A nurse is counseling a client who has undergone a kidney transplant and is taking cyclosporine as an immunosuppressant to prevent organ rejection. Which of the following statements by the nurse is appropriate?

The correct answer is

A. "You should avoid taking St. John's wort as an herb because it may reduce the effectiveness of cyclosporine."

Choice A reason: This statement is accurate and appropriate for counseling a client who has undergone a kidney transplant and is taking cyclosporine as an immunosuppressant to prevent organ rejection. The client should avoid taking St. John's wort as an herb because it may reduce the effectiveness of cyclosporine. St. John's wort is an herb that is used to treat depression, anxiety, and other mood disorders. However, St. John's wort can induce the enzyme cytochrome P450 3A4, which is involved in the metabolism of cyclosporine, and decrease its blood level. This may increase the risk of organ rejection or transplant failure in the client.

Choice B reason: This statement is incorrect and inappropriate for counseling a client who has undergone a kidney transplant and is taking cyclosporine as an immunosuppressant to prevent organ rejection. The client should not take St. John's wort as an herb because it may enhance the effectiveness of cyclosporine. As mentioned above, St. John's wort can reduce the effectiveness of cyclosporine by lowering its blood level. Taking St. John's wort with cyclosporine may result in subtherapeutic doses of cyclosporine and compromise the client's transplant outcome.

Choice C reason: This statement is incorrect and inappropriate for counseling a client who has undergone a kidney transplant and is taking cyclosporine as an immunosuppressant to prevent organ rejection. The client should not take cyclosporine with grapefruit juice to increase its absorption. Grapefruit juice can inhibit the enzyme cytochrome P450 3A4, which is involved in the metabolism of cyclosporine, and increase its blood level. This may increase the risk of side effects or toxicity of cyclosporine, such as kidney damage, high blood pressure, tremors, headache, or infection.

Choice D reason: This statement is incorrect and inappropriate for counseling a client who has undergone a kidney transplant and is taking cyclosporine as an immunosuppressant to prevent organ rejection. The client should not take cyclosporine with milk or yogurt to improve its digestion. Milk or yogurt may decrease the absorption of cyclosporine and reduce its effectiveness. Cyclosporine should be taken on an empty stomach, at least one hour before or two hours after a meal. If the client experiences stomach upset from cyclosporine, he should consult his health care provider for advice.

Choice A reason: This statement is correct and reflects one of the possible adverse effects or interactions that may occur with biologically based therapies such as herbs and supplements. Allergic reactions or hypersensitivity can occur when the body's immune system reacts to a foreign substance, such as a plant extract or a dietary supplement, and produces antibodies and other chemicals that cause symptoms such as itching, rash, hives, swelling, or anaphylaxis (a severe and potentially life-threatening reaction)¹². Some examples of herbs or supplements that may cause allergic reactions include echinacea, chamomile, garlic, ginkgo, and bee pollen¹².

Choice B reason: This statement is also correct and reflects another possible adverse effect or interaction that may occur with biologically based therapies such as herbs and supplements. Hepatic or renal toxicity or dysfunction can occur when the liver or the kidneys are damaged or impaired by a substance, such as a plant extract or a dietary supplement, that may be toxic or interfere with their normal function¹². Some examples of herbs or supplements that may cause hepatic or renal toxicity or dysfunction include kava, comfrey, chaparral, licorice, ephedra, and aristolochia¹².

Choice C reason: This statement is also correct and reflects another possible adverse effect or interaction that may occur with biologically based therapies such as herbs and supplements. Gastrointestinal distress or bleeding can occur when the stomach or the intestines are irritated or injured by a substance, such as a plant extract or a dietary supplement, that may cause inflammation, ulceration, perforation, or bleeding¹². Some examples of herbs or supplements that may cause gastrointestinal distress or bleeding include aloe vera, cascara sagrada, senna, ginger, ginseng, garlic, ginkgo, and feverfew¹².

Choice D reason: This statement is correct because it includes all of the above statements. Biologically based therapies such as herbs and supplements may cause various adverse effects or interactions depending on the type, dose, duration, quality, purity, and combination of these products¹². Therefore, choice D is the best answer for assessing the client for possible adverse effects or interactions that may occur with biologically based therapies.