic

Acne; photosensitivity.

GI

Anorexia; nausea; vomiting.

Genitourinary

Dysuria; interstitial nephritis.

Hematologic-Lymphatic

Increased serum iron; sideroblastic anemia with erythroidhyperplasia; thrombocytopenia; vacuolation of erythrocytes.

Hepatic

Hepatotoxicity.

Metabolic-Nutritional

Porphyria.

Musculoskeletal

Mild arthralgia, myalgia.

Miscellaneous

Fever; hypersensitivity reactions, including pruritus, rash,urticaria.

 Adverse reactions

CNS: headache

GI: nausea, vomiting, diarrhea, peptic ulcer, abdominal cramps,anorexia

GU: dysuria, increased uric acid secretion

Hematologic: hemolytic anemia

Hepatic: hepatotoxicity

Metabolic: hyperuricemia, gout

Musculoskeletal: joint pain

Skin: urticaria, photosensitivity

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Nursing Responsibilities:Monitor 

Measure baseline serum uric acid and liver function prior to theonset of therapy and periodically during treatment.

Patient Information/ Teaching Points

• Emphasize need to be compliant with regimen andthat doses should not be missed.

• Explain that long-term therapy (6 mo to 2 yr) will be necessary.

• Inform diabetic patients that drug may interfere withurine ketone values.

• Emphasize importance of follow-up examinations tomonitor effectiveness of therapy and identify adversereactions.

• Instruct patient to report the following symptoms to

health care provider: fever; loss of appetite; malaise;nausea and vomiting; darkened urine; yellowish skin or eye discoloration; pain or swelling joints.

• Advise patient to avoid intake of alcoholicbeverages and alcohol-containing products.

Nursing Implications

Assessment & Drug Effect

• Observe and supervise closely. Patients should

receive at least one other effective antituberculosisagent concurrently.

• Examine patients at regular intervals and question

about possible signs of toxicity: Liver enlargement or 

tenderness, jaundice, fever, anorexia, malaise,

impaired vascular integrity (ecchymoses, petechiae,

abnormal bleeding).

• Hepatic reactions appear to occur more frequently in

patients receiving high doses.

• Lab tests: Obtain liver function tests (especially AST,

ALT, serum bilirubin) prior to and at 2–4 wk intervals

during therapy. Blood uric acid determinations are

advised before, during, and following therapy.

Patient & Family Education

• Report to physician onset of difficulty in voiding. Keep

fluid intake at 2000 mL/d if possible.

• Monitor blood glucose (diabetics) for possible loss of 

glycemic control.

• Do not breast feed while taking this drug without

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consulting physician.

Additional infos:

3.

Brand Name: Niazid

Generic Name: isoniazid

Drug Classification: Antituberculic

Mechanism of Action:This medication is used with other medications to treatactive tuberculosis (TB) infections or alone to preventthose who have a positive TB test from developingsymptoms of TB. Isoniazid belongs to a class of drugsknown as antibiotics that are active against tuberculosis.Interferes with lipid and nucleic acid biosynthesis inactively growing tubercle bacilli.

Isoniazid is a prodrug and must be activated by a bacterial

catalase-peroxidase enzyme that in M. tuberculosis is called

KatG.[5] KatG couples the isonicotinic acyl withNADH to form

isonicotinic acyl-NADH complex. This complex binds tightly to

the enoyl-acyl carrier protein reductase known as InhA, thereby

blocking the natural enoyl-AcpM substrate and the action

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of fatty acid synthase. This process inhibits the synthesis

of mycolic acid, required for the mycobacterial cell wall. A range

of radicals are produced by KatG activation of Isoniazid,

including nitric oxide,[6] which has also been shown to be

important in the action of another antimycobacterial

prodrug PA-824.[7]

Isoniazid is bactericidal to rapidly-dividing mycobacteria but

is bacteriostatic if the mycobacterium is slow-growing.[citation

needed ] Isoniazid inhibits the P450 system.

Indication:

Tuberculosis of all forms Prophylaxis in specific patients who are tuberculinreactors (positive Mantoux test)) or who are considered tobe high risk for TB.

