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141 Cards in this Set
- Front
- Back
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What herbs have ADDITIVE effects with Thiazides?
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Dandelion
Stinging nettle Laxative herbs Elder |
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What nutrients interact with Thiazides?
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Mg, CoQ10 and Zinc levels are decreased by thiazides
B12 is ↓with hydrochlorothiazide supplementation is advised (long term) |
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Which nutrient is increased by thiazides?
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Calcium - ↓excretion can cause hypercalcemia
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Which nutrients do Loop diuretics interact with?
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Magnesium (↑ excretion)
Zinc (↑ excretion) B1 levels are also ↓ |
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Fibrates effect which nutrient and how?
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CoQ10 levels are ↓
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Which nutrients DECREASE the efficacy of Calcium channel blockers?
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Calcium and Vitamin D
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Which nutrients INCREASE efficacy of Calcium Channel blockers, leading to decreased dosage of drug?
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Magnesium and Quercetin
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Name 2 nutrients that interact with beta-blockers and how
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Vitamin E potentially ↓ drug effects and CoQ10 levels are ↓ with MOST heart medication
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ACE inhibitors interact with which nutrients?
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Zinc (levels ↓)
Potassium (levels ↑) Iron (↓ drug efficacy) |
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Digoxin has a narrow therapeutic range. Name 3 nutrients that increase its toxicity.
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Calcium, vitamin D and Low magnesium levels all increase toxicity of digoxin
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Name the 5 substances that shuld be AVOIDED with digoxin medication
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SJW, Oats, Dandelion, Celery and Quercetin should be avoided
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Give five dietary suggestions to lower blood pressure
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↑ intake of potassium foods
↑ intake of magnesium foods Decrease intake of sodium Reduce intake of caffeine Reduce intake of alcohol |
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List some lifestyle strategies to lower blood pressure
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Reduce weight
↑intake of plant/whole foods (fibrous foods) ↑consumption of antioxidants (berries, red, orange, yellow, purple foods, dark green veggies) Brazil nuts Reduce saturated fat intake |
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Name some potassium depleting herbs/nutrients
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Licorice, Aloe vera, Guarana,
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Why is SJW not recommended with digoxin?
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St John’s Wort has been shown to induce P-gp leading to reduced drug effects
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How do Statins work?
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HMG-CoA reductase is the rate-limiting enzyme in the biosynthesis of cholesterol which is inhibited by statins causing hepatocytes upregulate LDL receptors promoting clearance of LDL and VLDL from plasma.
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How do fibrates work?
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Mainly reduce TG and elevate HDL, but not as potently as statins
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Bile Acid Binding Resins mechanisim of action is....
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to impede reabsorption of bile leading to increaed bile syntheisis (thus clearing cholesterol, as this is how bile is formed, leading to upregulation of HDL receptors and subsequenttly increased cholesterol excetion
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What vitamin has a lipid lowering role and what are the modes of action?
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Nicotinic acid (15-35g)
Inhibition of fatty acid mobilisation from adipose tissue Inhibition of triglyceride synthesis ADRs; rash A further limitation is that nicotinic acid is only available in 250mg tablets |
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Which other nutrients have been shown to reduce cholesterol levels?
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Cr (unknown action), Psyllium (binding) - time/dose dependant
Red Yeast Rice (statins), Oats (Beta-glucans ↑ bile acid synthesis), Garlic (allyl-disulfide modestly ↓ HMG-CoA reductase), Fish oils (↓ TG, ↥ vasodilation, ↓ PGs, ↓ vascular smooth muscle proliferation) |
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List 5 nutrients that interact with statins
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Policosanol ↓ LDL & TC ↑ HDL (5-20mg)
Sitosterol compete with cholesterol Nicotinic acid ↓ LDL & TC & TG Fish oils ↑↑ (additive) CoQ10 ↓ by drug impair cardiac function Vitamin A ↟vitamin activity |
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What nutrients are decreased by Resins?
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Fat soluble vitamins, A, D, E, K also Fe & B9- separate dosage by 4 hrs
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What are some suggested diet/lifestyle therapies to reduce hyperlipidemia
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Eliminate saturated fats
↑ Fibrous foods, psyllium, red yeast rice, cr foods, oats ↑ exercise and other physical activity |
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What is the aim of anti-coagulatio/anti-platelet drugs?
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Anticoagulants are drugs that are given to prevent blood clotting or prevent existing clots from getting larger. They can keep harmful clots from forming in the heart, veins or arteries. Clots can block blood flow and cause a heart attack or stroke.
