Exam 1 Study Guide PDF

**EXAM 1 Study Guide** **Module 1 Topics //** Introduction to Pharmacology **Term** **Definition** --------------------- ------------------------------------------------------------------------------------------------- **Pharmacology** The study of drugs, their properties,...

**EXAM 1 Study Guide** **Module 1 Topics //** Introduction to Pharmacology **Term** **Definition** --------------------- ------------------------------------------------------------------------------------------------- **Pharmacology** The study of drugs, their properties, effects, and interactions with living organisms. **Pharmacotherapy** The treatment of disease through the use of drugs. **Drug** Any substance that alters physiological function. **Placebo** An inactive substance or treatment used as a control in an experiment or a therapeutic measure. **Prototype** A standard or typical example of a drug used to compare with other drugs in the same class. **Ideal Drug** A medication that meets specific therapeutic criteria for efficacy, safety, and convenience. **Characteristics of an Ideal Drug** 1\. Effectively treats, prevents, or cures client's condition 2\. Produces a rapid and predictable response at low doses 3\. Quickly eliminated by body after therapeutic effect produced 4\. Can be taken infrequently or for a short length of time 5\. Cheap and easily accessible 6\. Administered conveniently 7\. Produces no adverse effects 8\. Does not interact with other medications or food **Drug Naming** - Trade Name (a.k.a. Brand Name) - Created by drug company - Possibility of multiple names - Easier to remember / pronounce - Must be approved by FDA - First letter capitalized - Examples: \_\_ Viagra, Tylenol, Advil, Lipitor\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Generic Name - Only 1 generic name - First letter lower case - Examples: \_\_ sildenafil, acetaminophen, ibuprofen, atorvastatin\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Chemical Name - Long/complex - Examples: \_\_\_\_\_ 2-\[(2-oxo-3-(4-(trifluoromethyl)phenyl)thiazolidin-5-yl)methylthio\]-1H-benzimidazole-5-carboxylic acid\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Drug Classification** - Therapeutic Class - What condition is being treated by the drug - Examples: \_\_\_\_ Antihypertensives (for high blood pressure), Antidepressants (for depression)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Pharmacologic Class - How the drug acts - Examples: \_\_\_\_ ACE inhibitors, SSRIs (Selective Serotonin Reuptake Inhibitors)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Drug Development and Approval** 1. Laboratory Research 2. Pre-Clinical Research 3. Clinical Trials a. Phase 1 - Safety b. Phase 2 - Effectiveness c. Phase 3 - Patient Variability & Drug Interactions 4. Government Review 5. Post-Marketing Surveillance **Controlled Drug Schedules\ ** **Schedule** **Description** **Drug Examples** -------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- **Schedule** **Description** **Drug Examples** 1 All non-research use illegal under federal law; highest potential for abuse Heroin, LSD, MDMA 2 Accepted medical use, but high potential for abuse leading to severe psychological/physical dependence; severely restricted, no telephone prescriptions, no refills Oxycodone, Morphine 3 Accepted medical use, moderate to low dependence risk; prescription re-written after 6 months (or 5 refills) Buprenorphine, Anabolic steroids 4 Accepted medical use, low potential for abuse/dependence; prescription re-written after 6 months (or 5 refills) Diazepam, Lorazepam **Legal Classification of Drugs** - Prescription (Rx) - Available to only those authorized (i.e., prescribed) - May require training/skill to administer - May be addictive and therefore regulated - Treat complex conditions - Can become OTC - Over-the-Counter (OTC) - Available to general population - No assistance from healthcare provider - May be harmful of ineffective **Pharmacokinetics** -- how medications travel through the body. What the body does to the drug. *Bioavailability:* Amount of a drug that reaches the blood stream after administration - What dosage form has the highest bioavailability? \_\_\_\_IV\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *First Pass Effect (a.k.a. first pass metabolism):* When a drug is absorbed through the intestines, it will enter the mesenteric circulation which passes through the liver before entering general circulation. As it passes through the