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80 Cards in this Set
- Front
- Back
What are the nutrients required at adequate levels for CYP450 enzymes in phase 1 metabolism?
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Copper
Magnesium Zinc Vitamin C |
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What is the most important endogenous antioxidant in neutralising free radical toxic metabolites in phase 1 metabolism?
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Glutathione
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What are the pathways involved in phase 2 metabolism?
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Glutathione conjugation
Amino acid conjugation Methylation Sulphation Acetylation Glucuronidation Sulphoxidation |
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High dose of vitamin C will do what in regards to interactions with excretion?
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Acidify the urine, which will increase the half life of acidic drugs and decrease the half life of basic drugs
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What is an antagonistic interaction?
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where the effects of drugs and herbs/nutrients counteract each other
eg sedative drug with stimulant herb |
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What is a physiochemical interaction?
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Where there is a chemical interaction that occurs between 2 compounds, resulting in reduced/increased absorption
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What is chelation?
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An interaction between a metal ion and another substance, leading to reduced activity or inactivation of mineral and/or drug
eg iron and tetracyclines |
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Name a positive disease interaction
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Glucosamine + OA
SJW + depression Kava + anxiety |
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Name a negative disease interaction
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Hypertension + licorice
Pregnancy + various substances |
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Name some postive interactions that reduce adverse effects of drugs
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Acidophilus + antibiotics
Gingko + SSRI's Cranberry + H2 antagonists St Marys + paracetemol |
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Name some positive interactions where we can minimise nutrient depletions caused by drug
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CoQ10 + statin drugs
B group vitamins + OCP |
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Name some positive interactions where herbs/ nutrients can strengthen clinical effects of drugs
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Echinacea + antibiotics
Gingko + dementia treatment Mg + antihypertensives |
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What drugs are most likely to be involved with interactions?
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Drugs with NTi
Anticoagulants Antihypertensives Antidiabetics |
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Who are the patients most likely at risk of interactions?
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Elderly
Children Patients with impaired liver or renal function |
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Name some nutrients/herbs that inhibit the P-gp system
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Grapefruit juice
Apple juice Orange juice Rosemary extract Genestein Diadezine Resveratrol Quercetin Green tea polyphenols Piperine St Mary's thistle |
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Name a herb/nutrient that induces the P-gp system
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SJW
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Name some nutrients/drugs that inhibits the cytochrome P450 enzymes
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Grapefruit juice
Fluoxetine Cimetidene |
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Name a herb that induces the CYP enzymes
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SJW (CYP3A4)
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What are the three most common ezymes in the cytochrome P450 system responsible for metabolism of most medicines
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CYP3A4, CYP2D6, CYP1A2
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Name the 4 types of diuretic drugs used in hypertension
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Thiazide & thiazide like
Loop Selective aldosterone blocker Potassium sparing |
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What is the most common side effect of diuretics?
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Hypokalaemia
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What is the mechanism of action for diuretics?
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Increase sodium excretion, therefore increasing fluid excretion, which then reduces plasma volume and cardiac output
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What is the most common drug for the treatment of hypertension?
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B-blockers
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Name 2 examples of a beta blocker
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Atenolol
Bisoprolol Propranolol Metoprolol |
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What is the mechanism of action for b-blockers?
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Inhibit the binding of catecholamines at the B-adrenoreceptor site, which reduces CO, peripheral resistance, venous return and renin inhibition
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What type of antihypertensive drug is contraindicated for use in congestive heart disease, asthma, COPD and diabetes?
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Beta blockers
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What are some adverse effects of beta blockers?
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Bradycardia
Heart failure Hypertriglyceridaemia Depression GI effects |
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What are some examples of ACE inhibitors?
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Captopril
Lisinopril Fosinopril |
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What is the mechanism of action of ACE inhibitors?
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Competitive inhibition of the antiogensin-converting enzyme, which then reduces the total peripheral resistance
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What are some adverse effects of ACE inhibitors?
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Cough
Rash Hypotension Hyperkalaemia |
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What are the 3 classes of calcium channel blockers?
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Dihydropyridines
Phenylalkylamines Benzothiazipines |
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What is the mechanism of action of calcium channel blockers?
