Le métronidazole (Flagyl) reste la référence dans le traitement des infections anaérobies et des parasitoses comme la giardiase ou l’amibiase. Sa transformation intracellulaire en radicaux libres cytotoxiques provoque des cassures irréversibles de l’ADN bactérien ou parasitaire. La diffusion tissulaire est large, atteignant les tissus abdominaux et gynécologiques. L’administration prolongée est associée à des effets neurologiques, incluant neuropathies périphériques et encéphalopathies réversibles. L’association avec l’alcool déclenche une réaction de type antabuse. Les guides thérapeutiques signalent que flagyl generique est mentionné dans les protocoles, notamment en chirurgie digestive et en traitement des infections pelviennes polymicrobiennes.

C15_nonphenothiazine.qxd

CHAPTER 15
Nervous System Drugs
Nonphenothiazine
Half-life: Onset:
Duration:
IM: 15–30 min IM: 30–45 min IM: 4–8 h IM: Decanoate IM: Decanoate IM: Decanoate behavioral problems in children, short-term treatment of hyperactivity in children; treatment of infantile autism, Huntington’s chorea, nausea/vomiting associated with cancer therapy.
Pregnancy Pharmacokinetic: PB: 80–90%;
category: C
readily absorbed from GI tract;extensively metabolizedin liver,excreted in urine; not removedby hemodialysis.
• Competitively blocks postsynaptic dopamine receptors, interrupts impulse movement and increases turnover of braindopamine,producing tranquilizing effect. Strong extrapyramidal,antiemetic effects, weak anticholinergic, sedative effects.
• PO: 0.5–5 mg 2–3 times/day. Maximum 100 mg/day.
• IM (lactate) 2–5 mg q4–8 h as needed.
• IM (decanoate) 10–15 times stabilized oral dose given at • IV: only lactate is given IV; IV push at rate of 5 mg/min; infuse piggy back over 30 min; up to 25 mg/hr has been used titratedto patient response.
• Obtain medical and drug history.
• Assess mental status, cardiac, eye, and respiratory disorders CHAPTER 15
Nervous System Drugs
Nonphenothiazine
• PO: give without regarad to meals.
• PO: scored tablets may be crushed.
• Prepare Decanoate IM injection with 21 gauge needle; do not exceed maximum volume of 3 ml per IM site; inject slowly,deep IM into upper outer quardant of gluteus maximus.
• IV may given undiluted; flush with at least 2 mL 0.9% NaCl before and after administration; may add to 30–50 mL mostsolutions (D5W preferred).
• IM: Patient must remain recumbent for 30–60 min in head-low position with legs raised to minimize hypotensive effect.
• Monitor blood pressure for hypotension.
• Assess for extrapyramidal symptoms.
• Monitor WBC, differential count for blood dyscrasias.
• Monitor for fine tongue movement (may be early sign of • Place on suicide precautions if necessary.
• Coma, alcohol ingestion, Parkinson’s disease, thyrotoxicosis.
• Caution: impaired respiratory/hepatic/cardiovascular function, alcohol withdrawal, history of seizures, urinary retention,glaucoma, prostatic hypertrophy, elderly.
• Frequent: blurred vision, constipation, orthostatic hypotension, dry mouth, swelling or soreness of female breasts, peripheraledema.
• Occasional: allergic reaction, difficulty urinating, decreased thirst, dizziness, decreased sexual ability, drowsiness, nausea,vomiting, photosensitivity, lethargy.
• Extrapyramidal symptoms appear to be dose related and may be noted in first few days of therapy; Marked drowsiness andlethargy, excessive salivation, fixed stare may be mild to severein intensity. Less frequently seen are severe akathisia and acutedystonias. Tardive dyskinesia may occur with long-term therapyand is more common in female geriatric patients. This may beirreversible. Abrupt withdrawal following long-term therapymay provoke transient dyskinesia signs.
• Toxic blood serum level >1 mcg/mL.
CHAPTER 15
Nervous System Drugs
Nonphenothiazine
• May take up to 6 weeks or longer to achieve full clinical effect • Do not consume alcohol or other CNS depressants such as • Do not abruptly discontinue the drug.
• Read labels on OTC and herbal preparations. Some are contraindicated when taking antipsychotics.
• Advise health care provider if you smoke. The dose may need to be adjusted as smoking increases metabolism of some antipsychotics.
• Maintain good oral hygiene by frequent brushing and flossing.
• Effects of antipsychotics on the fetus are unknown; discuss family planning with health care provider.
• Drug passes into breast milk which could cause drowsiness and • Maintain routine follow-up appointments with health care • Obtain laboratory tests as scheduled. • Wear an ID bracelet indicating medication taken.
• Tolerance to sedative effect develops over a period of days • Avoid potentially dangerous situations such as driving until • Be aware of EPS and report them immediately to provider.
• Avoid direct sunlight or use a sun block and protective clothing.
• Avoid arising from a lying or sitting position quickly as

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