Which of the following antibiotics is associated with a risk of tendon rupture?

Choice A reason: Tetracyclines, like doxycycline, cause photosensitivity by forming phototoxic compounds under UV light, leading to severe sunburn or rashes. Avoiding sunlight and tanning beds prevents skin damage, as tetracycline’s protein synthesis inhibition does not mitigate its phototoxic effects, making this the correct instruction.

Choice B reason: Taking tetracycline only until feeling better is incorrect, as incomplete treatment promotes bacterial resistance. Tetracyclines require a full course to eradicate infection, preventing survival of resistant mutants, which could worsen infections like acne or respiratory infections, making this an unsafe instruction.

Choice C reason: Milk and cheese reduce, not increase, tetracycline levels by chelating the drug, forming insoluble complexes that decrease absorption. This interaction lowers efficacy, requiring tetracycline to be taken away from dairy, making this statement incorrect for patient education.

Choice D reason: Antacids reduce tetracycline absorption by chelating with divalent cations (e.g., calcium, magnesium), forming insoluble complexes. This decreases efficacy, not gastrointestinal distress. Taking tetracycline away from antacids ensures proper absorption, making this statement incorrect and potentially harmful.

Choice A reason: Immunosuppression is not significantly increased with inhaled fluticasone and hydrochlorothiazide. Fluticasone has minimal systemic absorption, limiting systemic immunosuppression. Hydrochlorothiazide, a diuretic, does not enhance immune suppression but affects electrolytes, making hypokalemia a more relevant concern in this combination.

Choice B reason: Increased clearance of fluticasone is unlikely with hydrochlorothiazide. Fluticasone is metabolized by hepatic CYP3A4, and hydrochlorothiazide does not significantly induce this enzyme. Drug interactions affecting clearance are minimal, and the primary concern is the additive effect on potassium levels, not fluticasone metabolism.

Choice C reason: Reduced clearance of fluticasone is not a known interaction with hydrochlorothiazide. Fluticasone’s low systemic absorption and hepatic metabolism are unaffected by hydrochlorothiazide, which primarily affects renal electrolyte excretion. The combination does not increase fluticasone’s systemic side effects but may exacerbate electrolyte imbalances.

Choice D reason: Hydrochlorothiazide, a thiazide diuretic, promotes potassium excretion, causing hypokalemia. Inhaled fluticasone has minimal systemic effects but may contribute to hypokalemia when combined with systemic corticosteroids. The nurse should monitor potassium levels, as the diuretic’s effect is the primary driver of this electrolyte imbalance in this scenario.