Mrs. Z is a 76 year old female who is seen by the internal medicine physician because she has been feeling very depressed. She also gets chronic migraines. The physician takes a full history from Mrs. Z, which reveals that several medications have been prescribed to her by a variety of specialists. It seems that each specialist neglected to pay attention to the meds that Mrs. Z was prescribed by

Question

her other doctors and the potential drug-nutrient interactions. She also takes some daily health supplements. The physician's notes are as follows: Current Meds / Supplements Reason for Prescribing / Taking St. John's wort ............................... she read in a magazine that this helps with depression Slow Fe (iron supplement) ............ for prior anemia Warfarin ......................................... history of embolic stroke Omeprazole ................................... history of peptic ulcer Tums ............................................. chronic upset stomach Amoxicillin ................................... recent respiratory infection Doxazosin ..................................... incontinence Allegra .......................................... seasonal allergies Lipitor ........................................... high cholesterol Vitamin E ...................................... she heard it was good for heart disease Typical Daily Diet Breakfast: eggs, bacon, ½ grapefruit, fresh orange juice Lunch: hotdogs, sausages, or pepperoni sub, sliced tomatoes, cold tea Dinner: cooked spinach, chicken breast, mashed potatoes, hot tea What current med / supplement is Mrs. Z taking that likely results in diminished clinical effectiveness or increased dosage requirements for her other medications?
a. Tums
b. vitamin E
c. St. John's wort
d. slow iron
e. tea

Answer 1

c