Pharmacology Flashcards
(190 cards)
1
Q
What are the key learning outcomes of Nutritional Pharmacology?
A
Drug restrictions, administration and metabolism, side effects of drugs, drug-nutrient interactions, drug-induced nutrient depletions, major groups and actions of pharmaceutical drugs, pharmaceuticals and the nutrition consultation.
2
Q
What is a medicine defined as according to the UK MHRA?
A
Any substance or combination of substances presented as having properties for treating or preventing disease in human beings.
3
Q
What must all drugs have according to regulatory restrictions?
A
A regulatory licence.
4
Q
What are the four types of drug supply routes?
A
- Prescription only (POM)
- Controlled medicines
- Pharmacy only (PO)
- General sales list (GSL)
5
Q
What do OTC drugs allow clients to do?
A
Self-medicate a range of common illnesses.
6
Q
List some common OTC drugs.
A
- Analgesics (e.g., codeine, paracetamol, aspirin, ibuprofen)
- Laxatives (e.g., bisacodyl, senna)
- Proton pump inhibitors (e.g., omeprazole)
- Cough mixtures (e.g., diphenhydramine)
- Anti-histamines (e.g., chlorphenamine, cetirizine)
- Decongestants (e.g., pseudoephedrine)
7
Q
What are the two types of ingredients in a drug?
A
- Active ingredients
- Inactive ingredients
8
Q
What is the role of the active ingredient in a drug?
A
It delivers the mode of action and is responsible for side effects.
9
Q
What is the difference between generic and brand names of drugs?
A
Generic name is the actual active ingredient, while brand name is the marketed name given by manufacturers.
10
Q
What is pharmacokinetics?
A
The study of the movement of drugs within the body, involving absorption, distribution, metabolism, and elimination (ADME).
11
Q
True or False: Drugs target the underlying cause of health issues.
A
False
12
Q
What is a drug class? Give an example.
A
A category of drugs that share similar properties, e.g., Penicillin is an antibiotic.
13
Q
Fill in the blank: A drug’s _______ indicates what it is intended for.
A
indication
14
Q
What are common drug-induced nutrient depletions?
A
e.g., metformin and vitamin B12.
15
Q
What are the four key processes of pharmacokinetics?
A
- Absorption
- Distribution
- Metabolism
- Elimination
16
Q
What can inactive ingredients in drugs potentially trigger?
A
Allergic reactions and food intolerances.
17
Q
What is the significance of drug-nutrient interactions?
A
They can lead to significant side effects and affect nutrient absorption.
18
Q
What is the main purpose of nutrients in comparison to drugs?
A
Nutrients aim to restore homeostasis and heal the body.
19
Q
Name a drug that can cause gastric ulcers as a side effect.
A
Ibuprofen
20
Q
What does ADME stand for in pharmacokinetics?
A
Absorption, Distribution, Metabolism, Elimination.
21
Q
What does ADME stand for?
A
Absorption, Distribution, Metabolism, Excretion
22
Q
What is the process by which drugs taken orally are absorbed into the bloodstream?
A
First pass metabolism
23
Q
What two main factors determine whether a drug reaches its target site of action?
A
- Bioavailability
- Route of administration
24
Q
What is bioavailability?
A
The proportion of drug that reaches the bloodstream and is available for distribution
25
List three routes of drug administration.
* Oral
* Sublingual
* Parenteral
26
How does gastrointestinal motility affect drug absorption?
Diarrhoea increases motility and reduces absorption
27
What type of drugs absorb best in an acidic environment?
Acidic drugs
28
What are the two phases of drug metabolism?
* Phase I
* Phase II
29
What is the main route for drug excretion?
Urine
30
What is the process by which drugs are chemically changed for excretion?
Drug metabolism
31
What is pharmacodynamics?
The study of how drugs interact with the body to exert their effects
32
True or False: Side effects of drugs can range from mild to life-threatening.
True
33
What are the most commonly experienced short-term side effects of drugs? List at least five.
* Nausea
* Vomiting
* Headache
* Dizziness
* Constipation
34
What can long-term use of metformin lead to?
Vitamin B12 deficiency
35
List two long-term side effects of taking corticosteroids.
* Osteoporosis
* Gout
36
What serious side effects are associated with Proton Pump Inhibitors (PPIs)? List at least three.
* Bone fractures
* Hypomagnesaemia
* Vitamin B12 deficiency
37
What condition can result from the long-term use of NSAIDs like diclofenac?
