A patient is being discharged on anticoagulant therapy. The nurse will include in the patient-education conversation that it is important to avoid herbal products that contain which substance?

Choice A reason: Increased appetite is not a common side effect of inhaled corticosteroids due to their minimal systemic absorption. Systemic corticosteroids, like prednisone, stimulate appetite by altering metabolism and increasing hunger signals, but inhaled forms like fluticasone primarily act locally in the lungs, limiting such systemic effects.

Choice B reason: Oral thrush (candidiasis) is a frequent side effect of inhaled corticosteroids. Residual drug in the oral cavity disrupts local microbial flora, promoting Candida albicans overgrowth. Rinsing the mouth after use reduces this risk by removing excess corticosteroid, preventing fungal infections while maintaining anti-inflammatory effects in the airways.

Choice C reason: Hypertension is not typically caused by inhaled corticosteroids, as their systemic absorption is low. Systemic corticosteroids can cause fluid retention and increased blood pressure via mineralocorticoid effects, but inhaled forms like budesonide have minimal impact on cardiovascular parameters, making this an unlikely side effect.

Choice D reason: Constipation is not associated with inhaled corticosteroids. Their action is localized to the respiratory tract, with negligible gastrointestinal effects due to low systemic bioavailability. Systemic corticosteroids may cause metabolic changes, but constipation is not a reported side effect, and inhaled forms do not affect bowel motility.

Choice A reason: Garlic can enhance warfarin’s anticoagulant effect by inhibiting platelet aggregation and potentially increasing INR, raising bleeding risk. Its sulfur compounds may also induce hepatic enzymes, affecting warfarin metabolism. Patients on warfarin should avoid high garlic intake to maintain stable anticoagulation and prevent hemorrhage.

Choice B reason: Acetaminophen has no significant interaction with garlic. Acetaminophen is metabolized by the liver, primarily via glucuronidation, and garlic’s effects on platelet function or enzymes do not notably affect its pharmacokinetics or analgesic efficacy, making this an unlikely interaction concern.

Choice C reason: Phenytoin, an anticonvulsant, is metabolized by hepatic CYP450 enzymes, but garlic’s weak enzyme induction does not significantly alter phenytoin levels. Garlic’s primary interaction is with anticoagulants like warfarin, not anticonvulsants, making this drug less relevant for garlic-related concerns.

Choice D reason: Digoxin has no major interaction with garlic. Digoxin’s pharmacokinetics are primarily renal, and garlic’s effects on platelets or minor enzyme induction do not significantly alter digoxin levels or cardiac effects. Warfarin’s bleeding risk is more impacted by garlic’s antiplatelet properties.