A nurse is reinforcing teaching about fluticasone topical lotion with the parent of a 9-month-old infant who has atopic dermatitis on the wrist. Which of the following instructions should the nurse include?

A. Hypertension. Filgrastim, a granulocyte colony-stimulating factor (G-CSF), primarily stimulates white blood cell production. While minor blood pressure fluctuations can occur, hypertension is not a common or significant adverse effect. Monitoring blood pressure is important, but sustained hypertension is not expected.

B. Fluid retention. Filgrastim does not typically cause significant fluid retention. Medications such as corticosteroids or certain chemotherapeutic agents are more likely to lead to fluid overload. While rare cases of capillary leak syndrome have been reported, general fluid retention is not a primary concern.

C. Bone pain. Bone pain is the most common adverse effect of filgrastim. The medication stimulates bone marrow activity, leading to increased production of neutrophils, which can cause discomfort in bones, particularly in long bones such as the femur and sternum. Pain is usually mild to moderate and can be managed with acetaminophen or NSAIDs if appropriate.

D. Hypokalemia. Filgrastim does not have a direct effect on potassium levels. Electrolyte imbalances are more commonly associated with diuretics, corticosteroids, or chemotherapy. Clients on filgrastim typically do not require routine potassium monitoring unless other risk factors are present.

A. Drowsiness. Alendronate, a bisphosphonate used to treat osteoporosis, does not cause drowsiness. It primarily affects bone metabolism rather than the central nervous system. If a client experiences drowsiness, it is likely due to another cause rather than the medication itself.

B. Dyskinesia. Dyskinesia refers to involuntary movements often associated with neurological disorders or medications affecting dopamine, such as antipsychotics or Parkinson’s medications. Alendronate does not affect dopamine or the nervous system, making dyskinesia an unlikely adverse effect.

C. Musculoskeletal pain. A known side effect of alendronate is musculoskeletal pain, including bone, joint, and muscle discomfort. This occurs due to the medication’s effects on bone remodeling and turnover. While mild pain may resolve on its own, persistent or severe pain should be reported to the provider as it may require dose adjustment or discontinuation.

D. Weight gain. Alendronate does not cause weight gain. It primarily acts on bone tissue to inhibit osteoclast-mediated bone resorption, preventing further bone loss. Clients experiencing unexplained weight gain should be evaluated for other potential causes, such as metabolic conditions or lifestyle factors.