Cardiovascular disease
38
What should a nutritional therapist do if they suspect a client is experiencing side effects from a drug?
Check the presenting sign/symptom against the drug and advise the client to consult their GP
39
Fill in the blank: The _______ system affects Phase I drug metabolism.
Cytochrome P450
40
Name two factors that can affect the absorption of a drug.
* Gastrointestinal motility
* Presence of other substances
41
What is entero-hepatic circulation?
The re-absorption of very lipid soluble drugs from renal excretion
42
What is the role of cytochrome P450 enzymes in drug metabolism?
They chemically alter drugs/toxins to make them suitable for Phase II reactions
43
True or False: All drugs can produce unwanted side effects.
True
44
What is a significant risk associated with long-term use of PPIs?
Dementia
45
How does the cytochrome P450 system affect drugs?
It is involved in Phase 1 drug metabolism.
46
Name TWO factors that can affect the absorption of a drug.
* Food and drink
* Drug interactions
47
What is ONE long-term side effect of taking corticosteroids?
Bone loss or osteoporosis.
48
List FOUR side effects of taking PPIs.
* Headache
* Diarrhea
* Nausea
* Abdominal pain
49
What is an interaction in pharmacology?
When the effects of one drug are altered by the co-administration of another substance.
50
Name some substances that can cause drug interactions.
* Drugs
* Herbal medicines
* Food and drinks
* Nutritional supplements
* Environmental chemical agents
51
What are Narrow Therapeutic Index (NTI) drugs?
Drugs that may become dangerously toxic or ineffective with small changes in their blood concentrations.
52
Give examples of NTI drugs.
* Digoxin
* Phenytoin
* Theophylline
* Warfarin
* Lithium
53
What patient populations are at increased risk for serious side effects due to polypharmacy?
* Patients with renal and liver dysfunction
* Elderly patients
* Patients with chronic long-term illnesses
* Critically-ill patients
54
What is a comprehensive resource for checking herb and nutrient interactions with pharmaceutical drugs?
The ANP (Association of Naturopathic Practitioners) database.
55
True or False: Garlic has been shown to have a significant effect on warfarin-stabilized patients at a dietary intake of 4g/day.
False
56
What does Ginkgo interact with?
Antiplatelet and anti-coagulant medication.
57
What effect does grapefruit have on drug metabolism?
It selectively inhibits CYP3A4 in the intestinal wall.
58
Fill in the blank: Large amounts of green vegetables can reduce the effect of _______.
anticoagulants
59
What is the effect of soy on levothyroxine absorption?
Decreases absorption; separate ingestion by three hours.
60
How can calcium affect the absorption of antibiotics?
It can bind to antibiotics like quinolones and tetracycline, reducing their absorption.
61
What dietary change can affect the effectiveness of lithium?
Salt restriction can increase serum lithium to toxic levels.
62
What nutrients are affected by Proton Pump Inhibitors (PPIs)?
* Beta-carotene
* Calcium
* Chromium
* Iron
* Magnesium
* Folate
* Vitamin B12
* Vitamin C
* Zinc
63
What effect do steroids have on nutrient levels?
Increase urinary excretion and losses from bone tissue.
64
What nutrients are depleted by statins?
* CoQ10
65
What is the mechanism by which antibiotics deplete nutrients?
Destruction of normal intestinal microflora leads to decreased production of various B vitamins and vitamin K.
66
What nutrients are affected by diuretics?
* Calcium
* Magnesium
* Potassium
* Folate
* Vitamins B1, B6, C
67
What is the effect of antacids on nutrient absorption?
Increased gastric pH may reduce solubility and absorption.
68
What nutrients are affected by the oral contraceptive pill?
* Folate
* Magnesium
* Vitamin B6
* Vitamin B2
* Vitamin B1
* Vitamin A
* Vitamin B12
* Vitamin C
* Zinc
69
How can long-term alcohol ingestion affect drug metabolism?
It may activate drug-metabolizing enzymes, decreasing drug availability and diminishing effects.
70
True or False: Alcohol can magnify the inhibitory effects of sedative and narcotic drugs.
True
71
What are the effects of chronic alcohol consumption on drug metabolism?
Enzymes activated by chronic alcohol consumption transform some drugs into toxic chemicals that can damage the liver or other organs.
72
How does alcohol affect the action of sedative and narcotic drugs?
Alcohol can magnify the inhibitory effects of sedative and narcotic drugs at their sites of action in the brain.
