Metronidazole: Anti-infective and Antibiotic
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Questions and Answers

Why should metronidazole IV infusions be administered through a separate IV line?

  • To ensure accurate dosage calculation.
  • To prevent the medication from precipitating.
  • To avoid potential solution incompatibilities with other IV medications. (correct)
  • To allow for faster administration of the drug.

    • A client taking metronidazole reports numbness and tingling in their extremities. What is the priority nursing action?

  • Instruct the client to take an antacid with each dose.
  • Reassure the client this is a harmless and expected side effect.
  • Report the CNS manifestations, such as numbness or paresthesia of the extremities, to the provider. (correct)
  • Instruct the client to increase their potassium intake.

    • A client is prescribed metronidazole for treatment of a bacterial infection. What instruction should the nurse provide regarding medication administration and food intake?

  • Crush the tablet and mix it with applesauce for easier swallowing.
  • Take the medication with food or milk if gastric distress occurs. (correct)
  • Take the medication on an empty stomach to maximize absorption.
  • Take each dose with a full glass of grapefruit juice to enhance absorption.

    • A client with a history of alcohol use disorder is prescribed disulfiram. What potential interaction should the nurse monitor for if metronidazole is added to the client's medication list?

    <p>Psychotic reaction. (C)</p> Signup and view all the answers

    A client is starting metronidazole therapy. Which of the following should the nurse include in the client's education?

    <p>A metallic taste is a common side effect. (C)</p> Signup and view all the answers

    Which of the following conditions is a contraindication for metronidazole administration?

    <p>Active CNS disease. (C)</p> Signup and view all the answers

    A client taking metronidazole concurrently with intravenous nitroglycerin should be monitored for what potential interaction?

    <p>Disulfiram-like reaction. (D)</p> Signup and view all the answers

    What instruction should a nurse provide to a client prescribed metronidazole regarding alcohol consumption?

    <p>Drinking alcohol can cause a disulfiram-like reaction and should be avoided. (C)</p> Signup and view all the answers

    A client is prescribed both metronidazole and lithium. What potential drug interaction should the nurse monitor for?

    <p>Increased lithium levels. (C)</p> Signup and view all the answers

    A client reports experiencing a 'disulfiram-like reaction.' Which of the following sets of symptoms are characteristic of this reaction?

    <p>Facial flushing, nausea, vomiting, and hypotension. (C)</p> Signup and view all the answers

    A patient is prescribed metronidazole for Clostridium difficile-associated diarrhea (CDAD). What is the primary mechanism by which metronidazole helps resolve this infection?

    <p>By damaging the DNA of anaerobic bacteria like Clostridium difficile, preventing replication. (A)</p> Signup and view all the answers

    A surgeon is considering prophylactic antibiotic use before a colorectal surgery. What property of metronidazole makes it particularly suitable for this purpose?

    <p>Its efficacy against anaerobic bacteria commonly found in the colon (A)</p> Signup and view all the answers

    Why is metronidazole often prescribed in combination with other medications, such as tetracycline and bismuth subsalicylate, for treating Helicobacter pylori infections?

    <p>To target Helicobacter pylori through multiple mechanisms and improve eradication rates. (C)</p> Signup and view all the answers

    A patient reports experiencing a metallic taste in their mouth after starting metronidazole. What is the most appropriate action for the healthcare provider to take?

    <p>Advise the patient that this is a common, harmless side effect that may affect their appetite. (D)</p> Signup and view all the answers

    A patient on IV metronidazole starts to exhibit symptoms of peripheral neuropathy. What is the priority nursing intervention?

    <p>Immediately stop the metronidazole infusion and notify the prescribing provider. (D)</p> Signup and view all the answers

    A patient receiving metronidazole is also taking warfarin. What potential interaction should the healthcare provider monitor for?

    <p>Increased anticoagulant effect of warfarin, leading to an increased risk of bleeding. (A)</p> Signup and view all the answers

    A patient with a known allergy to which class of antibiotics would most likely have a cross-sensitivity reaction to metronidazole?

    <p>Azoles (D)</p> Signup and view all the answers

    A female patient is prescribed metronidazole vaginal gel for bacterial vaginosis. What instructions should the healthcare provider include when educating the patient about administering the medication?

    <p>Insert the applicator high into the vagina and administer the gel as directed. (D)</p> Signup and view all the answers

    A patient taking metronidazole reports that their urine has turned a darker color. What is the most appropriate response from the healthcare provider?

    <p>Reassure the patient this is an expected and harmless side effect of the medication. (C)</p> Signup and view all the answers

    A patient being treated with metronidazole for a parasitic infection reports experiencing nausea and vomiting. What should the nurse advise to minimize these effects?

    <p>Take the drug with food or milk to decrease gastric irritation. (B)</p> Signup and view all the answers

    Signup and view all the answers

    Flashcards

    Metronidazole

    A broad-spectrum azole antibiotic used for bacterial and protozoal infections.

    CDAD

    Clostridium difficile-associated diarrhea, a bacterial infection treated by metronidazole.

    Protozoal infections

    Infections caused by protozoa, treated using metronidazole.

    IV Metronidazole

    Intravenous form of metronidazole used to prevent anaerobic bacterial infections during surgeries.

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    Bactericidal action

    Metronidazole's ability to kill anaerobic gram-negative bacteria and protozoa.

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    Adverse effects of Metronidazole

    Common reactions include nausea, vomiting, diarrhea, and dry mouth.

