The nurse is obtaining a health and medication history from a patient. The patient discloses daily use of St. John's wort in addition to prescription drugs. Which of the following effects would most concern the nurse?
a. It can accelerate the metabolism of some drugs.
b. It can enhance the effects of digoxin.
c. It can counteract the beneficial effects of central nervous system (CNS) depressants.
d. It increases the risk of bleeding.
ANS: A
St. John's wort has the potential to interact with many drugs through three different mechanisms. One mechanism, induction of P450, accelerates the metabolism of many drugs.
St. John's wort reduces the effects of digoxin, because P-glycoprotein transports drugs out of tubular cells of the kidney and into the urine. Therefore, levels of digoxin are greatly reduced.
St. John's wort does not counteract the beneficial effects of CNS depressants. It can actually intensify the effects of serotonin.
St. John's wort is not known to increase the risk of bleeding.
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