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How does warfarin work?
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It inhibits the synthesis of vitamin K
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What theoretically can foods drugs or herbs interact with that will cause changes in warfarin metabolism?
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CYP450 enzymes
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List 4 nutrients/herbs that cause a decrease in warfarin activity/efficay
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CoQ10 (↑ metabolism)
Vitamin K Green tea Psyllium (separate dose by 1 hr) |
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List 5 foods high in vitamin K (not recommended while takin g Warfarin)
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Asparagus
Cauliflower Lettuce Avocado Corn Meat Broccoli Eggs Milk Cabbage Fish Mustard greens Celery Kale Turnip |
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Which nutrients or food have additive effects with Warfarin?
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Carnitine (1g day) studies indicate acenocoumarol NOT warfarin
Chondroitin - ↑ bleeding Vitamin E - ↑ bleeding/bruising Fish Oils - ↑ bleeding with doses >12g/day Policosanol - high doses (conflicting studies) |
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What nutrients herbs should be AVOIDED with warfarin therapy?
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Garlic –Large doses (>4g/day) may increase INR
Ginger –Shown to inhibit platelet aggregation at high doses (>10g/day) Korean ginseng-Inhibits platelet aggregation SJW - increases metabolism of warfarin Guarana - may ↓ half life of warfarin Rosemary - anticoagulant activity St Marys Thistle - may ↛ (inhibit) CYP3A4 |
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Theoretically...which herbs can potentiate Warfarin activity?
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Celery,Fenugreek, horseradish - contains coumarins
Feverfew / Tumeric /Meadowsweet \Myrhh has been shown to have anticoagulant activity |
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List herbs/nutrients that can potentiate ASPRIN (name 5)
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Garlic / Ginger / Bilberry / Willowbark / Andrographis / Feverfew / Gingko / Gurana / Tumeric / Myrhh / Meadowsweet /
OBSERVE: Primrose oil / Fish oils (beneficial) / Grapeseed extract / Policosanol / SUPPLEMENT: Vit C |
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What is Saquinavir?
what does it do? What are some ADRs? |
Fortovase ® (Saquinavir) is a protease inhibitor that stops immature HIV cells from maturing.
SIDE EFFECTS: GIT effects, headache, weakness, parasthesias, taste changes, allergic reactions, DIABETES, HYPERGLYCAEMIA & KETOACIDOSIS - less common |
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Which NUTRIENTS are beneficial with Saquiniavir?
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Folic Acid (B9) or B12 are both at risk of depletion
There are also reduced carnatine levels which cause muscle damage |
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What id Nicotinic acid useful for wheen taking saquinivair?
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Reducing induced hyperlipidemia and reducing side effects
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What does glutamine supplementation help with in regards to HIV?
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Supplementation has been found to support endogenous glutathione levels & maintain lean muscle mass (combined with arginine & leucine)
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What are Macrolides? List some examples
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Antibiotics mainly used for respiratory infections.
E.G erythromycin Roxithromycin |
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What are some common side effects of macrolides? Eg erythromycine
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•Gastrointestinal (stomach pain, nausea, vomiting, diarrhoea, abdominal cramps).
Lethargy, dizziness, headaches. Rash / hypersensitivity reactions. Oral and / or vaginal thrush (especially with erythromycin). |
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What is the method of action of quinolones?
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Impedes topoisomerase II (DNA gyrase) which supecroils DNA (allowing for transcription, replication and repair of DNA)
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What is the main use of teracyclines?
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Skin irritations (acne - long term therapy) and respiratory infections.
It damages TEETH so is not indicated for kids |
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Tetracyclines act by....
E.G. Tetracycline (Tetrex) •Doxycycline (Vibramycin, Vibratabs) •Minocycline (Minomycin) |
Inhibiting protein synthesis (reversibly) blocking 30s subunit of ribosomes
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Which nutrients lower quinolone absorption?
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Caffeine, Ca, Fe, Mg, Zn, Chinese dandelion, quercetin
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Which nutrients lowed absorption of tetracyclines?
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B12, Ca, Zn, Fe, Mg (alos lowers nutrient absorption so dosages should be separated by 2 hrs
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Vitamin A is not advised to be taken concurrently with tetracyclines because....
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It can increase side effects
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Which antibiotic specifically lowers Mg absorption?