liver, some of the drug can be broken down or redirected to the bile, thereby reducing the amount that eventually makes it into circulation (i.e., reduces bioavailability). - If a drug can be given enterally or parenterally, which dosage form would require a lower dose to achieve the same effect? \_\_\_\_\_ Parenteral\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Why? \_\_\_\_ Because parenteral administration bypasses the first pass metabolism, allowing more of the drug to enter circulation\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Routes of Administration:] - **Enteral** -- oral (tablet, capsule, controlled release, sustained release), sublingual, buccal, nasogastric tube, rectal - Pros: convenient, cheap, self-use - Cons: subject to first pass effect, gastric irritation, slow effect, need to be conscious, can't be vomiting - **Parenteral** -- intravenous, intramuscular, subcutaneous, intradermal, epidural - Pros: rapid effect, avoid gastric irritation, can be used in unconscious - Cons: aseptic technique, painful, expensive, risk of nerve injury, requires training to administer - What is a depot injection? \_\_\_ **Depot Injection:** A method of delivering a drug for prolonged release over time. - **Topical** -- transdermal, eye (ocular), ear (otic), vaginal - Pros: high local concentration, minimal systemic effect - Cons: slow effect, localized, limited drug options, systemic effect with tissue destruction - How should transdermal patches be administered? - **Clean and Dry Area**: Choose a clean, dry area of skin that is free of hair, scabs, or irritation. Common sites include the upper arm, chest, or back. - **Wash Hands**: Always wash your hands before applying the patch. - **Prepare the Patch**: Remove the patch from its packaging, making sure not to touch the sticky side. - **Apply the Patch**: Press the patch firmly onto the skin and hold it in place for about 10 to 30 seconds to ensure good adhesion. - **Dispose of Old Patches**: If replacing a patch, remove the old patch first, fold it in half with the sticky sides together, and dispose of it properly, away from children and pets. - **Rotate Application Sites**: To prevent skin irritation, rotate the application site with each new patch and avoid applying patches to the same area within a certain period. - **Wash Hands Again**: After application, wash your hands again to remove any medication residue. - **Follow Manufacturer Instructions**: Always follow the specific instructions provided with the patch regarding duration of wear and any specific precautions. - **Inhalation** -- vaporization, gas inhalation, nebulization - Pros: rapid effect, large surface area for absorption - Cons: hard to regular dosage - **Factors that affect the choice of route:** - Drug properties - Site of desired location - Rate/extent of absorption - Effect of digestive juices - Effect of first pass metabolism - Onset of response - Accuracy of dose - Client condition **[1. Absorption]** - [**Definition:** The process of a drug entering the bloodstream after administration.] - [**Regulation:** Influenced by the route of administration, drug formulation, and physiological conditions.] - **[Factors Affecting Absorption:]** - [Route of administration (oral, intravenous, etc.)] - [Drug solubility (water-soluble vs. lipid-soluble)] - [pH levels (affects solubility and ionization)] - [Presence of food (can alter absorption rates)] - [**Bioavailability:** The fraction of the drug that reaches systemic circulation.] **[2. Distribution]** - [**Definition:** Transportation of the drug from the bloodstream to target tissues and organs.] - [**Regulation:** Affected by blood flow to tissues, lipid solubility, and plasma protein binding.] - **[Factors Affecting Distribution:]** - [Blood flow (organs with high blood flow receive drugs faster)] - [Binding to plasma proteins (like albumin)] - [Blood-brain barrier (limits access to the brain)] - [Fetal-placental barrier (affects drug distribution to the fetus)] **[3. Metabolism]** - [**Definition:** The chemical modification of drugs, mainly occurring in the liver.] - [**Regulation:** Primarily controlled by liver enzyme activity.] - **[Factors Affecting Metabolism:]** - [Age (may slow metabolism in neonates and older adults)] - [Liver function (impairment can reduce metabolism)] - [Drug interactions (other drugs can induce or inhibit metabolism)] **[4. Excretion/Elimination]** - [**Definition:** The removal of drugs and metabolites from the body, mainly