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Block the entry of calcium ions into cells, which reduces the amount of calcium available for excitation-contraction proccess
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What are some side effects of calcium channel blockers?
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Tachycardia
Flushing Oedema GI disturbances Headache Hyperkalaemia Risk of heart block |
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What are some non drug measures that can reduce hypertension?
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Cessation of smoking
Reduction of obesity Reduction of alcohol consumption Increased exercise Reduced sodium intake Relaxation & stress management |
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What herb/nutrients have a benefical interaction with hypertensive drugs?
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Garlic
Oats Hawthorn Fish oil Olive leaf Evening primrose oil |
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What herb/nutrients have a a negative interaction with hypertensive drugs?
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Licorice
Guarana |
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What herb/drug interactions may exist with all diuretic drugs?
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Dandelion leaf - positive
Elder - positive Guarana - positive Stinging nettle - positive Licorice - negative Laxative herb - negative |
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What nutrient/drug interactions may exist with thiazide diuretics?
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Ca- may cause hypercalcaemia
Mg- increase excretion CoQ10-positive but thiazides increase excretion Zn-increase urinary exretion B12 - reduce risk of hyperhomocysteimaemia |
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What nutrient/drug interactions exist with loop diuretics?
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Mg-increase excretion
Zn -increase urinary excretion B1- reduce levels |
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What nutrients should be assessed for deficiency if a patient is taking diuretics?
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Mg
Zn Ca B1 B12 CoQ10 |
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What are the nutrient/drug interactions for b-blockers?
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CoQ10- reduce serum levels
Vit E-reduced drug effects |
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What herb/drug interactions exist for b-blockers?
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Myrrh-reduce drug bioavailability
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What nutrient/drug interactions exist for ACE inhibitors?
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Fe-reduced drug effect, separate doses
Zn-reduced levels, supplement K-increase serum levels |
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What nutrient/drug interactions exist for calcium channel blockers?
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Ca-reduced drug effect
Vit D - reduced drug effect Mg - additive effect Quercetin - increased drug effect |
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What herb/drug interactions exist with calcium channel blockers?
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SJW - reduces drug serum levels via CYP3A4
Guggul-reduced drug effect Peppermint oil- increased drug effect Korean ginseng - increased drug effect |
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What nutrients should you not supplement with in conjunction with calcium channel blockers/
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Calcium & Vit D - due to a reduction in drug effect
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What nutrient would be beneficial in supplementing with calcium channel blockers?
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Magnesium
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What would be some drug therapies in the treatment of congestive heart failure?
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Digoxin
Diuretics ACE inhibitors B-blockers Peripheral vasodilators Dopamine antagonists |
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Why is potassium indicated with digoxin?
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Low K levels can increase digoxin toxicity, as K competes with digoxin for binding at the Na+-K+ATPase pump
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What are some nutrient/drug interactions with digoxin?
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Mg - low levels increase risk of toxicity
Ca- excess calcium with digoxin may lead to sinus bradycardia, AV block |
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What are some herb/drug interactions with digoxin?
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Aloe vera - depletes K levels
Guarana - depletes K levels Licorice - reduces K levels Anthraquinone laxatives - reduces K levels Hawthorn - positive inotropic properties & potentiates effects |
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What are the drug therapies used in the treatment of hyperlipidaemia/hypercholesterolaemia?
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Statins (HMG-CoA reductase inhibitors)
Fibrates Bile acid binding resins Nicotinic acid Cholestrol absorption inhibitors |
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What are some examples of statins?
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Atorvastatin - Lipitor
Rosuvastatin - Crestor Simvastatin - Zocor |
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What is the mechanism of action for statins?
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They inhibit the enzyme action of HMG-CoA reductase
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What are some adverse events of statins?
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GIT disturbances
Headache Fatigue Rash |
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What is the mechanism of action of fibrates?
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They act at several sites by decreasing triglycerides and increasing HDL
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What are some adverse effects of fibrates?
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GI symptoms
LFT abnormalities Increased risk of gallstones MSK pain Blurred vision Raised blood glucose Mild anaemia Nephrotoxicity Sexual dysfunction |
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What is the mechanism of action of bile acid binding resins?