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Aminoglycasides (gentamycine) which inhibit protein synthesis 30S ribosomal subunit
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Which herbs are used for withdrawl from benzodiapines?
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Kava Kava
Valerian (↑ GABA) Passionflower (opiate withdrawl) Lavendar (anticonvulsant) |
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Which herbs nutrients have ADDITIVE effects with benzos?
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Withania (therotically)
Chamomile (beneficial) Hops (with withania is useful in sleep) Glutamine and B6 |
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Which nutrients are used with anxious patients and why?
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Glutamine (converts to GABA)
B6 (PLP) is its cofactor |
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What are some herbs that could be useful in depresion?
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Verbena (antispasmodic/antidepressant)
SJW - traditional use Lavendar Schizandra Vervain |
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What nutrients can help with depression? Name 5
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5HTP (serotonin precursor)
Tryptophan Phenylalanine (converts to DA, NA & A) Tyrosine (converts to DA, NA & A) SAMe (increases serotonin activity) Vitamin B6 (cofactor) Folic acid (deficient in depressed patients) B12 (A-Ch synthesis) B3 (cerebral circulation) B5 (adrenal functions) Fish oils Zinc (deficient in depressed ppl) Glutamine (converts GABA) |
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Why are fish oils helpful in depression?
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They help conduct nerve impulses and are essential for brain activity
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What do phenylalanine and tyrosine have in common in regards to depression?
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Tyrosine and phenylalanine act predominately to increase dopamine, norepinephrine and epinephrine and are thus most similar to TCAs and MAOI
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What is the mechanism of action for TCAs?
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They are potent NA reuptake inhibitors, although some (imipramine, clomipramine amitriptyline) also inhibit the reuptake of serotonin.
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How are TCA's eliminated?
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Via hepatic metabolism (CYP450). As such they are likely to interact with other drugs metabolized this way.
Some have active METABOLITES which may accumulate |
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List 5 ADRs of TCA's
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•Sedation
•Impaired thinking, concentration and memory •Orthostatic hypotension •Weight gain •Dry mouth •Constipation •Urinary retention •Blurred vision •Tachycardia |
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What are some beneficial nutrients used in conjunction with TCAs?
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B vitamins: improved ability to think as well as less symptoms of depression
tryptophan and niacinamide: Improve efficacy of imipramine (bipolar) <4g CoQ10: depleted in depressed patients SAMe: decreased symptoms |
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What are some negative interactions with TCAs?
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Cruciferous vegetables may cause glucorindation
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Which herbs reduce side effects of TCAs?
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St marys thistle and andrographis
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How do SSRIs work?
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Selectively block 5HTP allowing for greater circulation of serotonin
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List 5 ADRs of SSRIs
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•Nausea
•Vomiting •Diarrhoea •Sexual dysfunction •Headache •Insomnia or sedation •May cause anorexia and weight loss (except paroxetine) |
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How is DHEA and B9 beneficial with SSRIs?
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DHEA:Shown to reduce the response of beta endorphin to fluoxetine
Folic Acid: depleted in depressed patients |
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What are some adverse drug reactions with MAOIs
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Korean ginseng causes headache, tremor and mania
SJW has an SSRI action thus is best AVOIDED Ephedra may interact with PHENELZINE ↑ BP Tyrosine should be avoided as should tyramine containing foods (salami, chocolate, cheese wine beer, bananas, pineapple nuts..) |
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How do MAOIs work?
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Bind reversibly and non-selectively to monoamine oxidase-A and monoamine oxidase-B
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Which herbs have a additive MAOI interactions?
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Ginkgo reduces side efects (sexual dysfuntion, sleep continuinity)
SJW (more effective than placebo) Albizia (theoretical) SAMe (↑ seroternergic symptoms) |
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Which herbs should be avoided with MAOIs
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L-tyrosine
5-hydroxytryptophan |
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Which nutrients negatively interact with bipolar medication lithium?
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Na (sodium) and Na containing foods increase drug levels
Psylium (binds) Slip Elm (↓ lithium bio availability) Diuretic herbs |
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Which nutrients may benefit lithium users?
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B9 (SAMe cofactor)
Tryptophan |
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What is Phenytoin(Dilantin) mode of action?
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Inhibits Na channels creating action potentials in neurons thereby reducing nerve firing nad has slow absorption
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Ho does Carbamazepine (Tegretol) work?
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Blocks sodium channels which reduces nerve firing
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What nutrients can be used to lower the side effects of Epileptic drugs?