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    CNS manifestations

    Central nervous system side effects of metronidazole, like headache and vertigo.

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    Dark urine

    Harmless side effect of metronidazole, may cause worry for clients.

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    Combination therapy

    Using metronidazole with tetracycline and bismuth for Helicobacter pylori in peptic ulcers.

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    Forms of Metronidazole

    Available as tablets, capsules, topical cream, vaginal gel, and IV infusion.

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    Reconstituting IV Medications

    Mixing a powdered medication with a diluent before IV administration.

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    Sustained-Release Tablets

    Medications designed to release over time; must be swallowed whole.

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    Crushing Regular Tablets

    Regular tablets can be crushed if the client cannot swallow them.

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    Best Absorption Timing

    Oral doses are best taken 1 hour before or 2 hours after meals.

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    Taking Metronidazole with Food

    Metronidazole can be taken with food to reduce gastric distress.

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    CNS Manifestations of Metronidazole

    Possible side effects include dizziness, numbness, and paresthesia.

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    Contraindications for Metronidazole

    Do not use in clients with active CNS disease or severe blood disorders.

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    Disulfiram-like Reaction

    An adverse reaction occurring when metronidazole is mixed with alcohol.

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    Effects of Disulfiram

    Disulfiram discourages drinking through adverse physical reactions.

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    IV Medication Compatibility

    Metronidazole has multiple solution incompatibilities; infuse separately.

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    Study Notes

    Metronidazole: Study Notes

    • Classification: Anti-infective, antiprotozoal, antiulcer agent
    • Prototype Medication: For various protozoal infections
    • Mechanism of Action: Damages DNA in anaerobic organisms. Its action occurs only within anaerobic microorganisms. This disrupts replication.
    • Broad-spectrum Antibiotic: Treats both bacterial and protozoal infections.
    • Bacterial Infections: Clostridium difficile-associated diarrhea (CDAD), bacterial vaginal infections
    • Protozoal Infections: Intestinal and systemic amebiasis, giardiasis, trichomoniasis (in both genders)
    • Used in Surgery: Prevents anaerobic bacterial infections in procedures like colorectal, abdominal, and vaginal surgeries.
    • Combination Therapy: Used with tetracycline and bismuth subsalicylate for Helicobacter pylori (a peptic ulcer cause)
    • Other Antiparasitic Medications: Tinidazole, ivermectin, permethrin

    Pharmacologic Effects

    • Bactericidal: Against various anaerobic gram-negative bacteria
    • Protozoacidal: Against protozoa.

    Adverse Effects

    • Common: Nausea, vomiting, diarrhea, anorexia, dry mouth, metallic taste.
    • CNS: Headache, vertigo, ataxia. Rare but serious: seizures, peripheral neuropathy. Stop the medication if these occur.
    • Harmless Side effect: Darkening of urine

    Interventions

    • Monitor: Severe GI effects and CNS manifestations
    • Administration: With food/milk to minimize gastric distress
    • Monitor: Neurological status, stop medication if seizures or neuropathy occur.
    • Inform: Clients about potential darkening of urine.

    Administration

    • Forms: Tablets, capsules, sustained-release capsules, topical cream, vaginal gel, IV infusion.
    • IV Preparation: Reconstitute powder and dilute according to manufacturer's directions for slow infusion.
    • Sustained-Release: Swallow whole; do not crush or chew.
    • Oral Tablets: Can be crushed if swallowing difficulty.
    • Oral Absorption: Best absorption 1 hour before or 2 hours after a meal. Can be taken with food/milk if gastric upset occurs.

    Client Instructions

    • Adjusting Schedule: Take before, with, or after meals if GI manifestations occur. Notify provider if severe.
    • Inform: Of potential metallic taste, dizziness, headaches; CNS manifestations (numbness, paresthesia); urine discoloration (not alarming).

    Contraindications & Precautions

    • Avoid: Clients with active CNS disease, severe blood disorders, or pregnancy.
    • Caution: History of blood dyscrasias, heart failure, liver/renal failure, or seizure disorder.

    Drug Interactions

    • Disulfiram-like Reactions: With citalopram, ritonavir, IV nitroglycerin, sulfamethoxazole, trimethoprim.
    • Psychotic Reaction: With disulfiram (alcohol use disorder medication)
    • Decreases Blood Levels: Phenobarbital.
    • Increases Blood Levels: Lithium.
    • Other Interactions: Fluorouracil and azathioprine can cause temporary neutropenia. IV metronidazole interacts with some other IV medications requiring separate IV lines.
    • Alcohol Interaction: Avoid alcohol consumption while taking metronidazole. Causes a disulfiram-like reaction.

    Safety Alert: Disulfiram Reaction

    • Description: A reaction similar to disulfiram (used for alcohol aversion therapy), which can discourage alcohol consumption.
    • Symptoms: Facial flushing, nausea, vomiting, hypotension, sweating, shortness of breath, dizziness, anxiety
    • Duration: Typically within an hour.
    • Seriousness: Potentially life-threatening in some cases (shock). Supportive measures needed.
    • Client Education: Must advise clients about the disulfiram-like reaction. Avoid alcohol and alcohol-containing products.

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    Description

    Explore Metronidazole, a versatile anti-infective, antiprotozoal, and antiulcer agent. It is effective against anaerobic bacteria and protozoal infections, including CDAD and giardiasis. It is also used to prevent infections in surgery and in combination to treat H. pylori.

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