Contraindication: Isoniazid is contraindicated in patients who develop severe

hypersensitivity reactions, including drug -induced hepatitis;

previous isoniazid-associated hepatic injury; severe adverse

reactions to isoniazid such as drug fever, chills, arthritis; and

acute liver disease of any etiology.

Contraindications

• Hypersensitivity to drug• Acute hepatic disease or previous hepatitis caused byisoniazid therapy

Side Effects:Side effects

Peripheral neuropathy

Nausea and vomitting Thrombocytopenia

Local irritation at IM site

Epigastric distress

Elevated AST

Mao ra ni naa sa uban nga sites

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Adverse Drug Effects: Adverse reactions

CNS: peripheral neuropathy, dizziness, memory impairment,slurred speech, psychosis, toxic encephalopathy, seizures

EENT: visual disturbances

GI: nausea, vomiting

GU: gynecomastia

Hematologic: eosinophilia, methemoglobinemia, hemolyticanemia, aplastic anemia, agranulocytosis,thrombocytopenia

Hepatic: hepatitis

Metabolic: pyridoxine deficiency, hyperglycemia, metabolic

acidosis

Respiratory: dyspnea

Other: fever, pellagra, lupuslike syndrome, injection siteirritation, hypersensitivity reaction

Nursing Responsibilities: History: allergy to the drug.

Can cause peripheral neuropathy which is manifestedby tingling sensation on extremities. It can be preventedthrough use of supplemental vitamin B6 (pyridoxine).

Physical: skin color, lesions, T; orientation, reflexes,peripheral sensirivity, bilaterally grip strengthophthalmologic examination; R, adventitious sounds; liver evaluation; CBC;LFTs renal fxn tests, blood glucose.

Give in an empty stomach 1 hr before or 2 after meals;may be given with food if GI UPSET OCCURS.

Give in a single daily dose. Reverse parenteral dosefor pt unable to take oral meds.

Dec. foods containing tyramine or histamine in pt diet.

Consult doctor and arrange for daily pyridoxine indiabetic, alcoholic or malnourished pt also for pt thatdevelops peripheral neuritis, and those with HIV.

Family health teachings:

Take this drug in single daily dose.

Take drug on an empty stomach, 1 hour before or 2 hours after meals. If GI distress occurs, maybe taken with food.

Take this drug regularly, avoid missing doses,do not discontinue without first consulting your healthcare provider.

Do not drink alcohol or drink as little as

possible. There is an inc. risk of heap if these two drugs

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are combined.

Avoid foods containing tyramine, consult adietitian to obtain a list of foods containing tyramine or histamine.

Have periodic medical check-ups, includingan eye examination and blood test, to evaluate the drugeffects.

Report for weakness, fatigue, loss of appetite,n/v, yellowing of skin or eyes, darkening of the urine,numbness or tingling in hands or feet.

Additional infos:

4.

Brand Name: Myambutol, Servambutol

Generic Name: ethambutol

Drug Classification: Antituberculotic

Mechanism of Action: Ethambutol is bacteriostatic against actively growing TB bacilli,

it works by obstructing the formation of cell wall. Mycolic acids

attach to the 5′-hydroxyl groups of D-arabinose residues of arabinogalactan and form mycolyl-arabinogalactan-

peptidoglycan complex in the cell wall. It disrupts

arabinogalactan synthesis by inhibiting the enzyme arabinosyl

transferase. Disruption of the arabinogalactan synthesis inhibits

the formation of this complex and leads to increased

permeability of the cell wall.

Mao ra ni,.

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Indication: • Ethambutol eliminates certain bacteria that causetuberculosis (TB). It is used with other medicines to treattuberculosis and to prevent you from giving the infection toothers.

• This medication is sometimes prescribed for other uses;ask your doctor or pharmacist for more information.

Wala na koy laing makit.an.

Contraindication: Ethambutol hydrochloride is contraindicated in patients who areknown to be hypersensitive to this drug. It is also

contraindicated in patients with known optic neuritis unless

clinical judgemnet determines that it may be used. Ethambutol

hydrochloride is contraindicated in patients who are unable to

appreciate and report visual side ettects or changes in vision

(eg, young children, unconscious patients).

