A nurse is educating a client who wants to use acupuncture as a CAM practice to manage his chronic pain. The nurse should inform the client that acupuncture involves which of the following actions?

The correct answer is

D. All of the above.

Choice A reason: This statement is correct and the nurse should inform the client that St. John's wort may interact with oral contraceptives. St. John's wort is an herbal supplement that has antidepressant and anti-inflammatory effects. However, it may also affect the metabolism and clearance of some drugs by inducing the activity of certain enzymes in the liver. One of these enzymes, called CYP3A4, is responsible for breaking down oral contraceptives, such as ethinyl estradiol and norethindrone. Taking St. John's wort with oral contraceptives may reduce their effectiveness and increase the risk of pregnancy or breakthrough bleeding. Therefore, the nurse should advise the client to use an alternative or additional method of birth control while taking St. John's wort.

Choice B reason: This statement is also correct and the nurse should inform the client that St. John's wort may interact with anticoagulants. Anticoagulants are drugs that prevent blood clots by inhibiting the activity of certain clotting factors in the blood. Some examples of anticoagulants are warfarin, heparin, and dabigatran. Taking St. John's wort with anticoagulants may decrease their effectiveness and increase the risk of thrombosis or embolism. This is because St. John's wort may induce the activity of CYP3A4 and CYP2C9, two enzymes that are involved in the metabolism and clearance of warfarin and dabigatran. Therefore, the nurse should advise the client to monitor his or her blood clotting tests, such as INR or PT, and to report any signs or symptoms of bleeding or clotting while taking St. John's wort.

Choice C reason: This statement is also correct and the nurse should inform the client that St. John's wort may interact with antiretrovirals. Antiretrovirals are drugs that inhibit the replication of human immunodeficiency virus (HIV) by targeting different stages of its life cycle. Some examples of antiretrovirals are protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitors. Taking St. John's wort with antiretrovirals may decrease their effectiveness and increase the risk of HIV resistance or progression to acquired immunodeficiency syndrome (AIDS). This is because St. John's wort may induce the activity of CYP3A4 and P-glycoprotein, two proteins that are involved in the absorption, distribution, metabolism, and excretion of many antiretrovirals. Therefore, the nurse should advise the client to avoid taking St. John's wort with antiretrovirals and to consult his or her health care provider before starting or stopping any herbal supplements.

Choice D reason: This statement is correct because it includes all of the above statements. St. John's wort may interact with many conventional drugs by affecting their pharmacokinetics or pharmacodynamics. Some of these interactions may have serious consequences for the client's health and well-being. Therefore, choice D is the best answer for informing the client that St. John's wort may interact with oral contraceptives, anticoagulants, and antiretrovirals.

The correct answer is

A. Aspirin, an antiplatelet agent for cardiovascular prevention.

Choice A reason: Aspirin, an antiplatelet agent for cardiovascular prevention, may interact with garlic and increase the risk of bleeding. This is because garlic has antiplatelet and anticoagulant properties that may enhance the effects of aspirin and other drugs that slow blood clotting.

Choice B reason: Simvastatin, a statin for hyperlipidemia, may not interact with garlic significantly. This is because garlic does not appear to affect the metabolism or absorption of simvastatin or other statins. However, some studies suggest that garlic may have additive lipid-lowering effects when combined with statins.

Choice C reason: Metoprolol, a beta blocker for hypertension, may not interact with garlic significantly. This is because garlic does not appear to affect the metabolism or absorption of metoprolol or other beta blockers. However, some studies suggest that garlic may have additive blood pressure-lowering effects when combined with beta-blockers.

Choice D reason: All of the above is not a correct answer because only aspirin may interact with garlic in a clinically relevant way. Simvastatin and metoprolol may not have significant interactions with garlic, although they may have additive effects on lipid levels and blood pressure, respectively.