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: Grapefruit juice inhibits hepatic CYP3A4, increasing plasma levels of statins like simvastatin, which are metabolized by this enzyme. This can lead to toxicity, including myopathy or rhabdomyolysis. Patients on antilipemic therapy must avoid grapefruit juice to prevent excessive drug accumulation and adverse effects.

Choice B reason: Bran muffins, high in fiber, do not significantly interact with antilipemic drugs like statins. Fiber may reduce cholesterol absorption, complementing therapy, but it does not affect drug metabolism or efficacy, making it an irrelevant food interaction to discuss for antilipemic therapy.

Choice C reason: Licorice may cause hypokalemia or hypertension, affecting drugs like diuretics, but it has no major interaction with antilipemics like statins. Its effects on mineralocorticoid activity are unrelated to cholesterol-lowering drug metabolism, making it less relevant for antilipemic therapy education.

Choice D reason: Dairy products do not significantly interact with antilipemic drugs. They may affect absorption of bile acid sequestrants, but statins, the most common antilipemics, are unaffected. Grapefruit juice’s impact on statin metabolism is a more critical drug-food interaction to address with patients.

Choice A reason: Hair loss is not a common side effect of isoniazid, nor is it prevented by pyridoxine. Isoniazid primarily causes hepatotoxicity or neurotoxicity due to its metabolism and pyridoxine depletion. Hair loss may occur with other drugs, but pyridoxine supplementation is unrelated to this effect.

Choice B reason: Pyridoxine (vitamin B6) is given with isoniazid to prevent peripheral neuropathy. Isoniazid depletes pyridoxine by forming inactive complexes, impairing nerve function and causing numbness or tingling. Supplementation restores pyridoxine levels, protecting peripheral nerves while allowing isoniazid to effectively treat tuberculosis by inhibiting mycolic acid synthesis.

Choice C reason: Heart failure is not associated with isoniazid or prevented by pyridoxine. Isoniazid’s primary toxicities are hepatic and neurological. Pyridoxine supports nerve health, not cardiac function, and heart failure is more linked to drugs like anthracyclines, not antitubercular therapy.

Choice D reason: Renal failure is not a common side effect of isoniazid, nor is it prevented by pyridoxine. Isoniazid is metabolized by the liver, and its toxicities include hepatotoxicity and neuropathy. Pyridoxine addresses neurological side effects, not renal function, making this an incorrect choice.