73
What effect does cimetidine have on alcohol metabolism?
Cimetidine appears to inhibit the enzyme needed to break down alcohol (alcohol dehydrogenase).
74
What can happen when alcohol is consumed with slow-release depot injections?
Alcohol can force certain drugs out of their depot storage in muscle, resulting in overdose.
75
What medication is Mark taking, and what symptom might it cause?
Mark is taking metformin for Type 2 diabetes, which might contribute to him feeling fatigued.
76
Why should grapefruit juice be avoided with statins?
Grapefruit juice significantly increases the GI absorption of CYP3A4 substrates and increases peak levels of statins.
77
What dietary considerations should Derek keep in mind while taking warfarin?
Derek should pay attention to foods that can interact with warfarin, particularly those high in vitamin K.
78
List some commonly-used pharmaceutical drugs.
* ACE inhibitors
* Statins
* Diuretics
* Digoxin
* PPIs/antacids
* Anti-coagulants (e.g., warfarin)
* SSRIs
* Antihistamines
* NSAIDs
* Corticosteroids
* Thyroid replacement hormones
79
What are ACE inhibitors prescribed for?
ACE inhibitors are prescribed for heart failure and hypertension.
80
Provide examples of ACE inhibitors.
* Ramipril
* Lisinopril
* Captopril
81
What are common side effects of ACE inhibitors?
* Hyperkalaemia
* Postural hypotension
* Constipation
* Diarrhoea
* Nausea
* Vomiting
82
What specific side effect is associated with ACE inhibitors?
ACE inhibitors cause a persistent dry cough due to a rise in bradykinin.
83
What are statins prescribed for?
Statins are prescribed for hypercholesterolaemia, hypertriglyceridemia, and prevention of cardiovascular events.
84
What is the mode of action of statins?
Statins competitively inhibit HMG CoA reductase, an enzyme involved in cholesterol synthesis.
85
List some examples of statins.
* Simvastatin
* Atorvastatin
* Pravastatin
* Rosuvastatin
86
What are common side effects of statins?
* GIT disturbance
* Headaches
* Fatigue
* Insomnia
* Myositis
* Statin-induced myopathy
87
What serious condition can result from statin use?
Statin use can lead to rhabdomyolysis, which can result in kidney disease and failure.
88
What is the mode of action of diuretics?
Diuretics inhibit reabsorption of filtrate from various sections of the nephron, increasing urine output.
89
List some contraindications for diuretics.
* Metabolic imbalances (hypokalaemia, hyponatraemia, hypercalcaemia)
* Addison’s disease
90
What are common side effects of diuretics?
* Hypokalaemia
* Hypotension
* GIT disturbance
* Impotence
91
What is the mode of action of digoxin?
Digoxin increases the force of myocardial contraction and reduces conductivity within the atrio-ventricular node.
92
What are common side effects of digoxin overdose?
* Nausea
* Vomiting
* Diarrhoea
* Loss of appetite
* Abdominal pain
* Visual disturbance
* Arrhythmias
93
What are proton pump inhibitors (PPIs) prescribed for?
PPIs are prescribed for gastro-oesophageal reflux disease (GORD) and indigestion.
94
What is a key long-term side effect of PPIs?
Increased risk of GI infections (e.g., Clostridium difficile) and vitamin B12 deficiency.
95
What can happen with sudden withdrawal of PPIs?
Sudden withdrawal may cause rebound reflux.
96
What alternative treatments are available for GORD?
* Chew food well
* Fluids away from meals
* Anti-inflammatory herbs (e.g., aloe vera juice, slippery elm)
* Avoid caffeine and manage stress
97
What factors does PPI withdrawal depend on?
Dose and duration of treatment
## Footnote
Sudden withdrawal may cause rebound reflux.
98
What is the first step in the 5R approach for PPI withdrawal?
Remove trigger foods and manage food intolerances
## Footnote
Trigger foods include acidic foods, alcohol, caffeine, spicy food, fatty foods, dairy, and chocolate.
99
List three trigger foods to remove during PPI withdrawal.
* Tomatoes
* Alcohol
* Caffeine
100
What should clients avoid to reduce stomach distension during PPI withdrawal?
Overeating and fluid intake with meals
101
What position should clients adopt to alleviate symptoms during PPI withdrawal?
Prone position with head of bed elevated by 4-6 inches
102
What are two types of supplements that clients may need during PPI withdrawal?
