A nurse is providing discharge education to a patient with a new prescription for Baclofen. Which of the following instructions should the nurse include?

A. Respiratory arrest and coma: These are late, life-threatening manifestations of local anesthetic systemic toxicity (LAST) that occur after CNS and cardiovascular collapse. Recognizing early signs is critical to preventing progression to this severe stage.
B. Ventricular arrhythmias and cardiac arrest: These are also late signs of LAST, resulting from the anesthetic’s depressant effects on cardiac conduction. By the time these occur, toxicity is advanced and may require immediate resuscitation measures.
C. Hypotension and tachycardia: Although cardiovascular symptoms may eventually develop, they are typically preceded by neurological signs. Early identification and management of CNS symptoms can often prevent progression to cardiovascular compromise.
D. Tinnitus, metallic taste, and perioral numbness: These are classic early signs of LAST and indicate CNS involvement. They often occur within minutes of administration and should prompt immediate intervention to stop drug absorption and initiate supportive care.

A. Hepatic metabolism will fully compensate for the decreased renal excretion: This is inaccurate. While the liver may play a role in metabolizing some drugs, it cannot fully compensate for reduced renal clearance of medications that are primarily excreted by the kidneys.
B. Dose adjustment may be necessary to prevent drug accumulation: In patients with kidney failure, reduced renal clearance slows the elimination of renally-excreted drugs. Without dose adjustment, drug levels can build up, increasing the risk of toxicity. Dosing must be tailored to the patient’s renal function, often guided by creatinine clearance or GFR.
C. The medication's half-life will likely be shorter due to decreased renal function: The opposite is true. Impaired renal function slows drug excretion, prolonging the drug’s half-life, which means the drug stays in the system longer and can accumulate to toxic levels if not adjusted.
D. The risk of drug toxicity is decreased due to impaired excretion: Impaired excretion increases, not decreases, the risk of toxicity. Renally-excreted drugs that are not properly cleared can accumulate and reach dangerous concentrations in the bloodstream.