Reproductive System Disorders Q 36

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When caring for a male client with acute renal failure (ARF), Nurse Fatrishia expects to adjust the dosage or dosing schedule of certain drugs. Which of the following drugs would not require such adjustment?

  

    A. Acetaminophen (Tylenol)

    B. Gentamicin sulfate (Garamycin)

    C. Cyclosporine (Sandimmune)

    D. Ticarcillin disodium (Ticar)

    

    

Correct Answer: A. acetaminophen (Tylenol)

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Because acetaminophen is metabolized in the liver, its dosage and dosing schedule need not be adjusted for a client with ARF. Acetaminophen use has been linked to liver failure and sometimes has led to liver transplant or death. The hepatotoxicity occurring with acetaminophen use typically correlates with high doses of acetaminophen that exceed the recommended maximum dose.

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Option B: In contrast, the dosages and schedules for gentamicin, which are metabolized and excreted by the kidney, should be adjusted. The gentamicin is prone to accumulate in the renal proximal tubular cells and can cause damage. Hence, mild proteinuria and reduction of the glomerular filtration rate are potential consequences of gentamicin use, achieving 14% of gentamicin users in a review. Once proximal tubular cells carry regeneration capacity, renal injury and its consequences often are reversible.

Option C: Because cyclosporine may cause nephrotoxicity, the nurse must monitor both the dosage and blood drug level in a client receiving this drug. Decreases glomerular filtration rate (GFR) due to an increased tone of the glomerular afferent arterioles. Serum creatinine concentration rises and decreases creatinine clearance. The undesirable effects correlate with the duration of treatment and dose.

Option D: Third-generation penicillins such as carbenicillin and ticarcillin are also able to penetrate gram-negative bacterial porin channels. Most penicillin derivatives are not metabolized much by the liver. They are rapidly excreted in the urine as they are water-soluble, and some of the drugs are excreted in bile. Penicillin has a relatively short half-life of about 2 hours.

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