* B12
* Magnesium
103
What is the purpose of introducing probiotics in the PPI withdrawal process?
To repopulate the gut microbiome, especially if clients suffer from SIBO
104
What is slippery elm used for during PPI withdrawal?
To protect and repair the gut lining
105
True or False: Slippery elm can reduce the absorption of oral drugs.
True
106
What is the mode of action for Warfarin?
Antagonises the effects of vitamin K
107
List three contraindications for Warfarin.
* Haemophilia
* Cerebral thrombosis
* Peptic ulcers
108
What does INR stand for, and what does it measure?
International Normalised Ratio; measures how long it takes blood to clot
109
What is a major side effect of Warfarin?
Haemorrhage
110
What should be avoided in combination with Warfarin due to increased bleeding risk?
High doses of vitamin E
111
What is the primary prescribed medication for hypothyroidism?
Levothyroxine
112
What is the mode of action of Levothyroxine?
Lifelong replacement therapy
113
What caution should be taken when prescribing Levothyroxine?
Elderly patients and those with cardiovascular disorders
114
Fill in the blank: The dose of Levothyroxine should be taken _______ before breakfast.
30–60 minutes
115
What are two side effects of SSRIs?
* GIT disturbance
* Sexual dysfunction
116
True or False: SSRIs should be stopped abruptly.
False
117
What syndrome is associated with an excess of serotonin?
Serotonin syndrome
118
What are two symptoms of serotonin syndrome?
* Confusion
* Fever
119
What should not be combined with SSRIs due to the risk of serotonin syndrome?
5-HTP and St. John's wort
120
What is the mode of action of NSAIDs?
Inhibits cyclooxygenases (COX-1 and COX-2)
121
List three prescribed NSAIDs.
* Ibuprofen
* Diclofenac
* Naproxen
122
What is a significant side effect of long-term NSAID use?
Increased risk of gastric bleeding and ulceration
123
What is the primary action of corticosteroids?
Modulates protein synthesis by binding to DNA
124
List two side effects of long-term corticosteroid use.
* Cushing’s syndrome
* Osteoporosis
125
Fill in the blank: Abrupt withdrawal of corticosteroids can lead to _______.
Acute adrenal insufficiency
126
What alternative approach can be taken for managing inflammation?
An anti-inflammatory diet rich in nutrients
127
What is the role of lipocortin in the action of corticosteroids?
Inhibits the activity of phospholipase A2
128
What should be avoided when taking Levothyroxine?
Oral iron and calcium supplements
129
Which phytonutrient has anti-histamine properties?
Quercetin
130
What is the primary action of beta-blockers?
Block the effects of adrenaline on the beta receptors
131
What can abrupt withdrawal of corticosteroids after a prolonged period lead to?
Acute adrenal insufficiency, hypotension, or death
## Footnote
This highlights the importance of careful management when discontinuing corticosteroid therapy.
132
Name one alternative approach to corticosteroids.
Anti-inflammatory diet
## Footnote
This can include nutrients and herbs that inhibit inflammatory mediators.
133
List three nutrients or herbs that can inhibit inflammatory mediators.
* EFAs
* Quercetin
* Turmeric
* Ginger
## Footnote
These substances are known for their anti-inflammatory properties.
134
What effect does liquorice root have on cortisol levels?
It can modify or increase the body’s levels of cortisol.
## Footnote
Liquorice can have pharmacodynamic interactions with certain medications.
135
What can occur if liquorice is given in large quantities with corticosteroids?
Additive hypokalaemia
## Footnote
This indicates the potential for dangerous interactions between liquorice and corticosteroid treatments.
136
Identify one bulk laxative.
Psyllium
## Footnote
This is a common over-the-counter bulk-forming laxative.
137
Name one stimulant laxative.
Bisacodyl
## Footnote
This is a well-known stimulant laxative used for constipation.
138
List two side effects of laxatives.
* Dehydration
* Electrolyte imbalance
## Footnote
These side effects can occur due to overuse or misuse of laxatives.
139
Consider two natural approaches to addressing constipation.
* Increased fiber intake
* Hydration
## Footnote
These methods can help improve bowel regularity without the need for laxatives.
140
True or False: It is essential to ask clients about their use of OTC medications during consultations.
True
## Footnote
Many clients may forget to mention OTC medications, which can be important for their health assessment.
141
Why is it important to document a full list of drugs during a nutritional consultation?
To understand the client's overall drug picture and potential interactions.
