A patient with angina who is taking ranolazine Ranexa has ...

[SGallaher96]

A patient with angina who is taking ranolazine Ranexa has developed a respiratory infection and a dysrhythmia. The provider has ordered azithromycin Zithromax for the infection and amlodipine for the dysrhythmia.
 
  A nursing student caring for this patient tells the nurse that the patient's heart rate is 70 beats per minute, and the blood pressure is 128/80 mm Hg. The nurse asks the student to discuss the plan for this patient's care. Which action is correct? a. Observe the patient closely for signs of respiratory toxicity.
  b. Question the order for azithromycin Zithromax.
  c. Report the patient's increase in blood pressure to the provider.
  d. Request an order for a different calcium channel blocker.

Question 2

A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0 . What will the nurse do?
 
  a. Increase the aspirin dose to treat the pa-tient's headache.
  b. Notify the provider of possible renal tox-icity.
  c. Prepare to provide respiratory support, because the patient shows signs of over-dose.
  d. Withhold the aspirin until the patient's symptoms have subsided.

[Laurenleakan]

Answer to Question 1

B
Agents that inhibit CYP3A4 can increase levels of ranolazine and also the risk of torsades de pointes. Macrolide antibiotics, such as azithromycin, are CYP3A4 inhibitors. Respiratory toxicity is not an expected effect with this patient. The patient's blood pressure is not elevated enough to notify the provider. Amlodipine is the only CCB that should be used with ranolazine.

Answer to Question 2

D
This patient shows signs of salicylism, which occurs when ASA levels climb just slightly above the therapeutic level. Salicylism is characterized by tinnitus, sweating, headache, and dizziness. Tinnitus is an indication that the maximum acceptable dose has been achieved. Toxicity occurs at a salicylate level of 400 mcg/mL or higher. ASA should be withheld until the symptoms subside and then should be resumed at a lower dose. Increasing the dose would only increase the risk of toxicity. Signs of renal impairment include oliguria and weight gain, which are not present in this patient. This patient has salicylism, not salicylate toxicity, so respiratory support measures are not indicated.

[SGallaher96]

Thank you!

[Laurenleakan]

Always glad to help...