via urine.] - [**Regulation:** Controlled by kidney function and drug properties.] - **[Factors Affecting Excretion:]** - [Kidney function (reduced function can slow elimination)] - [Urine pH (affects drug reabsorption)] - [Age (may affect kidney function)] **[5. First Pass Metabolism / First Pass Effect]** - [**Definition:** Initial metabolism of a drug in the liver before it reaches systemic circulation.] - [**Affected Dosage Forms:** Primarily oral formulations; intravenous and sublingual routes typically bypass this effect.] - **Pharmacodynamics --** how medications interact with their targets to produce effects. What the drug does to the body. **Term** **Definition** -------------------- ----------------------------------------------------------------------------------------------------- Agonist Drug that binds to a receptor to cause an effect Partial Agonist Drug that binds to a receptor and causes a partial effect Antagonist Drug that binds to a receptor, but does not cause an effect Loading Dose Higher amount of drug administered to quickly establish therapeutic levels Maintenance Dose Lower amount of drug administered to keep concentration within therapeutic range (i.e., usual dose) Peak Level Highest drug concentration of medication in an individual Trough Level Lowest drug concentration of medication in an individual Onset of Action Time it takes after administration to reach minimum therapeutic effect Peak Effect/Level Time it takes after administration to reach maximum therapeutic effect Duration of Action The time that the drug concentration remains within the therapeutic range after a dose. [Therapeutic Index/Window]: the dosage range in which the medication has a therapeutic effect without causing toxicity - Toxic Dose -- Minimum Therapeutic Dose - Which is safer, a drug with a low/narrow therapeutic index or a drug with a high/wide therapeutic index? \_\_ The dosage range without causing toxicity; a drug with a high therapeutic index is safer. [Half Life]: the amount of time it takes for the plasma drug concentration to reduce by half its original value - A woman takes a zolpidem (Ambien) at 8pm in order to go to bed. If she takes a 6mg dose, and the half-life of zolpidem is 2 hours, what is the concentration in her plasma at 4am? \_\_\_ **Example Calculation:** If she takes zolpidem (Ambien) at 8 PM (6 mg, half-life = 2 hours), by 4 AM (8 hours later), the concentration is: - 6 mg → 3 mg (10 PM) → 1.5 mg (12 AM) → 0.75 mg (2 AM) → 0.375 mg (4 AM) [Efficacy]: the maximum therapeutic response that can be achieved from a drug [Potency]: the amount of drug required to produce a specific effect [Tolerance]: requiring increasing amounts of a drug over time to elicit the same effect [Dependence]: the body begins to rely on a substance in order to function such that in the absence of the substance, the body begins to experience adverse (even life-threatening) effects (i.e., withdrawal) **Drug Effects\ ** [Side Effect]: predictable, expected, occur at therapeutic dose [Adverse Effect]: harmful, undesirable, may occur at or above therapeutic dose [Black Box Warning]: label FDA warning of the potential for severe adverse effects [Allergic Reaction]: immune-mediated response that occurs relatively rapidly after administration of a medication - Mild -- pruritis (itching), rash - Anaphylaxis -- severe reaction involving multiple body systems, treat with epinephrine - Respiratory: chest tightness, airway swelling, hoarseness, wheezing, difficulty breathing - Cardiovascular: chest pain, hypotension, rapid heart rate - Skin: urticaria (hives), flushing, pruritis, angioedema (swelling of tongue, face, throat) - CNS: anxiety, headache, confusion, drowsiness - GI: nausea/vomiting, diarrhea, cramping [Toxicities:] - Teratogenicity -- cause harm to the developing fetus and cause birth defects - Nephrotoxicity -- cause damage to the kidneys - Monitor BUN, creatinine - Drug causes: DAAMN (diuretics, ACE inhibitors/Angiotensin receptor blockers, aminoglycosides, metformin, NSAIDs) - Hepatotoxicity -- cause damage to the liver - Monitor liver function tests (LFTs) - Signs/Symptoms: jaundice - Neurotoxicity -- cause damage to the brain or nerves - Signs/Symptoms: headache, neuropathy, confusion - Dermatologic toxicity -- causes damage to the skin - Rash, pruritis, angioedema, photosensitivity, Stevens-Johnson Syndrome - Drug causes: antiepileptic drugs, sulfa drugs - Ototoxicity -- causes damage to the ear - Tinnitus, hearing loss - Drug