A patient is receiving warfarin (Coumadin), which is 98% bound to plasma proteins. The antidepressant paroxetine (Paxil), which is 95% bound to plasma proteins, is added to the patient's daily medication. If the paroxetine displaces warfarin from its protein binding sites, which of the following will most likely to occur?

A. To prevent overuse of prescription medications: While some patients may use herbal therapies as an alternative to avoid overuse of prescription medications, this is not the primary reason for the widespread use of herbal therapies. People often turn to herbal remedies for their perceived natural benefits and to complement conventional treatments, rather than to prevent overuse.

B. Because herbal therapies are so much safer than manmade drugs: This is a common misconception. Herbal therapies are not necessarily safer than prescription drugs. They can have potent effects and interact with medications, potentially causing adverse reactions. The safety of herbal remedies varies widely depending on the specific herb and its use.

C. To increase feelings of wellness and promote holistic treatment: Many patients use herbal therapies as part of a holistic approach to health. They seek to improve overall wellness, balance, and harmony in their body, mind, and spirit. Herbal therapies are often integrated into a lifestyle that values natural and preventive health measures.

D. Because herbal therapies are much more regulated than prescription drugs: This statement is incorrect. Herbal therapies are generally less regulated than prescription drugs. In many countries, herbal supplements are not subject to the same rigorous testing and approval processes as prescription medications, leading to variability in quality and potency.

A. Clotting at the incision site. Enoxaparin (Lovenox) is an anticoagulant medication used to prevent blood clots, particularly deep vein thrombosis (DVT) and pulmonary embolism (PE), which are common complications following orthopedic surgeries like knee replacement. Monitoring for clotting at the incision site is essential to ensure that the medication is effectively preventing excessive clot formation while also ensuring that the patient does not experience excessive bleeding.

B. Increased pain. While increased pain could be a concern postoperatively, particularly after a surgical procedure like knee replacement, it is not a specific monitoring parameter for enoxaparin administration. Pain management is typically addressed separately, and increased pain may indicate issues such as inadequate analgesia, surgical complications, or other factors unrelated to enoxaparin therapy.

C. Gingival hyperplasia. Gingival hyperplasia refers to an overgrowth of gum tissue and is not directly associated with enoxaparin therapy. This side effect is more commonly associated with certain medications such as phenytoin and cyclosporine rather than anticoagulants like enoxaparin. Monitoring for gingival hyperplasia would not be relevant in this context.

D. Signs and symptoms of bruising and bleeding. This is the correct answer. Enoxaparin is an anticoagulant medication, which increases the risk of bleeding. Therefore, monitoring for signs and symptoms of bruising and bleeding is crucial to detect any potential complications such as hemorrhage or hematoma formation. This includes assessing for unusual bruising, bleeding from the gums, nosebleeds, hematuria, melena, or any other signs of internal or external bleeding. Prompt recognition and management of bleeding complications are essential to ensure patient safety during enoxaparin therapy, especially following orthopedic surgery.