Ethambutol hydrochloride is contraindicated in patientswho are known to be hypersensitive to this drug. Renalimpairment, old age and optic neuritis are relativecontraindications (PDR, 1989).

 

Side Effects: loss of appetite

upset stomach

vomiting

numbness and tingling in the hands or fee

optic neuritis–blurring of vision

Ethambutol side effects.

- blurred vision;

- inability to see the colors red and green;

- itching;

- loss of appetite;- numbness and tingling in the hands or feet;

- skin rash;

- sudden changes in vision;

- upset stomach;

- vomiting;

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Adverse Drug Effects: Serious Reactions

• anaphylaxis

• hypersensitivity syndrome

• erythema multiforme

• thrombocytopenia

• neutropenia

• leukopenia

• optic neuritis

• blindness, irreversible

• peripheral neuropathy

• pulmonary infiltrates

• hepatotoxicity, incl. fatal

Nursing Responsibilities: Assess patient for infection (appearance of wounds,sputum, VS, urine and stool and WBC.) at beginning andduring therapy.

Obtain specimens before initiating therapy. Take drugas indicated.

Not to be given to children 6 years below due to opticneuritis

Provide supplemental vitamin A. if not contraindicated

Perform visual

acuity and color 

discrimination

test before and

during therapy

Ensure that any

changes in

vision don’t

result from an

underlying

condition

Obtain AST and

ALT levels

before therapy,

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and monitor 

these levels

every 3 to 4

weeks

In patients with

impaired renal

function, base

dosage on drug

level.

Always give

drug with other 

antituberculotics

to prevent

development of resistant

organisms

Monitor uric

acid level;

observe patients

signs and

symptoms of 

gout.

Additional infos:

5.

Brand Name: Zovirax

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Generic Name: acyclovir  

Drug Classification: Antiviral

Mechanism of Action: Mechanism of action

Aciclovir differs from previous nucleoside analogues in

containing only a partial nucleoside structure: the sugar ring is

replaced with an open-chain structure. It is selectively

converted into acyclo-guanosine monophosphate (acyclo-GMP)

by viral thymidine kinase, which is far more effective (3000

times) in phosphorylation than cellular thymidine kinase.

Subsequently, the monophosphate form is further 

phosphorylated into the active triphosphate form, acyclo-

guanosine triphosphate (acyclo-GTP), by cellular kinases.

Acyclo-GTP is a very potent inhibitor of viral DNA polymerase; it

has approximately 100 times greater affinity for viral than

cellular polymerase. As a substrate, acyclo-GTP is incorporated

into viral DNA, resulting in chain termination. Although acyclovir 

resembles a nucleotide, it has no 3' end. Therefore, after its

incorporation into a growing DNA strand, no further nucleotides

can be added to this strand. It has also been shown that

viral enzymes cannot remove acyclo-GTP from the chain, which

results in inhibition of further activity of DNA polymerase.

Acyclo-GTP is fairly rapidly metabolised within the cell, possibly

by cellular phosphatases.

In sum, aciclovir can be considered a prodrug: it is administered

in an inactive (or less active) form and is metabolised into a

more active species after administration.

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Indication: Initial and recurrent mucosal and cutaneous HSV 1and 2 and varicella zoster infectionsin immunocompromised patients

Severe initial and recurrent genital herpes infectionsin selected patients

Herpes simplex encephalitis in patients > 6 mo Acute treatment of herpes zoster (shingles) and

chickenpox Ointment: Initial HSV genital infections;

limited mucocutaneous HSV infectionsin immunocompromised patients

Cream: Recurrent herpes labialis (cold sores) inpatients > 12 yr 

Unlabeled uses: Cytomegalovirus and HSVinfection following transplant, herpes simplexinfections, varicella pneumonia, disseminated primaryeczema herpeticum

Contraindication: Contraindicated with allergy to acyclovir, seizures,CHF, renal disease, lactation.

Use cautiously with pregnancy.

Acyclovir is contraindicated in lactation, hypersensitivity, severe

renal impairment, hypoxia and in neurological diseases.

Side Effects: diarrhea, nausea, and a general ill feeling.

