Question

5. A 38 year old kidney transplant recipient is prescribed immunosuppressant therapy with IV cyclosporine (Sandimmune), prednisone, and ketoconazole. Answer all questions and include a detailed rationale for your answer. a. The client asks why she is prescribed ketoconazole in addition to cyclosporine. What should the nurse explain is the main reason these two drugs are administered concurrently? b. It is important for the nurse to teach the client about cyclosporine's possible effects on a developing fetus and that current contraceptive recommendations include use of which type of birth control? c. What teaching should the nurse provide relating to the adverse effect of increased risk of neoplasms from taking cyclosporine? d. The prescriber of cyclosporine (Sandimmune) has ordered a trough level after the fourth dose. Why after the fourth dose and when should the trough level be drawn? e. The client's cyclosporine orders are changed to oral cyclosporine (Genograf). The hospital pharmacy sends the Sandimmune formulation (100 mg/mL). What should the nurse do? f. The client has a history of osteoarthritis and a seizure disorder. What should be included in the plan of nursing care relating to immunosuppressant therapy that she is receiving and her medical history?

Answer 1

A. Inhibition of cyclosporine metabolism

Ketoconazole raises cyclosporine levels and can increase the risk of toxicity. However, some physicians administer ketoconazole [Nizoral] with cyclosporine [Sandimmune], because this greatly reduces the cost of cyclosporine treatment; the dosage of cyclosporine [Sandimmune] may be reduced by up to 88%. An improved glomerular filtration rate, decreased risk of lymphoma occurrence, and decreased risk of bacterial and viral infections are not effects of cyclosporine.

B. Cyclosporine causes pregnancy category c complications

BENEFITS OF MEDICATION COULD OUTWEIGH THE PROBABLE RISKS.

It causes increased pre- and postnatal mortality, reduced fetal weight, and skeletal retardation