Which of the following nursing diagnoses is appropriate for a patient receiving famotidine (Pepcid)?
A. Increased risk for infection due to immunosuppression.
B. Potential risk for bleeding related to thrombocytopenia.
C. Alteration in urinary elimination related to retention.
D. Alteration in tissue perfusion related to hypertension.
Correct Answer: B. Potential risk for bleeding related to thrombocytopenia.
A serious side effect of famotidine is thrombocytopenia, which is manifested by a decrease in platelet count and an increased risk of bleeding. The over-the-counter tablets should not be used if the patient has trouble and/or pain when swallowing food, vomiting with blood, or bloody or black stools.
Option A: Due to central nervous system (CNS) adverse effects, longer dosing intervals or reduced doses may be used instead to adjust for the resulting longer elimination half-life of famotidine. An increased risk of developing community-acquired pneumonia and acute gastroenteritis have been linked to the use of famotidine as well as other gastric acid inhibitors in the pediatric population.
Option C: As famotidine is excreted mainly by the kidney, the risk of toxic reactions may be greater in patients with impaired renal function. Dose adjustment in patients who have moderate to severe renal impairment is necessary. Per famotidine’s package insert, oral doses outside of FDA-approved doses of up to 640 mg per day have been given to adult patients with pathological hypersecretory states with no serious adverse outcomes.
Option D: Famotidine is substantially excreted by the kidney; thus, it may be useful for healthcare professionals to monitor renal function especially in elderly patients. A patient’s complete blood count (CBC), gastric pH, and occult blood in patients with gastrointestinal (GI) bleeding should be monitored.
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