Adverse Drug Effects: Systemic administration  CNS: Headache, vertigo, depression,

tremors, encephalopathic changes  Dermatologic: Inflammation or phlebitis at injection

sites, rash, hair loss  GI: Nausea, vomiting, diarrhea, anorexia  GU: Crystalluria with rapid IV

administration, hematuriaTopical administration  Dermatologic: Transient burning at site of 

application

General: Anaphylaxis, angioedema, fever, headache, pain,

peripheral edema.

Nervous: Aggressive behavior, agitation, ataxia, coma, 

confusion, decreasedconsciousness, delirium, dizziness, dysarthria, encephalopathy,

hallucinations,paresthesia, psychosis, seizure, somnolence,

tremors. These symptoms may be marked, particularly in older 

adults or in patients with renal impairment

(seePRECAUTIONS).

Digestive: Diarrhea, gastrointestinal distress, nausea.

Hematologic and Lymphatic :Anemia, leukocytoclastic

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vasculitis, leukopenia,lymphadenopathy, thrombocytopenia.

Hepatobiliary Tract and Pancreas: Elevated liver function

tests, hepatitis,hyperbilirubinemia, jaundice.

Musculoskeletal: Myalgia.

Skin:Alopecia, erythema multiforme, photosensitiverash, pruritus, rash,Stevens-Johnson syndrome, toxic epidermal

necrolysis, urticaria.

Special Senses: Visual abnormalities

Urogenital: Renal failure, renal pain (may be associated with

renal failure), elevated blood urea nitrogen, elevated

creatinine, hematuria

Nursing Responsibilities:  Assessment   History: Allergy to acyclovir, seizures, CHF, renal

disease, lactation, pregnancy  Physical: Skin color, lesions; orientation; BP, P,

auscultation, perfusion, edema; R, adventitious

sounds; urinary output; BUN, creatinine clearance InterventionsSystemic administration Ensure that the patient is well hydrated.

Topical administration Start treatment as soon as possible after onset of 

signs and symptoms. Wear a rubber glove or finger cot when applying

drug. Teaching pointsSystemic administration Complete the full course of oral therapy, and do not

exceed the prescribed dose.

Oral acyclovir is not a cure for your disease butshould make you feel better.

Avoid sexual intercourse while visible lesions arepresent.

These side effects may occur: Nausea, vomiting,loss of appetite, diarrhea; headache, dizziness.

Report difficulty urinating, rash, increased severityor frequency of recurrences.

Topical administration Wear rubber gloves or finger cots when applying the

drug to prevent autoinoculation of other sites andtransmission to others.

This drug does not cure the disease; applicationduring symptom-free periods will not preventrecurrences.

Avoid sexual intercourse while visible lesions arepresent.

This drug may cause burning, stinging, itching, rash;notify your physician if these are pronounced.

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Additional infos:

6.

Brand Name: Diflucan

Generic Name: fluconazole

Drug Classification: Antifungal

Mechanism of Action: Therapeutic actionsBinds to sterols in the fungal cell membrane, changingmembrane permeability; fungicidal or fungistatic depending onconcentration and organism.

Indication: Treatment of oropharyngeal, esophageal, vaginal,and systemic candidiasis

Treatment of cryptococcal meningitis Prophylaxis of candidiasis in bone marrow

transplants

Contraindication: Contraindicated with hypersensitivity to fluconazole,lactation.

Use cautiously with renal impairment.

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Side Effects: Vomiting, headaches, and dizziness are among the most

commonly reportedside effects of fluconazole.

Adverse Drug Effects:Adverse drug reactions associated with fluconazole therapy

include:[4]

Infrequent (0.1–1% of patients): anorexia, fatigue,

constipation

Rare (<0.1% of 

patients): oliguria, hypokalaemia, paraesthesia,

seizures, alopecia, Stevens-Johnson

syndrome, thrombocytopenia, other blood dyscrasias,

serious hepatotoxicity including hepatic

failure,anaphylactic/anaphylactoid reactions

Very rare: prolonged QT interval, torsades de pointes

 

Nursing Responsibilities:  Assessment   History: Hypersensitivity to fluconazole, renal

impairment, lactation, pregnancy  Physical: Skin color, lesions; T; injection site;

orientation, reflexes, affect; bowel sounds; renal

function tests; CBC and differential; culture of areainvolved Interventions Culture infection prior to therapy; begin treatment

before lab results are returned. Decrease dosage in cases of renal failure. Infuse IV only; not intended for IM or SC use. Do not add supplement medication to fluconazole. Administer through sterile equipment at a maximum

rate of 200 mg/hr given as a continuous infusion. Monitor renal function tests weekly, discontinue or 

decrease dosage of drug at any sign of increasedrenal toxicity.