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Carnitine ↓ side effects
L-Carnitine deficiency may potentiate valproic acid toxicity, supplemet can ↓ fatigue Folate ↓side effects |
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Which vitamins are effected by anti epileptics?
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B12 (depleted) by Carbamazepine but ↑ by Phenobarbitone & Phenytoin
Vitamin D is excessively broken down by Phenytoin & Valproate |
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Which herbs increase sedation with anti-epileptics?
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Withania and Kava-Kava
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Which herbs decrease/increase effects of anti-epileptics?
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Theoreticallly, slippery elm
Studies report Gingko ↓ and St Marys Thistle ↑ drug efficacy |
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Why is pyridoxine contraindicated in Parkinson's?
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B6 is a cofactor in the peripheral conversion of LEVODOPA which is responsible for side effects such as
nausea, vomiting, arrhytmias and postural hypotension |
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What do the minerals Ca, Mg and Zn do when administered with L-dopa
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form an insoluble complex, seperate doses by 2 hours
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How does iron effect anti-epileptic meds?
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Lowers absorption of drugs (carbidopa and L-dopa)
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Explain the mechanism which B6 interacts with L-dopa
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Concomitant use will reduce the amount of levodopa that is available to cross the blood-brain-barrier (where it is required) and may increase the risk of adverse effects (due to ↑peripheral conversion)
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How do L-dopa and Tyrosine interact?
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L-dopa competes with tyrosine for uptake leading to reduced efficacy of both drug/nutrient. AVOID
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What does SAMe do to L-dopa?
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Theoretical interaction may present as SAMe adds a methyl group to L-dopa. This could lead to reduced drug effectiveness
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How does carbidopa administration effect nutrient supplementation?
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In the presence of carbidopa, supplementation with pyridoxine (50-100mg/day) does not increase extracerebral conversion, thus drug efficacy is maintained
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How does selegiline work?
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It inhibits MAO-B (dopamine metabolising enzyme) delaying breakdown of DA and DA from levodopa
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How do the anti-cholinergics Biperiden, benztropine work?
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They block the action ACh restoring balance btw dopaminergic and cholinergic activity. Used in early stages.
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What are some supportive nutritional therapies used in Parkinsons?
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A diet high in sulphur containing foods.
Antioxidants (C, E, carotenoids) Glutathione CoQ10 Green tea (infusion) Phosphatidylserine |
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What are some sulphur containing foods?
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(garlic, onion, eggs, Broccoli, cauliflower, cabbage, kale, kohlrabi and other cruciferous vegetables, Red Meat, Poultry, Fish, Fava beans, leeks, shallots, chives and other members of the Allium genus)
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Which vitamins should be avoided or used with caution in parkinsons?
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Vitamin B6 should be used with CAUTION
Iron and manganese supplements should be AVOIDED |
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How is pain perceived?
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Nociceptors convert stimulations that injure or threaten body’s tissues into impulses that generate sensation of pain via (PNS) to spinal cord which release substance P activating further neurons
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Which NTs reduce substance P?
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NA and Serotonin. Serotonin also stimulates opiod release further reducing pain sensation
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List the beneficial nutrient interactions of Morphine
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L-tyrosine (↑↑morphine-induced analgesia (by 154% in mice)
Kava (May enhance CNS depression OBSERVE) Passionflower (opiate withdrawal) |
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Which herbs or nutrients may not be appropriate with morphine?
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SJW - induce CYP450 enzymes ↑ metabolism
Valerian - may cause drowsiness |
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How does codine work?
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It binds to opiiod receptors in the brain and converts to morphine through the liver 15% of the amalagesic effect of morphine
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Due to side effects such as constipation which herbs nutrientes may be beneficial?
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Fibre, Aloes, cascara, rhubarb & senna
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Which herbs enhance sedation with codine?
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Kava, Valerian,
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How do Taninnis effect codine therapy?
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They may inhibit absorption thus should be separated by 2 hours
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Which herbs are indicate with paracetamol use and why?
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Schisandra
Andrographis Garlic St Mary’s Thistle Due to their ability to protect the liver |
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Which nutrientsare indicate with paracetamol use and why?
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Quercetin
Taurine and thioproline Oleanolic acid, OPCs (Grape seed) N-acetyl cysteine, methionine and SAMe May reduce liver damage from toxicity by indirectly stimulating glutathione production |
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List herbs used for protection with aspirin therapy
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Glutathione & phosphatidylcholine (inhibit ulcers)
Glutathione & capsaicin( protect gastric mucosa) Policosanol (>10mg/day) and vitamin E enhance effectiveness |
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Melatonin and testosterone are effected by asprin. How?