causes: aminoglycosides (e.g., gentamycin) - Musculoskeletal toxicity -- causes damage to muscles or tendons - 'Statin' drugs cause rhabdomyolysis - Fluoroquinolone antibiotics (e.g., levofloxacin, ciprofloxacin) cause tendonitis/rupture - Bone marrow suppression -- causes damage to bone marrow, resulting in impaired production of red blood cells (RBCs), white blood cells (WBCs), and platelets - Low RBCs → anemia, fatigue, paleness, weakness, falls - Low WBCs → fever, infection, cough - Low platelets → bleeding, bruising, petechia - Drug causes: antineoplastic agents - Cardiotoxicity -- causes damage to the heart - Prolonged QT interval can lead to Torsade's de Pointes, an abnormal heart rhythm that can lead to sudden cardiac death - Drug causes: doxorubicin [Drug Interaction] -- a change in the way a drug acts in the body when taken alongside another drug, food, or other substance - Warfarin - Green leafy vegetables (high in vitamin K) - Statins - Grapefruit juice - Acetaminophen - Alcohol - MAOI antidepressants - Cheese, cured meats, ripe fruit Stevens-Johnson syndrome (SJS) is a severe and potentially life-threatening condition characterized by the painful shedding of the skin and mucous membranes. It is often triggered by a reaction to medications, infections, or other factors, leading to symptoms like fever, flu-like symptoms, and the development of blisters and sores on the skin and inside the mouth. SJS requires immediate medical attention, and treatment focuses on managing symptoms and preventing complications. Stevens-Johnson syndrome (SJS) can be triggered by a variety of medications, including: 1. **Antibiotics**: Sulfonamides, penicillins, and certain cephalosporins. 2. **Anticonvulsants**: Carbamazepine, lamotrigine, phenytoin, and valproate. 3. **Non-steroidal anti-inflammatory drugs (NSAIDs)**: Such as ibuprofen and diclofenac. 4. **Allopurinol**: Often used to treat gout. 5. **Certain drugs for HIV**: Such as nevirapine and efavirenz. 6. **Other medications**: Including some psychiatric medications like phenothiazines and certain chemotherapy agents. **Medication Error Reduction Strategies** - Up-to-date knowledge - Stick to what you know - Scan & confirm (barcode technology) - Consult interdisciplinary teams - Write it out - Do not store look-alikes together - Do not store sound-alikes together - Double check high-alert medications - Double check neonatal prescriptions **Geriatric Care** Physiological Changes in the Elderly - Weaker Hearts: reduced cardiac output  less circulation of medication - Blood Pressure: weaker vascular control  increased risk of orthostatic hypotension, bradycardia, tachycardia  falls, fractures, immobility - Reduced Kidney Function: less ability to ELIMINATE medications increased risk of renal injury - Reduced Liver Function: less ability to METABOLIZE medications  increased accumulation of drugs - Decreased Muscle: reduced body mass  reduced volume of DISTRIBUTION  increased accumulation of medicine due to less of an area for them to distribute - Thinner skin: Increased efficiency of topical medications [Polypharmacy] - ≥5 medications - Increased risk of drug interactions - Increased risk of adverse effects - Complicated drug regiments may reduce adherence [Beers Criteria] -- list of medications to use with caution in elderly clients due to an increased risk of experiencing adverse effects +-----------------------------------+-----------------------------------+ | **Drug** | **Adverse Response** | +===================================+===================================+ | Antihistamines (-[iramine or | Sedation, confusion, | | -amine)] | anticholinergic effects, falls | | | | | (e.g., | | | chlorphen[iramine], | | | diphenhydr[amine], | | | hydroxyzine, promethazine) | | +-----------------------------------+-----------------------------------+ | Antipsychotic drugs | Increased mortality (in patients | | ([-ridone)] | with dementia-related psychosis), | | | increased confusion, sedation | | (e.g., chlorpromazine, clozapine, | | | rispe[ridone]) | | +-----------------------------------+-----------------------------------+ | Benzodiazepines ([-azolam or | Confusion, depression, over | | -azepam)] | sedation, falls, risk with | | | driving | | (e.g., alpr[azolam], | | | lor[azepam], | | | ox[azepam]) | | +-----------------------------------+-----------------------------------+ | Digoxin | Reduced renal excretion (in | | | patients with pre-existing | | | chronic kidney disease), so | | | potential