Mrs. Oza, age 69, has hypertension and has one functioning kidney. She loves chocolates and enjoys an alcoholic beverage twice a week. Her hobby is gardening and she goes for long walks despite having arthritis. Which one of the following pieces of information is likely to have the greatest significance if she is prescribed vancomycin?
She only has one functioning kidney
She remains outdoors for long periods of time
She has hypertension
She enjoys an alcoholic beverage twice a week
The Correct Answer is A
A. She only has one functioning kidney:
This choice is the most significant consideration when prescribing vancomycin to Mrs. Oza. Vancomycin is primarily eliminated from the body through the kidneys. Individuals with reduced kidney function, such as Mrs. Oza with only one functioning kidney, have a higher risk of vancomycin-associated nephrotoxicity (kidney damage). Therefore, her renal status is crucial information for determining the appropriate dosage of vancomycin and monitoring for any signs of kidney impairment during treatment.
B. She remains outdoors for long periods of time:
While spending time outdoors for long periods may have implications for Mrs. Oza's overall health, it is not directly relevant to the prescription of vancomycin. This information may be important for considering sun exposure, hydration, and other factors related to her arthritis and general well-being, but it does not specifically impact the pharmacokinetics or pharmacodynamics of vancomycin.
C. She has hypertension:
Mrs. Oza's hypertension is a relevant medical condition to consider in her overall health management. However, hypertension alone does not directly affect the prescription of vancomycin. Hypertension may influence the choice of antihypertensive medications or other aspects of her medical care, but it does not have a direct impact on the renal clearance or potential nephrotoxicity of vancomycin.
D. She enjoys an alcoholic beverage twice a week:
While alcohol consumption can interact with certain medications and impact overall health, it is not the most significant consideration when prescribing vancomycin to Mrs. Oza. Moderate alcohol consumption is unlikely to directly affect the pharmacokinetics or pharmacodynamics of vancomycin. However, excessive alcohol intake may contribute to liver dysfunction, which could indirectly influence drug metabolism. Nonetheless, in Mrs. Oza's case, her reduced renal function is a more critical factor to consider when prescribing vancomycin.
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Related Questions
Correct Answer is B
Explanation
A. “It’s fine for me to become pregnant while taking this medication.”
This statement is incorrect. Tetracycline is known to have teratogenic effects, meaning it can harm the developing fetus if taken during pregnancy. Women of childbearing age should use effective contraception while taking tetracycline and avoid becoming pregnant during treatment.
B. “I will need to postpone my vacation at the beach until I finish this medication."
This statement demonstrates an understanding of the discharge instructions. Tetracycline can increase the risk of sunburn and photosensitivity reactions. Therefore, it's advisable for the client to avoid prolonged sun exposure, particularly during peak sunlight hours, and to use sun protection measures such as wearing protective clothing, using sunscreen, and avoiding tanning beds or sunlamps. Postponing a vacation at the beach until after finishing the medication is a prudent precaution to minimize the risk of sun-related side effects.
C. “I am so glad to be leaving today because I have an appointment at the tanning salon."
This statement is incorrect. Tetracycline can increase the risk of sunburn and photosensitivity reactions. Visiting a tanning salon while taking tetracycline can further increase the risk of skin damage and should be avoided.
D. "I will stop taking this medication as soon as I feel better.”
This statement is incorrect. It's important for the client to complete the full course of tetracycline as prescribed by their healthcare provider, even if they start to feel better before finishing the medication. Stopping the medication prematurely can lead to incomplete treatment and potential recurrence of the infection.
Correct Answer is C
Explanation
A. "Expect your urine to turn pink or red while taking this medication."
This statement is incorrect. Vancomycin does not typically cause urine discoloration. However, red man syndrome, characterized by flushing of the skin, particularly on the face and upper body, can occur with rapid infusion of vancomycin. This is not related to urine color change.
B. "Discontinue the medication once your symptoms subside."
This statement is incorrect. It's crucial for the client to complete the full course of antibiotics as prescribed, even if symptoms improve before completing the treatment course. Discontinuing the medication prematurely can lead to the development of antibiotic resistance and recurrence of the infection.
C. "Notify your provider if you experience any changes in your hearing."
This statement is correct. Vancomycin can potentially cause ototoxicity, which may manifest as changes in hearing, including ringing in the ears (tinnitus) or hearing loss. Clients should be instructed to report any such symptoms to their healthcare provider promptly.
D. "Decrease your fluid intake to 1000ml per day."
This statement is incorrect. Adequate hydration is essential, especially when taking medications like vancomycin, to help prevent kidney damage and promote drug elimination. Restricting fluid intake is not advisable unless specifically instructed by the healthcare provider for a particular medical reason.
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