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They interfere with the reabsorption of bile acids (made from cholesterol), therefore the reduced bile levels stimulates an increase in bile production using cholesterol.
The increase in bile depletes cholestrol, this then stimulates the up-regulation of HDL receptors to draw more cholestrol from the bloodstream for bile maintenance |
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What are some adverse effects of resins (bile acid binding?
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Bloating
Indigestion Constipation Nausea Bleeding haemorrhoids |
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What is the mechanism of action for nicotinic acid drugs?
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It inhibits VLDL which results in a reduction of LDL.
Occurs by the inhibition of fatty acid metabolism and the inhibition of triglyceride productions |
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What are the adverse effects of nicotinic acid ?
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Hypotension
Nasal stuffiness Diarrhoea Headache Hyperuricaemia Hepatic dysfunction |
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What drug with a dose of 2g/day can cause liver toxicity?
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Nicotinic acid
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What nutrient/drug interactions exist for hyperlipadaemia drugs?
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Oats - positive, reduce total cholestrol levels
Garlic - positive Chromium - positive Psyllium - positive Red Yeast rice - positive Fish oil - positive Nicotinic acid - positive |
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What herb/drug interactions exist with hyperlipidaemia drugs?
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Myrrh - positive, lipid lowering
Fenugreek - positive |
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What nutrient/drug interactions exist for statins?
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Sitosterol - positive
Policosanol - positive CoQ10 - positive Vit A - negative |
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What herb/drug interactions exist with statins?
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SJW - negative due to induction of CYP3A4
St Marys thistle - positive Peppermint oil - positive |
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What nutrient/drug interactions exist with fibrate
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CoQ10- positive
Vit A,E,K,D, Fe & folate - reduce absorption - separate dose by 4 hours |
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What are some examples of anti-coagulant/anti-platelet drugs?
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Warfarin
Aspirin Heparin Pehindione |
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What is the mechanism of action for warfarin?
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Inhibits the synthesis of Vit K dependent coagulation factors
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What are some mild adverse effects associated with warfarin?
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Easy bruising
Poor appetite Nausea Vomiting Abdominal cramps Patch hair loss Mild skin rash Hives |
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What are some more serious advserse effects associated with warfarin?
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Adnormal bleeding
Abnormally heavy/persistent periods Blood in stools Nosebleeds Allergic reaction |
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What cytochrome P450 enzymes is warfarin metablised by?
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CYP2C9
CYP3A4 CYP1A2 |
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What is the most significant nutrient interaction with warfarin?
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Vitamin K - patients should avoid any products that contain Vit K
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What are some foods with a high vitamin K level?
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Asparagus
Avocado Brocolli Cabbabe Celery Cauliflower Corn Eggs Fish Kale Lettuce Meat Milk Mustard greens Turnip |
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What are some nutrient/drug interactions for warfarin?
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CoQ10- decreases drug effects
Carnitine- may cause excess bleeding/bruising Chondroitin- increased risk of bleeding/bruising Vit E - increased risk of bleeding/bruising Evening primrose oil - negative Fish oil - negative Psyllium - reduce absorption |
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What herb/drug interactions exists with warfarin?
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Garlic - negative, may increase bleeding
Ginger- negative, inhibits platelet aggregation Korean ginseng - negative, inhibits platelet aggregation SJW- negative, increases metabolism of warfarin Andrographis, cranberry, devil's claw, dong quai, ginko, guarana, licorice, rosemary, St marys thistle |
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What are the actions of anti-platelet drugs like aspirin/
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Inhibition of platelet aggregation
Analgesic Anti inflammatory Antipyretic |
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What are some common adverse effects of aspirin?
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GIT distress
Nausea Vomiting Erosion of gastric mucosa Ulceration Blood loss |
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What are the herb/drug interactions for anti-platelet drugs?
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Garlic - negative, increase bleeding time
Ginger- negative, inhibits platelet aggregation Willowbark - positive, enhance antiinflammatory & antiplatelet effects |
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What nutrient/drug interactions exist for anti-platelet drugs?
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Fish oil - negative, possible increased bleeding/bruising
Vit C - aspirin decreases levels, supplement |