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Mrs. Z is a 76-year-old female who consults an internal medicine physician because she has been 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 medications that Mrs. Z was prescribed by her other doctors and the potential drug–nutrient interactions. She also takes some daily health supplements.
The physician's notes are as follows:
Current Medication/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
Because of the connection between increased levels of tyramine and migraine headaches, what dietary changes should Mrs. Z make?
A. eliminate grapefruit
B. eliminate deli (cured) meats
C. eliminate orange juice
D. eliminate eggs
E. eliminate fresh tomatoes
Answer: B
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