When to hold nephrotoxic IV antibiotics?

Nurse Kyles, BSN, RN · Oct 2, 2012

That is something that our pharmacists do at my hospital. They will adjust the dosing based on creatinine clearance. I am not sure what the actual lab value is, but I am sure they have a protocol of some sort that they follow. If I was questioning the appropriateness of the medication d/t abnormal labs and medical hx, I would call the pharmacist to find out. I guess if you need a definitive answer on an assignment, this will not really be very helpful. I think in real life it is just important to know that kidney function is something to keep in mind, and know the resources available to you. As far as morphine and norvasc, I guess it would depend on the situation and what that pts BP and trends are.

KelRN215, BSN, RN · Oct 2, 2012

For drugs like Vanco, you tend to go more by the Vanco trough than the BUN/Creatinine. I've never worked anywhere that had a blanket policy of "hold Vanco for creatinine > _____." In most people, Vanco is not the sole cause of kidney problems. I've seen issues more in people with known kidney disease...and in those cases, the dose is adjusted based on trough values and kidney function. If someone with kidney problems is on vanco, there's a reason they're on it. I have only ever held Vanco for critically high trough levels (seen them at levels of 60 and above).

Norvasc is an antihypertensive and Morphine is an opiod analgesic. If someone is on Norvasc, they probably have hypertension. It shouldn't cause HYPOtension in an otherwise hypertensive patient, just bring their BP to an acceptable range. You don't not treat pain because of a potential side effect of the pain medication.

hhm22 · Oct 2, 2012

Thank you so much. This wasn't for a particular assignment, I was just wondering for when I'm in RN role (real life situations). Thanks again! :)

allnurses Guide · Oct 2, 2012

I'm a second semester nursing student. I just had a general question about Nephrotoxic IV antibiotics like Vancomycin. I know they can damage your kidneys and you need to check the BUN and Creatinine to make sure that isn't happening. But at what values would you hold the piggyback? All of my patients that i've given vanco to have had normal BUN/Creatinine and I &O values. So i was just wondering. Also on a side note, morphine (po) and norvasc both decrease bp. would it be ok to give those drugs together? Thank you so much in advance!

Most meds with a narrow therapeutic index are closely monitored by the prescriber. This may vary based on the patient, the infection being treated, PMH, and the current medication inventory but as a rule of thumb I generally will discontinue vanco (or any other nephro) if the Cr changes by more than 50% of baseline or goes over 2.0 without any other compelling reason. Normally I would try and push fluids after one lab draw was changed 50% and then dc if a second was the same.

Make sure to let the provider know if the baseline significantly changes or the value exceeds 2.0.