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Production is inhibited
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Which nutrients are depleted by aspirin?
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iron, potassium, glutathione, vitamins A & C, Zn (2hrs apart)
Ca and folate are also effected |
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Which herbs have ADDITIVE effects on Aspirin?
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Devil’s claw
Ginger (at high doses) Nettle Willowbark |
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Which natural therapies reduce gastric side effects of aspirin?
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Colostrum
Glutamine (may ↓ the incidence of increased intestinal permeability –demonstrated with indomethacin) Celery seed extract Chamomile |
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Which nutrients enhance anti-inflam effects of Aspirin?
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Chondroitin
Fish Oils Glucosamine (in OA) SAMe Vitamin E (high doses in RA) NB ↑ of ADRs (adjustment may be necessary) |
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What is Aldrenotae used for andhow does it work?
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Alendronate (Fosamax®) Inhibit the resorption of bone by osteoclasts, binding to hydroxyapetitie crystals and integrating into bone permanently increasing bone density. They reduce bone ersoion and fractures
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What are some side effects of Aldronate?
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Dyspepsia
Nausea Vomiting Oesophageal irritation Gastritis Abdominal pain Diarrhoea Sever erosive oesophagitus and ulceration has been reported with INCORRECT use |
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What does Aldrenotae interact with?
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Ca, Mg, Fe and zinc all affect drug absorption
Adequate minerals are neeeded for drug efficacy (mg, Ca) |
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What are some dietary reccomendations for Menopause
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Increase intake of calcium rich foods, vitamin D & ensure sun exposure
Increase consumption of green leafy vegetables Include soy foods in the diet Include foods rich in mucopolysaccharides Increase intake of lysine Reduce coffee, alcohol and smoking Avoid carbonated soft drinks Avoid excessive intake of dietary animal protein Increase exercise Avoid cigarette smoking Hypoglycemic diet |
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What are some dietary reccommnedations for PMS
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Follow a vegetarian or predominantly vegetarian diet -Shown to assist with excretion of excess oestrogens
Reduce intake of fat -Reduces oestrogens Eliminate sugar -Affects mood symptoms in PMS. High sugar intake impairs oestrogen metabolism Reduce exposure to environmental oestrogens Increase intake of soy foods Eliminate caffeine -Worsens symptoms of anxiety, depression, irritability, insomnia, breast tenderness Keep salt intake low -High salt intake (incl. processed foods) may lead to fluid retention. Increased potassium intake (e.g. fruit and veg) helps balance sodium Exercise |
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Which nutrients are effected with OCP use?
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Vitamin A (↑ A levels)
Folate (defeciecny) B vitamins (defeciency) |
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Which nutrients have interaction s with HRT? (oestrogen)
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Ca - ↑↑ effects in bone minerilazation
Chromium - ↓ IL-6 in concommitant use, ↓ Cr levels |
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What is Theophylline? How does it work?
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Theophylline is a methylxanthine(bronchodilator)
It is unknown EXACTLY how it works but it inhibits early and late asthmatic reactions, controls S M & has a weak anti-infl action as well as enhances muco-cilliary clearance and ↓ vascular permeability They dont reach the bronhci via inhalation |
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What are Theophylline side effects
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Nausea
epigastric pain intestinal bleeding irritability, nervousness tremor insominia |
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What are some safety concerns of Theophylline?
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It is particularlly risky in childen during viral illness. Levels are increased in Febrile illness, Liver disease, Congestive heart failure, Pregnancy and with cimetidine and macrolides
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List serious side effects of corticosteroids
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Skin thinning
Impaired wound healing, Immuno-suppression Growth retardation Skeletal muscle myopathy, Osteoporosis Obesity, Hypothalamic-pituitary-adrenal suppression |
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What are some natural ways to contorl asthmas allergic response?
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Albizia lebeck
Scutellaria baicalensis Breathing fully out and half breaths in Anti inflam herbs Ginkgo (anti-PAF) Andrographis Echinacea Licorice Bupleurum Inhibition of leukotriene biosynthesis Boswellia Anti asthma herbs Black Haw Immunosuppressive herbs |
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What is some nutritional support we can offer Asthmatics?