for digoxin toxicity | +-----------------------------------+-----------------------------------+ | Muscle relaxants | Sedation, anticholinergic effects | | | | | (e.g., cyclobenzaprine, | | | oxybutynin) | | +-----------------------------------+-----------------------------------+ | Nonsteroidal Anti-Inflammatory | Increased BP, nephrotoxicity, | | Drugs (NSAIDs) | fluid retention, aggravates Heart | | ([-profen]) | failure, GI bleeding | | | | | (e.g., aspirin, | | | ibu[profen], | | | naproxen) | | +-----------------------------------+-----------------------------------+ | Opioid analgesics \...IV | Sedation, confusion, falls, | | | reduced breathing, constipation | | (e.g., hydromorphone, morphine, | | | oxycodone) | | +-----------------------------------+-----------------------------------+ | Blood thinners | Increased GI bleeding, bleeding | | ([-parin] or | with falls | | -[farin] or | | | -[grel]) | Combined are considerable risk | | | | | (war[farin], | | | he[parin], | | | clopido[grel]) | | +-----------------------------------+-----------------------------------+ Strategies for Improving Medication Adherence - Ask the pharmacy to use non-safety caps - Caution: ask the client first because you should not do this if the household has small children - Use large font on pill bottles and instructions - Provide patients and/or their caregivers with adequate instructions - Pill reminders - Simplify the drug regimen **Complementary and Alternative Medicines\ ** [Dietary Supplement Health and Education Act (DSHEA)] -- exempts dietary supplements from FDA standards (treats them like food) [Herbal Medications] -- nutritional supplement sold without a prescription and lack FDA approval [Alternative Medicine] -- therapies that fall outside of conventional medicine (naturopathy, yoga, hypnosis, acupuncture) [Synergism] -- the total effect of 2 drugs combined is equal to the effect of both drugs when taken individually [Agonism] -- the total effect of 2 drugs combined is greater than the effect of both drugs when taken individually [Antagonism] -- the total effect of 2 drugs combined is lesser than the effect of both drugs when taken individually [GABA (gamma-amino butyric acid)] -- amino acid neurotransmitter in the CNS that inhibits nerve transmission and reduces neuronal excitation within the CNS **Herbal Supplements** +-------------+-------------+-------------+-------------+-------------+ | **Name** | **Uses | **Mechanism | **Effects** | **Specials/ | | | (Indication | of Action** | | Contraindic | | | s)** | | | ated** | +=============+=============+=============+=============+=============+ | **Aloe** | **Topical: | Anti-inflam | Oral -- | **Oral -- | | | burns, | matory, | fluid/elect | contraindic | | | soften | analgesic, | rolyte | ated | | | skin, | laxative | imbalance, | in renal & | | | psoriasis** | | cramping | cardiac | | | | | | disorders** | | | **Oral: | | | | | | constipatio | | | | | | n** | | | | +-------------+-------------+-------------+-------------+-------------+ | **Black | **Post-meno | Estrogen | Blood | **Contraind | | Cohosh** | pausal | substitute | thinning, | icated | | | symptoms, | | hepatotoxic | in | | | premenstrua | | ity, | pregnancy, | | | l | | GI upset, | breast | | | syndrome | | headache | cancer, | | | (PMS)** | | | renal | | | | | | disease, | | | | | | hepatic | | | | | | disease** | +-------------+-------------+-------------+-------------+-------------+ | **Cannabis* | **Cachexia, | Activates | Increased | **Contraind | | * | N/V, pain, | cannabinoid | appetite & | icated | | | spasticity* | receptors | weight | in asthma, | | | * | in the CNS | gain, | cardiac | | | | | increased | disease** | | | | | heart rate, | | | | | | sleepiness, | | | | | | dry mouth, | | | | | | dry eyes, | | | | | | paranoia, | | | | | | impaired | | | | | | memory and | | | | | | attention | | +-------------+-------------+-------------+-------------+-------------+ | **Echinacea | **Boost | Stimulates | Allergic | **Requires | | ** | immunity** | the immune | reaction, | functional | | | | system | Fever, GI | immune | | | | | upset | system: | | | | | | contraindic | | | | | | ated | | | | | | in | | | | | | immunocompr | | | | | | omised** | +-------------+-------------+-------------+-------------+-------------+ | **Feverfew* | **Migraines | Inhibits | Post-feverf | **Contraind | | * | , | platelet | ew | icated | | | arthritis** | aggregation | syndrome, | with blood | | | | | GI upset, | thinners, | | | | | bleeding | pregnancy, | | | | | | surgery** | +-------------+-------------+-------------+-------------+-------------+ | **Garlic** | **Atheroscl | Increases | Bleeding, | **Contraind | | | erosis, | HDL, | GI upset, | icated | | | heart | reduces | bad breath, | with blood | | | disease, | LDL, | body odor | thinners, | | | high | inhibits | | hemophilia, | | | cholesterol | platelet | | surgery** | | | , | aggregation | | | | | high blood | , | | | | | pressure** | induces | | | | | | vasodilatio | | | | | | n | | | +-------------+-------------+-------------+-------------+-------------+ | **Ginger** | **Nausea, | Relieves | Bleeding, | **Contraind | | | upset | vertigo and | Hypoglycemi | icated | | | stomach, | nausea, | a | with blood | | | morning | increases | when taken | thinners, | | | sickness, | gastric | with | pregnancy** | | | motion | motility, | diabetic | | | | sickness** | decreases | drugs | | | | | GI spasms, | | | | | | Inhibits | | | | | | platelet | | | | | | aggregation | | | +-------------+-------------+-------------+-------------+-------------+ | **Ginkgo | **Dementia, | Promotes | Possible | **Contraind | | biloba** | arterial | vasodilatio | seizures, | icated | | | occlusion, | n | headache, | with blood | | | thins | and | GI upset | thinners, | | | blood** | increased | | antihistami | | | | blood flow | | nes, | | | | to | | antidepress | | | | | | ants, | | | | brain, | | antipsychot | | | | decreases | | ics** | | | | platelet | | | | | | aggregation | | | +-------------+-------------+-------------+-------------+-------------+ | **Ginseng** | **Improve | Ginsenoside | Insomnia, | **Contraind | | | memory, | effects | hypoglycemi | icated | | | dementia, | | a, | in | | | erectile | | bleeding | pregnancy, | | | dysfunction | | | bleeding** | | | ** | | | | | | | | | **disorders | | | | | | , | | | | | | use with | | | | | | warfarin, | | | | | | autoimmune | | | | | | disease** | +-------------+-------------+-------------+-------------+-------------+ | **Glucosami | **Osteoarth | Stimulates | Bleeding, | **Contraind | | ne** | ritis, | cells to | heartburn, | icated | | | joint | make | nausea, | with blood | | | inflammatio | cartilage | shellfish | thinners** | | | n** | and | allergy | | | | | synovial | | | | | | fluid, | | | | | | suppresses | | | | | | inflammatio | | | | | | n | | | | | | of joints, | | | | | | decreases | | | | | | cartilage | | | | | | degradation | | | +-------------+-------------+-------------+-------------+-------------+ | **Kava** | **Insomnia, | Promotes | Dry, flakey | **Contraind | | | anxiety, | sleep, | skin, | icated | | | muscle | decreases | hepatotoxic | with other | | | cramping** | anxiety, | at large | CNS | | | | muscle | doses | depressants | | | | relaxant, | | , | | | | Possible | | including | | | | GABA effect | | alcohol** | +-------------+-------------+-------------+-------------+-------------+ | **Omega-3 | **Hypertrig | Inhibits | Arthralgia, | **Contraind | | Fatty | lyceridemia | thromboxane | GI upset, | icated | | Acids** | , | , | Belching, | in | | | reduce risk | prostagland | fish/seafoo | pregnancy** | | | of | ins, | d | | | | MI/Stroke, | leukotriene | allergy | | | | improve | s | | | | | Brain | | | | | | function, | | | | | | visual | | | | | | acuity** | | | | +-------------+-------------+-------------+-------------+-------------+ | **Saw | **Benign | Reduces | Blood | **Contraind | | Palmetto** | prostatic | prostate | thinning, | icated | | | hyperplasia | enlargement | GI Upset | with | | | (BPH)** | | | finasteride | | | | | | , | | | | | | blood | | | | | | thinners, | | | | | | pregnancy** | +-------------+-------------+-------------+-------------+-------------+ | **St. | **Mild | Increases | Serotonin | **Contraind | | John's | depression, | serotonin, | syndrome, | icated | | Wort** | mild pain** | analgesic | photosensit | with | | | | | ivity, | antidepress | | | | | dry mouth, | ants, | | | | | constipatio | amphetamine | | | | | n | , | | | | | | cocaine** | +-------------+-------------+-------------+-------------+-------------+ | **Valerian* | **Insomnia, | Increases | Drowsiness, | **Contraind | | * | anxiety** | GABA | Depressive | icated | | | | effects | effects, | in | | | | | risk of | pregnancy, | | | | | dependence | breastfeedi | | | | | | ng, | | | | | | CNS | | | | | | depressants | | | | | | , | | | | | | including | | | | | | alcohol** | +-------------+-------------+-------------+-------------+-------------+