A patient who is diagnosed with genital herpes is using topical acyclovir, and the nurse is providing instructions about adverse effects. What topic will the nurse include?

Choice A reason: Holding albuterol treatment for 24 hours is inappropriate, as jitteriness is a common side effect of beta-2 agonists due to sympathetic stimulation. Albuterol’s benefits in relieving bronchospasm outweigh transient side effects. Discontinuing therapy could worsen asthma symptoms, and monitoring is preferred over stopping treatment.

Choice B reason: Jitteriness is an expected side effect of albuterol, a beta-2 agonist, due to its stimulation of beta-adrenergic receptors, increasing cyclic AMP and causing mild tremors or nervousness. Checking the pulse ensures no serious tachycardia, allowing the nurse to monitor and reassure the patient while continuing necessary therapy.

Choice C reason: Notifying the physician is unnecessary for jitteriness, a common and expected side effect of albuterol. It results from beta-2 receptor stimulation, not a severe adverse reaction. Monitoring vital signs, like pulse, is sufficient to assess the patient’s response without escalating to physician notification immediately.

Choice D reason: Skipping the next albuterol treatment is not warranted, as jitteriness is a transient, expected side effect due to sympathetic stimulation. Albuterol is critical for asthma management, and discontinuation could exacerbate symptoms. Monitoring and patient education about expected effects are more appropriate than altering the treatment schedule.

Choice A reason: Valerian, used for sleep disorders, has no significant interaction with anticoagulants like warfarin. It may cause sedation but does not affect hepatic CYP450 enzymes or vitamin K-dependent clotting factors, making it safe for patients on anticoagulant therapy, with no impact on bleeding risk or drug metabolism.

Choice B reason: St. John’s wort induces hepatic CYP450 enzymes, particularly CYP3A4, accelerating warfarin metabolism. This reduces warfarin’s anticoagulant effect, decreasing INR and increasing thrombosis risk. Patients must avoid it to maintain therapeutic anticoagulation, making this a critical herbal interaction to report.

Choice C reason: Saw palmetto, used for prostate health, has minimal interaction with anticoagulants. It does not significantly affect CYP450 enzymes or clotting factor synthesis. While it may have mild antiplatelet effects, it is not a primary concern for warfarin therapy compared to St. John’s wort’s enzyme induction.

Choice D reason: Soy has no significant interaction with anticoagulants like warfarin. It does not affect hepatic metabolism or vitamin K-dependent clotting factors. While dietary vitamin K can influence warfarin, soy’s impact is minimal, making it less critical to avoid compared to enzyme inducers like St. John’s wort.