## Footnote
This includes both prescribed and OTC medications.
142
What should a nutritional therapist do if a client wants to stop a prescribed medication?
Educate the client about the drug and its side effects.
## Footnote
Abruptly stopping medications can lead to adverse effects.
143
What is a common side effect of long-term use of PPIs?
Rebound heartburn
## Footnote
This can occur when discontinuing PPIs after prolonged use.
144
What nutrient depletion is associated with simvastatin?
CoQ10
## Footnote
This depletion can contribute to fatigue in patients taking simvastatin.
145
What is an important dietary consideration for a client taking simvastatin?
Avoid alcohol
## Footnote
Alcohol can increase liver toxicity in patients taking simvastatin.
146
What is the risk of combining sertraline and St. John's wort?
Serotonin syndrome
## Footnote
This dangerous condition can occur due to increased serotonin levels.
147
What should be avoided in patients taking warfarin?
* High dose vitamin E
* Ginkgo biloba
* Garlic
## Footnote
These can increase the risk of bleeding when taken with warfarin.
148
What dietary advice should be given to a client taking warfarin?
Avoid excessive intake of vitamin K-rich foods.
## Footnote
Foods like broccoli and spinach can counteract the effects of warfarin.
149
Fill in the blank: Berberine inhibits _______.
CYP3A4
## Footnote
This interaction can affect the metabolism of various drugs.
150
What is a common side effect of sertraline?
Constipation
## Footnote
This is a noted side effect of selective serotonin reuptake inhibitors (SSRIs).
151
What should be monitored in clients taking warfarin?
INR levels
## Footnote
Regular monitoring is crucial to ensure safe and effective anticoagulation therapy.
152
What enzyme does Berberine inhibit?
CYP3A4
## Footnote
Berberine is a compound known for its various health benefits, including its impact on metabolic processes.
153
Which enzymes does Chamomile inhibit?
CYP1A2 and CYP3A4
## Footnote
Chamomile is often used for its calming effects and may interact with certain medications.
154
Which enzymes are inhibited by Cranberry?
CYP1A2, CYP2D6, CYP2C9, and CYP3A4
## Footnote
Cranberry is commonly known for its urinary health benefits.
155
What is the effect of Curcumin on enzymes?
Inhibits CYP2C19, CYP2B6, CYP2C9, and CYP3A4
## Footnote
Curcumin is the active component in turmeric and has anti-inflammatory properties.
156
Echinacea inhibits which enzymes?
CYP1A2 and CYP3A4
## Footnote
Echinacea is frequently used to boost the immune system.
157
Garlic inhibits and induces which enzymes?
Inhibits CYP2E1, CYP2C9, CYP2C19; induces CYP3A4
## Footnote
Garlic is known for its cardiovascular benefits and may affect drug metabolism.
158
Ginger inhibits which enzymes?
CYP1A2, CYP2D6, and CYP3A4
## Footnote
Ginger is commonly used to alleviate nausea and digestive issues.
159
What is the effect of Panax Ginseng on CYP enzymes?
Induces CYP3A4 and inhibits CYP2D6
## Footnote
Panax Ginseng is often used for its energy-boosting properties.
160
Which enzymes does Siberian Ginseng inhibit?
CYP1A2, CYP2C9, CYP2D6, and CYP3A4
## Footnote
Siberian Ginseng is known for its adaptogenic properties.
161
Which enzymes does Ginkgo induce?
CYP1A2, CYP2C9, CYP2C19, CYP2D6; may induce or inhibit CYP3A4
## Footnote
Ginkgo is often used for cognitive enhancement and memory support.
162
What is the effect of Grape Seed Extract on CYP enzymes?
Inhibits CYP2C9 and CYP3A4
## Footnote
Grape Seed Extract is known for its antioxidant properties.
163
Which enzyme does Grapefruit inhibit?
CYP3A4
## Footnote
Grapefruit can significantly affect the metabolism of various medications.
164
Liquorice inhibits which enzymes?
CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4
## Footnote
Liquorice is used for its soothing properties in digestive issues.
165
What is the effect of Milk Thistle on CYP enzymes?
Inhibits CYP2C9
## Footnote
Milk Thistle is often used for liver health.
166
Pomegranate inhibits which enzymes?
CYP2D6 and CYP3A4
## Footnote
Pomegranate is recognized for its antioxidant benefits.
167
Which enzymes does Quercetin inhibit?
