A patient has undergone liver transplantation. The provider orders cyclosporine (Sandimmune), prednisone, and sirolimus (Rapamune). What will the nurse do?
a. Question the order for sirolimus.
b. Request an order for a serum glucose level.
c. Request an order for a macrolide antibiotic.
d. Suggest changing the cyclosporine to tacrolimus.
ANS: A
Sirolimus is given to prevent rejection in renal transplantation; it has no proof of efficacy in patients with heart, lung, or liver transplants. A serum glucose level is not indicated; patients taking repaglinide for diabetes should be monitored closely while taking cyclosporine. Although antibiotic prophylaxis may be necessary, macrolide antibiotics increase the level of cyclosporine. Tacrolimus is more toxic than cyclosporine.
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