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Fish oils
Vitamin B6 Vitamin C Flavonoids- quercetin Antioxidants-Beta-carotene, A, C, E, zinc, selenium, copper Vitamin B12 Magnesium Grape seed extract |
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Theophylline interactions include....
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SJW which reduces drug effectiveness
Cayenne which increase drug absorption B6 which is significantly depleted and has beneficial effects Probiotics can reduce oral thrush Liquorice can ↑↑ corticosteroids |
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Isotenrtin shouldnt be used with vitamin A because....
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It will increase toxicity and ADRs
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How does Metfromin work?
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Increase insulin's sensitivity and inhibits hepatic glucogeneisis.
Acts as ANTI hyperglycemic (not hypoglycemic |
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What herbs/nutrients are useful with Metformin ?
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Andrographis, Gymena, Cr, Fenugreek, Cinnamon, Myrhh
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What are some anti-catarrhal foods?
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Bromelain - ↓ mucous quantity in bronchitis/pneumonia and staphyloccocus aureus infections
Chicken soup Fenugreek seeds - soften & dissolve mucous Mustard seeds & onion - stimulate mucous elimination Garlic - dissolves excess mucous |
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What are 2 nutrients that assist in cell membrane integrity especially in the lungs?
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Vitamin E - stability of membranes
800 -1 00 IU Vitamin A - structural & functional integrity 10 000 - 50 000 |
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How is N Acetyl Cystine helpful in respiratory infections?
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The sulflhydryl groups bind and break peptides in mucous glycoproteins (they are mucolytic)
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What is Acetylcholine
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ACh is an excitatory neurotransmitter in the PNS for autonomic responses, at parasympathetic junctions between nerves, organs and muscles.
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What does ACh aids with?
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Learning
Memory Cognitive processes Autonomic function Fine motor control |
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What are some dopaminergic functions
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Motor function, cognition (memory, attention, problem solving) and a role in pleasure and motivation (euphoric feelings, pain, increasing the desire to be motivated).
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What does depletion in dopamine resulti in?
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Rigidity, tremors, bradykinesia (Slow movement)
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How does dopamine act in the SNS?
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Involved in activating fight, flight, fright responses e.g. increased heart rate, increased adrenal hormone secretion.
It is also the precursor to adrenaline and noradrenaline |
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What do dercersaed GABA levels result in?
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Increased excitatory NTM to function by allowing allow more Na+ particles to enter the neuron thus generating the excitatory effect.
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WHat are the somatic symptoms of anxiety
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oTremor
Sweating palpitations chest pain Breathlessness Headache Dizziness Diarrhea Frequency of micturition Initial insomnia Poor concentration |
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Which nutrients are especially depleted in stress?
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B group vitamins, C and zinc which are cofactors in numerous pathways?
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How does shallow breathing effect metabolism?
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Aerobic metabolism (dependant on oxygen) is compromised and the anerobic pathway becomes most prevelant increaseing lactic acid and decreasing blood pH
This perpetuates the cycle causing more stress |
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What are some nutritional considerations for Anxiety disorders?
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Remove stimulating foods
Identify food allergies/sensitivities Maintain high quality protein intake Consume low GI foods Eat smaller more frequent meals |
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For anxiety you would Improve sleep patterns by...
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supplementing with Mg & Ca to control cellualr membrane signalling systems in the NM synapses
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Deep breathing exercises help anxiety by...
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increasing O2 to cells and removing excess build up of CO2 in the blood
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Name to other helpful strategies for anxiety
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Relaxation techniques – gentle exercise, meditation, yoga
Refer client to psychotherapy or counseling |
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An increase or decrease in GABA is helpful in treating anxiety?
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increase
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How does theanine help anxious patients?
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Reduces the physicaly symptoms of stress and increases alpha waves in the brain
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Which nutrients are helpful in reducing PMS related anxiety?
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M2 200mg (deficiency linked to mood disorders)
B6 50mg |
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Name 3nutrients useful in anxiety
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Try (300-4000mg)
Glutamine (500-3000mg) Theanine (50-200mcg) |
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What dosages of B5 & B6 are recommended for anxiety treatment>
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B5 - 20-500mg
B6 10-150mg both cofactors |
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What is the precursor to DA, A and NA and what is the recommended dosage in anxiety treatment?
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Tyrosine 400-6000mg or
Phenylalanaine 150-600mg |
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What in the 2nd messengar for NA serotonin and cholinergic receptors?
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Inositiol (750-13000mg)
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