The nurse administers intravaginal miconazole (Monistat) to a female patient with a vaginal candidiasis infection and a history of recent DVT, for which the patient takes warfarin (Coumadin)

Question

For which adverse effect should the nurse monitor the patient?
a. Hyperkalemia
b. Increase in WBCs
c. Bruising and bleeding gums
d. Increased vaginal itching and burning

Answer 1

ANS: C
Intravaginal miconazole can intensify the anticoagulant effects of warfarin; it can inhibit the metabolism of warfarin, causing levels to rise. Anticoagulation must be monitored closely, and warfarin doses may need to be reduced. The patient should be assessed for bleeding tendencies, such as bruising and bleeding gums.
Hyperkalemia would not occur as a result of concomitant use of warfarin and miconazole.
An increase in WBCs would not occur as a result of concomitant use of warfarin and miconazole.
An increase in vaginal itching and burning would not occur as a result of concomitant use of warfarin and miconazole. In fact, the itching and burning should be reduced with administration of intravaginal miconazole.