Curriculum
Module 12 · 75 min

Drug-Supplement Interactions & Clinical Counseling

Reconciling supplements with medications — the highest-value counseling skill.

CoreClinicalAdvanced
Core topics

Lessons in this module

Learning objectives

By the end of this module you will be able to

Lesson summary ↓Graded claims ↓Self-check ↓Vignettes ↓Glossary ↓
  • L01
    Conduct a structured supplement-medication reconciliation in <5 minutes.
  • L02
    List five supplements to stop ≥2 weeks before elective surgery.
  • L03
    Identify three life-threatening drug-supplement interaction scenarios.
  • L04
    Use a free interaction-checker tool (NIH ODS, Natural Medicines, LactMed for breastfeeding).
Expected takeaways

What you should walk away believing

  • →Ask 'any supplements, vitamins, herbs, or things from health food stores?' at every visit.
  • →St John's Wort, warfarin, transplant immunosuppressants, OCPs, and HIV protease inhibitors are highest-stakes interactions.
  • →Stop garlic, ginkgo, ginseng, fish oil, and vitamin E 1–2 weeks before elective surgery.
  • →Document every supplement in the chart problem list, not just the 'home meds' section.
Lesson · Core emphasis

What this means for you

Patient summary

Mixing supplements with prescription medications can be a problem. Always tell your doctor and pharmacist about every vitamin, herb, or supplement you take — even ones you think are harmless.

Clinician summary

Make supplement reconciliation a standing part of intake. Use a checker (NIH ODS, NatMed). Educate on the 'Big 4' — SJW, fish oil + anticoagulant, calcium/iron + levothyroxine, ginkgo + antiplatelet.

Advanced note

Perioperative bleeding risk is the most cited reason to stop supplements ≥1–2 weeks pre-op; ASRA and ASA guidance varies by drug. Document carefully.

Evidence framework

Where this module sits on the device evidence map

Capstone: reconciliation is the single highest-yield supplement-related clinical skill.

Tier map →Tier 1 →Tier 2 →Tier 3 →
Myth-buster

If a patient didn't list supplements on intake, they aren't taking any.

Reality

Patients commonly omit supplements from med lists; asking by name and example dramatically increases yield.

Evidence-graded claims

What the data says

A
SJW reduces tacrolimus, OCP, and protease inhibitor exposure
Established and clinically dangerous.
C
Stopping fish oil 7 days pre-op reduces bleeding
Bleeding-time effect modest; some surgeons require.
B
5-HTP combined with SSRI may precipitate serotonin syndrome
Mechanistically plausible; case reports.
Objective self-check

Test the learning objectives

Score0 / 1(0 answered)
Q1L01 — Most efficient reconciliation question?
Case vignettes

Apply it: real-world counseling scenarios

Short patient encounters that test your judgment, not your recall. Pick the most defensible response, then reveal the rationale and a sample coaching script you could actually say at the bedside.

Vignette proficiency
In progress · 0/1 submitted
Correct0/1 (0%)Pitfalls avoided0/0 (0%)Composite0
Composite weighting
Accuracy 60%Pitfalls 40%
← all pitfallsbalancedall accuracy →
Composite = 60% answer accuracy + 40% pitfalls avoided. Your weighting is saved for this module.
Order · randomized[1]
Vignette 1 of 1· source #1

Pre-op supplement reconciliation

Objective · Apply perioperative cessation guidance.

A 68-year-old scheduled for elective knee replacement in 4 days takes fish oil 4 g, garlic, ginkgo, vitamin E, and a multivitamin.

Best counseling?
Quick check

Test yourself

Q1Best counseling for SJW + tacrolimus?
Q2Supplements to stop before elective surgery typically include:
Flashcards · Spaced repetition

Lock it in — review what's due

Due2Total2
FrontNew
2 in queue
Free authoritative interaction database?
Click to reveal answer
Glossary

Key terms & abbreviations

P-glycoproteinP-gp
Efflux transporter affecting drug absorption and distribution; induced by SJW, inhibited by several botanicals.
Serotonin syndrome
Potentially fatal hyperserotonergic state — fever, clonus, agitation, autonomic instability.
Further reading

Optional deeper dive

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