RT Book, Section A1 Dennehy, Cathi E. A1 Tsourounis, Candy A2 Katzung, Bertram G. A2 Vanderah, Todd W. SR Print(0) ID 1176980057 T1 Dietary Supplements & Herbal Medications* T2 Basic & Clinical Pharmacology, 15e YR 2021 FD 2021 PB McGraw-Hill PP New York, NY SN 9781260452310 LK accessmedicine.mhmedical.com/content.aspx?aid=1176980057 RD 2024/03/28 AB CASE STUDYA 53-year-old woman with a history of knee osteoarthritis, high cholesterol, type 2 diabetes, and hypertension presents with new onset of hot flashes and a question about a dietary supplement*. She is obese (body mass index [BMI] 33), does not exercise, and spends a good portion of her work day in a seated position. She eats a low-sugar diet and regularly eats packaged frozen meals for dinner because she doesn’t have time to cook regularly. Her most recent laboratory values include a low-density lipoprotein (LDL) cholesterol that is above goal at 160 mg/dL (goal <100 mg/dL), her kidney function is normal, and her hemoglobin A1c is well controlled at 6%. Her blood pressure is high at 160/100 mm Hg. Her prescription medications include simvastatin, metformin, and benazepril. She also takes over-the-counter ibuprofen for occasional knee pain and a multivitamin supplement once daily. She has heard good things about natural products and asks you if taking a garlic supplement daily could help to bring her blood pressure and cholesterol under control. She’s also very interested in St. John’s wort after a friend told her that it helped alleviate her hot flashes and could also help improve mood. How should you advise her? Are there any supplements that could increase bleeding risk if taken with ibuprofen?