A patient with elevated lipid levels has a new prescription for niacin. The nurse informs the patient that which adverse effects may occur with this medication?

Choice A reason: Protamine sulfate is the antidote for heparin overdose, neutralizing heparin’s anticoagulant effect by binding to it, forming an inactive complex. This reverses excessive anticoagulation, reducing bleeding risk in patients with prolonged aPTT (e.g., 90 seconds), making it the appropriate treatment for heparin-induced bleeding.

Choice B reason: Vitamin E has no role in reversing heparin-induced bleeding. It is an antioxidant with potential antiplatelet effects, which could worsen bleeding. Heparin’s action, enhancing antithrombin to inhibit thrombin and factor Xa, is specifically countered by protamine sulfate, not vitamin E.

Choice C reason: Vitamin K reverses warfarin, not heparin, by restoring vitamin K-dependent clotting factors. Heparin acts via antithrombin, independent of vitamin K, and its overdose causes bleeding correctable by protamine sulfate. Vitamin K is ineffective for heparin-related bleeding, making this incorrect.

Choice D reason: Potassium chloride treats hypokalemia, not heparin-induced bleeding. Heparin’s anticoagulant effect, prolonging aPTT, is unrelated to potassium levels. Administering potassium chloride would not address excessive anticoagulation or bleeding, making it irrelevant for managing heparin overdose complications.

Choice A reason: Drowsiness is not a systemic effect of inhaled albuterol, a beta-2 agonist. Albuterol stimulates beta-adrenergic receptors, increasing cyclic AMP, which can cause CNS stimulation, not sedation. Drowsiness is more associated with antihistamines or other CNS-depressant drugs, not bronchodilators like albuterol.

Choice B reason: Bradycardia is unlikely with albuterol, which activates beta-2 receptors and, to a lesser extent, beta-1 receptors in the heart, potentially causing tachycardia. Systemic absorption of inhaled albuterol can increase heart rate, not decrease it, as it stimulates sympathetic activity, making this incorrect.

Choice C reason: Heartburn is not a recognized systemic effect of inhaled albuterol. While gastrointestinal irritation may occur with oral beta-agonists, inhaled albuterol has minimal systemic absorption, targeting airway smooth muscle. Its side effects are primarily cardiovascular or neurological, not gastrointestinal, making this an incorrect choice.

Choice D reason: Palpitations are a possible systemic effect of inhaled albuterol due to its beta-adrenergic stimulation. Even with low systemic absorption, albuterol can stimulate cardiac beta-1 receptors, increasing heart rate and causing palpitations. This is a known side effect, particularly in sensitive patients or with overuse.