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A nurse is preparing to administer cyclosporine (Sandimmune), a calcineurin inhibitor, to a client who had a kidney transplant. Which of the following actions should the nurse take? (Select all that apply.)¹
Shake the oral solution vigorously before administration. This is to ensure that the drug is well mixed and evenly distributed in the solution¹². Cyclosporine is a lipophilic drug that forms a microemulsion in the oral solution, which enhances its absorption and bioavailability¹². Shaking the oral solution helps to maintain the stability and consistency of the microemulsion¹².
Dilute the oral solution in a glass container with milk or orange juice. This is to improve the taste and palatability of the drug, which may otherwise be bitter or unpleasant¹². Cyclosporine can be diluted with milk, chocolate milk, or orange juice, but not with grapefruit juice, which can increase its blood levels and toxicity¹². The diluted solution should be consumed immediately or refrigerated and used within 24 hours¹². A glass container should be used instead of a plastic one, which may absorb some of the drug and reduce its dose¹².
Administer the medication at the same time every day. This is to maintain a consistent blood level of the drug and avoid fluctuations that may affect its efficacy and safety¹². Cyclosporine has a narrow therapeutic window and requires careful monitoring and dosing adjustment to prevent organ rejection or toxicity¹². Administering the medication at regular intervals helps to achieve optimal blood concentrations and avoid peaks and troughs that may increase the risk of adverse effects or suboptimal response¹².
Monitor blood pressure and report hypertension to the provider. This is to detect and manage one of the most common and serious side effects of cyclosporine, which is hypertension¹². Cyclosporine can cause vasoconstriction and sodium retention, which can increase blood pressure and lead to cardiovascular complications such as stroke, heart failure, or kidney damage¹². The nurse should measure blood pressure regularly and report any elevation or signs of hypertensive crisis to the provider¹². The provider may prescribe antihypertensive drugs or adjust the dose of cyclosporine to control blood pressure¹².
Obtain serum drug levels periodically to verify therapeutic range. This is to ensure that the dose of cyclosporine is adequate and appropriate for the individual patient's needs and response¹². Cyclosporine has a high inter- and intra-patient variability in pharmacokinetics, which means that its absorption, distribution, metabolism, and excretion can differ significantly among different patients or even within the same patient over time¹². Factors such as age, weight, gender, genetics, diet, drug interactions, organ function, and disease state can affect cyclosporine blood levels and require dose adjustment¹². The nurse should obtain serum drug levels at specified times (usually 12 hours after the last dose) and report them to the provider, who may modify the dose based on the results¹².
A. Shake the oral solution vigorously before administration. This is to ensure that the drug is well mixed and evenly distributed in the solution¹². Cyclosporine is a lipophilic drug that forms a microemulsion in the oral solution, which enhances its absorption and bioavailability¹². Shaking the oral solution helps to maintain the stability and consistency of the microemulsion¹².
B. Dilute the oral solution in a glass container with milk or orange juice. This is to improve the taste and palatability of the drug, which may otherwise be bitter or unpleasant¹². Cyclosporine can be diluted with milk, chocolate milk, or orange juice, but not with grapefruit juice, which can increase its blood levels and toxicity¹². The diluted solution should be consumed immediately or refrigerated and used within 24 hours¹². A glass container should be used instead of a plastic one, which may absorb some of the drug and reduce its dose¹².
C. Administer the medication at the same time every day. This is to maintain a consistent blood level of the drug and avoid fluctuations that may affect its efficacy and safety¹². Cyclosporine has a narrow therapeutic window and requires careful monitoring and dosing adjustment to prevent organ rejection or toxicity¹². Administering the medication at regular intervals helps to achieve optimal blood concentrations and avoid peaks and troughs that may increase the risk of adverse effects or suboptimal response¹².
D. Monitor blood pressure and report hypertension to the provider. This is to detect and manage one of the most common and serious side effects of cyclosporine, which is hypertension¹². Cyclosporine can cause vasoconstriction and sodium retention, which can increase blood pressure and lead to cardiovascular complications such as stroke, heart failure, or kidney damage¹². The nurse should measure blood pressure regularly and report any elevation or signs of hypertensive crisis to the provider¹². The provider may prescribe antihypertensive drugs or adjust the dose of cyclosporine to control blood pressure¹².
E. Obtain serum drug levels periodically to verify therapeutic range. This is to ensure that the dose of cyclosporine is adequate and appropriate for the individual patient's needs and response¹². Cyclosporine has a high inter- and intra-patient variability in pharmacokinetics, which means that its absorption, distribution, metabolism, and excretion can differ significantly among different patients or even within the same patient over time¹². Factors such as age, weight, gender, genetics, diet, drug interactions, organ function, and disease state can affect cyclosporine blood levels and require dose adjustment¹². The nurse should obtain serum drug levels at specified times (usually 12 hours after the last dose) and report them to the provider, who may modify the dose based on the results¹².