A patient is taking dicloxacillin (Dynapen) 500 mg every 6 hours to treat a severe penicillinase-resistant infection. At a 1-week follow-up appointment, the patient reports nausea, vomiting, and epigastric discomfort. The primary care NP should:
a. change the medication to a cephalosporin.
b. decrease the dose to 250 mg every 6 hours.
c. reassure the patient that these are normal adverse effects of this drug.
d. order blood cultures, a white blood cell (WBC) count with differential, and liver function tests (LFTs).
D
When giving penicillinase-resistant penicillins, it is important to monitor therapy with blood cultures, WBC with differential cell counts, and LFTs before treatment and weekly during treatment. This patient may have typical gastrointestinal side effects, but the symptoms may also indicate hepatic damage. Changing the medication is not indicated, unless serious side effects are present. Decreasing the dose is not indicated.
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