A patient is taking cyclosporine (Sandimmune) and prednisone to ...

[oliviahorn72]

A patient is taking cyclosporine (Sandimmune) and prednisone to prevent organ rejection after right renal transplantation. The patient is febrile and complains of right-sided flank pain.
 
  The nurse reviews the patient's chart and finds that the patient's BUN and serum creatinine are elevated. The cyclosporine trough is 150 ng/mL. What will the nurse do?
  a. Be concerned that the left kidney is failing.
  b. Expect the provider to order intravenous methylprednisolone.
  c. Request an order for a urine culture.
  d. Suspect nephrotoxicity secondary to an elevated cyclosporine level.

Question 2

A patient with a history of lung transplantation is admitted for treatment for a respiratory infection. The patient has been taking cyclosporine (Sandimmune), prednisone, and azathioprine (Imuran) for 8 months.
 
  The provider has ordered azithromycin (Zithromax) to treat the infection and acetaminophen (Tylenol) as needed for fever. The nurse will contact the provider to:
  a. ask whether a different antibiotic can be used.
  b. ask that the prednisone be discontinued until the infection clears.
  c. suggest increasing the dose of cyclosporine.
  d. suggest using ibuprofen instead of acetaminophen.

[matt95]

Answer to Question 1

ANS: B
The patient is showing signs of acute organ rejection, which include pain at the graft site, fever, and elevated BUN and creatinine; therefore, intravenous methylprednisolone is indicated. Because the patient is having pain on the right side, along with fever and elevated renal function test results, there is no reason to suspect that the left kidney is failing or that an infection is present. The cyclosporine level is within normal limits.

Answer to Question 2

ANS: A
Macrolide antibiotics, such as azithromycin, can inhibit cyclosporine metabolism, leading to increased levels of the drug. This patient needs either a reduced dose of cyclosporine or a different antibiotic. There is no indication for discontinuing the prednisone during treatment. The dose of cyclosporine would need to be reduced, because azithromycin leads to increased drug levels. There is no contraindication to using acetaminophen.

[oliviahorn72]

TYSM

[Dominic]

Excellent