Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (268 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(met-roe-ni′da-zole)
MetroCream, MetroGel, MetroGel Vaginal, MetroLotion, Noritate, Rosasol
, Rosadan, Vandazole
Func. class.:
Antiprotozoal, antibacterial
Chem. class.:
Nitroimidazole
Antibacterial and antiprotozoal activity may result from interacting with DNA
Acne rosacea, bacterial vaginosis
Hypersensitivity to this product or nitroimidazoles, parabens
Precautions:
Hepatic disease, blood dyscrasias; CNS conditions (vaginal), children
Calculator
• Adult:
TOP
apply to affected areas bid (0.75%) daily (1%); adjust therapy based on response
• Adult:
VAG
1 applicatorful bid × 5 days
Available forms:
Topical cream 0.75%, 1%; gel 0.75%, 1%; lotion 0.75%; vaginal gel 0.75%
•
Topical skin products are not for intravaginal therapy and are for external use only; do not use skin products near the eyes, nose, or mouth
•
Wash hands before and after use; wash affected area and gently pat dry
•
Cream/Gel/Lotion:
Apply a thin film to the cleansed affected area; massage gently into affected areas
•
Only use dosage formulations specified for intravaginal use; intravaginal dosage forms are not for topical therapy; do not ingest
•
Avoid vaginal intercourse during treatment
•
Cream:
Use applicator(s) supplied by the manufacturer
GU:
Vaginitis, cervicitis; nausea, vomiting, cramping
INTEG:
Redness, burning, dermatitis, rash, pruritus
•
MetroNIDAZOLE may increase warfarin anticoagulant effect
•
Caution with drinking alcohol or using disulfiram while using metroNIDAZOLE products(vaginal gel)
•
Possible lithium toxicity (vaginal gel)
•
Allergic reaction
: Assess for hypersensitivity, product may need to be discontinued
•
Infection
: Assess for number of lesions and severity of acne rosacea, itching in vaginosis
•
Decreased severity of acne rosacea, infection in vaginosis
•
That topical skin products are not for intravaginal therapy and are for external use only; not to use skin products near the eyes, nose, or mouth
•
To wash hands before and after use; to wash affected area and gently pat dry
•
Cream/Gel/Lotion:
To apply a thin film to the cleansed affected area and massage gently into affected areas
•
Intravaginal Route:
To use only dosage formulations specified for intravaginal use; not to ingest intravaginal dosage forms because these are not for topical therapy; to avoid vaginal intercourse during treatment
•
Cream:
To use applicator(s) supplied by the manufacturer
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(my-ca-fun′gin)
Mycamine
Func. class.:
Antifungal, systemic
Chem. class.:
Echinocandin
Inhibits an essential component of fungal cell walls; causes direct damage to fungal cell wall
Treatment of esophageal candidiasis; prophylaxis for
Candida
infections in patients undergoing hematopoietic stem-cell transplantation (HSCT); susceptible
Candida
sp.:
C. albicans, C. glabrata, C. krusei, C. parapsilosis, C. tropicalis
Unlabeled uses:
Aspergillus
sp., pediatrics to prevent candidiasis, endocarditis, endophthalmitis, infectious arthritis, myocarditis, osteomyelitis, pericarditis, pneumonia, sinusitis, tracheobronchitis, prophylaxis of HIV-related esophageal candidiasis
Hypersensitivity to this product or other echinocandins
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, severe hepatic disease, renal impairment
Calculator
• Adult:
IV INF
150 mg/day given over 1 hr
• Adult:
IV
100 mg/day over 1 hr
candida
infections
• Adult:
IV INF
50 mg/day given over 1 hr
• Adolescent/child/infant ≥6 mo (unlabeled):
IV INF
1 mg/kg/day, max 50 mg/day
sp. (unlabeled)
• Adult:
IV INF
25-150 mg/day × ≥30 days
Available forms:
Powder for inj 50 mg, in single-dose vials 50-, 100-mg vial
•
Do not use if cloudy or precipitated; do not admix; by IV inf only
•
Flush line before and after use with 0.9% NaCl
•
For
Candida
prevention,
reconstitute with provided dilutent 0.9% NaCl without bacteriostatic product; 50-mg vial/5 ml (10 mg/ml), swirl to dissolve, do not shake; further dilute with 100 ml 0.9% NaCl only; run over 1 hr
•
For
Candida
infection:
reconstitute with provided diluent 50 mg/5 ml (10 mg/ml); further dilute 3 reconstituted vials in 100 ml 0.9% NaCl, run over 1 hr
Y-site compatibilities:
Aminophylline, bumetanide, calcium chloride/gluconate, cycloSPORINE, DOPamine, eptifibatide, esmolol, fenoldopam, furosemide, heparin, HYDROmorphone, lidocaine, LORazepam, magnesium sulfate, milrinone, nitroglycerin, nitroprusside, norepinephrine, phenylephrine, potassium chloride, potassium phosphate, tacrolimus, vasopressin
CNS:
Seizures,
dizziness,
headache, somnolence
, fever, anxiety
CV:
Flushing, hypertension, phlebitis, tachycardia
GI:
Abdominal pain,
nausea, anorexia, vomiting, diarrhea, increased AST, ALT, alk phos, blood dehydrogenase, hyperbilirubinemia
HEMA:
Neutropenia, thrombocytopenia, leukopenia, coagulopathy, anemia, hemolytic anemia
INTEG:
Rash, pruritus, inj site pain
META:
Hypokalemia, hypocalcemia, hypomagnesemia
MS:
Rigors
Metabolized in liver; excreted in feces, urine; terminal half-life 14-17.2 hr; protein binding 99%
Increase:
plasma concentrations—itraconazole, sirolimus, NIFEdipine; may need dosage reduction
•
Infection,
clearing of cultures during treatment; obtain culture at baseline and during treatment; product may be started as soon as culture is taken (esophageal candidiasis); monitor cultures during HSCT for prevention of
Candida
infections
•
CBC (RBC, Hct, Hgb), differential, platelet count periodically; notify prescriber of results
•
Renal studies: BUN, urine CCr, electrolytes before and during therapy
•
Hepatic studies before and during treatment: bilirubin, AST, ALT, alk phos as needed
•
Bleeding:
hematuria, heme-positive stools, bruising, or petechiae, mucosa or orifices; blood dyscrasias can occur
•
For hypersensitivity:
rash, pruritus, facial swelling, phlebitis
•
For hemolytic anemia
•
GI symptoms:
frequency of stools, cramping; if severe diarrhea occurs, electrolytes may need to be given
•
Storage at room temp, away from light, do not freeze; discard unused sol
•
Therapeutic response: prevention of
Candida
infection with HSCT or decreased symptoms of
Candida
infection, negative culture
•
To notify prescriber if pregnancy is suspected or planned
•
To avoid breastfeeding while taking this product
•
To inform prescriber of kidney or liver disease
•
To report bleeding, facial swelling, wheezing, difficulty breathing, itching, rash, hives, increasing warmth, flushing
•
To report signs of infection: increased temp, sore throat, flulike symptoms
•
To notify prescriber of nausea, vomiting, diarrhea, jaundice, anorexia, clay-colored stools, dark urine; heptatotoxicity may occur