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As you can imagine, this is super handy for many challenges/achievements/unlocks.
Look on the wiki for 'item pools'. When an item is set to appear, it selects from the item pool based on what is unlocked. This is can be used to save you some frustration for more difficult challenges/unlocks (ie. lost) by not unlocking bad items and unlocking primarily good items.
Similarly, item cards and pills work the same way, so some challenges aren't worth doing to avoid getting some less useful pills/cards (ie. unlocking ace of diamonds only).