CYP2C8, CYP2C9, CYP2D6, and CYP3A4
## Footnote
Quercetin is a flavonoid with anti-inflammatory effects.
168
Resveratrol inhibits which CYP enzymes?
CYP2C9, CYP2D6, and CYP3A4
## Footnote
Resveratrol is known for its potential benefits in cardiovascular health.
169
St John’s wort induces which enzymes?
CYP1A2, CYP2C9, and CYP3A4
## Footnote
St John’s wort is commonly used for its antidepressant effects.
170
What is the primary focus of the study titled 'Vitamin E Serum Levels and Bleeding Risk in Patients Receiving Oral Anticoagulant Therapy'?
The relationship between vitamin E serum levels and bleeding risk in patients on oral anticoagulants
## Footnote
A retrospective cohort study published in J Am Heart Assoc.
171
What cardiovascular risks are associated with NSAIDs and COX-2 inhibitors?
Increased cardiovascular risk
## Footnote
Discussed in the article by Perry et al. in US Pharm.
172
What are the mechanisms of action of corticosteroids in health and disease?
Anti-inflammatory effects, immune system modulation
## Footnote
Detailed in Ramamoorthy and Cidlowski's work in Rheum Dis Clin North Am.
173
What pharmacokinetic interaction was studied between garlic and atorvastatin?
Impact on lipid levels in dyslipidemic rats
## Footnote
Research by Reddy et al. in Indian J Pharmacol.
174
What risks are associated with aluminium in over-the-counter drugs?
Potential health risks outweighing benefits
## Footnote
Explored in Reinke et al.'s article in Drug Saf.
175
What is the significance of 'inactive' ingredients in oral medications?
They can affect the efficacy and safety of the medication
## Footnote
Discussed by Reker et al. in Sci Transl Med.
176
What is the relationship between hyperthyroidism and bone disease?
Hyperthyroidism can lead to bone disease due to hormonal imbalances
## Footnote
Reviewed by Ross in an online article.
177
What gastrointestinal damage is associated with non-steroidal anti-inflammatory drugs (NSAIDs)?
Increased risk of gastrointestinal bleeding and ulcers
## Footnote
Addressed in Russell's article in BMJ.
178
What is the appropriate use of proton pump inhibitors (PPIs)?
To manage conditions like GERD while considering potential risks
## Footnote
Reappraisal discussed in Savarino's work.
179
What therapeutic uses does licorice have?
Potential treatment for pseudohyperaldosteronism and other conditions
## Footnote
Explored by Sabbadin et al. in Frontiers in Endocrinology.
180
What cardiovascular risks are associated with diclofenac use?
Increased risk of cardiovascular events
## Footnote
Investigated by Schmidt et al. in BMJ.
181
What are the efficacy and safety findings of white willow bark extracts?
Potential analgesic effects with safety considerations
## Footnote
Reviewed by Shara and Stohs in Phytother Res.
182
What side effects are associated with diuretics?
Electrolyte imbalances, dehydration
## Footnote
Discussed in Sica's article in The Journal of Clinical Hypertension.
183
What is the medicinal significance of Ginkgo Biloba?
Cognitive enhancement and antioxidant properties
## Footnote
Detailed by Sierpina et al. in Am Fam Physician.
184
What is the main focus of the article 'Overview of COX-2 selective NSAIDs'?
The benefits and risks associated with COX-2 selective NSAIDs
## Footnote
Provided by Solomon in an online resource.
185
What dietary factor influences serum tricyclic antidepressant levels?
High-fiber diet
## Footnote
Explored in Stewart's study in J Clin Psychopharmacol.
186
Do diuretics pose a risk factor for thiamin malnutrition?
Yes, they may contribute to thiamin deficiency
## Footnote
Investigated by Suter and Vetter in Nutr Rev.
187
What are the symptoms of lithium intoxication?
Nausea, tremors, confusion
## Footnote
Discussed in Timmers and Sands' article.
188
What effects do oral contraceptives have on nutrient status, particularly folate?
Potential reduction in folate levels
## Footnote
Reviewed by Wakeman in Journal of Advances in Medicine.
189
What is the purpose of protein-restricted diets in Parkinson's disease?
To improve motor fluctuations
## Footnote
Discussed by Wang et al. in Front Aging Neurosci.
190
What pharmacological activities are attributed to licorice?
Anti-inflammatory, antiviral, and antioxidant effects
## Footnote
Explored by Yang et al. in Planta Med.