 

Teaching points Drug may be given orally or intravenously as

needed. The drug will need to be taken for the fullcourse and may need to be taken long term.

Use hygiene measures to prevent reinfection or spread of infection.

Arrange for frequent follow-up while you are usingthis drug. Be sure to keep all appointments, includingthose for blood tests.

These side effects may occur: Nausea, vomiting,diarrhea (eat frequent small meals); headache

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(analgesics may be ordered). Report rash, changes in stool or urine color,

difficulty breathing, increased tears or salivation.

Additional infos:

7.

Brand Name: Trikacide (CAN)

Generic Name: metronidazole

Drug Classification: Antibiotic; Antibacterial; Amebicide; Antiprotozoal

Mechanism of Action: Therapeutic actionsBactericidal: Inhibits DNA synthesis in specific (obligate)anaerobes, causing cell death; antiprotozoal-trichomonacidal, amebicidal: Biochemical mechanism of actionis not known

Indication: Acute infection with susceptible anaerobic bacteria

Acute intestinal amebiasis Amebic liver abscess Trichomoniasis (acute and partners of patients with

acute infection) Preoperative, intraoperative, postoperative

prophylaxis for patients undergoing colorectal surgery Topical application: Treatment of inflammatory

papules, pustules, and erythema of rosacea Unlabeled uses: Prophylaxis for patients

undergoing gynecologic, abdominal surgery; hepaticencephalopathy; Crohn's disease; antibiotic-

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associated pseudomembranous colitis; treatmentof Gardnerella vaginalis, giardiasis (use recommendedby the CDC)

Contraindication:

Contraindicated with hypersensitivityto metronidazole; pregnancy (do not usefor trichomoniasis in first trimester).

Use cautiously with CNS diseases, hepaticdisease, candidiasis (moniliasis), blood dyscrasias,lactation.

Side Effects: Potential side effects seen with metronidazole include

diarrhea or constipation, dizziness, and nausea.

Adverse Drug Effects: Adverse effects  CNS: Headache, dizziness,

ataxia, vertigo, incoordination, insomnia, seizures,peripheral neuropathy, fatigue

  GI: Unpleasant metallic taste, anorexia, nausea,vomiting, diarrhea, GI upset, cramps

  GU: Dysuria, incontinence, darkening of the urine  Local: Thrombophlebitis (IV); redness, burning,

dryness, and skin irritation (topical)  Other: Severe, disulfiram-like interaction with

alcohol, candidiasis (superinfection)

Nursing Responsibilities:  Assessment   History: CNS or hepatic

disease; candidiasis (moniliasis); blood dyscrasias;pregnancy; lactation

  Physical: Reflexes, affect; skin lesions, color (withtopical application); abdominal exam, liver palpation;urinalysis, CBC, liver function tests

 Interventions Avoid use unless necessary. Metronidazole is

carcinogenic in some rodents. Administer oral doses with food. Apply topically (MetroGel, MetroCream) after 

cleansing the area. Advise patient that cosmetics maybe used over the area after application.

Reduce dosage in hepatic disease. Teaching points Take full course of drug therapy; take the drug with

food if GI upset occurs. Do not drink alcohol (beverages or preparations

containing alcohol, cough syrups); severe reactionsmay occur.

Your urine may appear dark; this is expected. Refrain from sexual intercourse unless partner 

wears a condom during treatment for trichomoniasis. Apply the topical preparation by cleansing the area

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and then rubbing a thin film into the affected area.Avoid contact with the eyes. Cosmetics may beapplied to the area after application.

These side effects may occur: Dry mouth withstrange metallic taste (use frequent mouth care, sucksugarless candy); nausea, vomiting, diarrhea (eatfrequent small meals).

Report severe GI upset, dizziness, unusual fatigueor weakness, fever, chills.

Additional infos: