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When you collect something, it will upgrade/downgrade Isaac's abilities/act as a follower (some items are ones you have to use though). Press Q to use a pill.
I think the biggest ones that confuse me are the Tarot cards. There are a few that when I use them nothing happens and I can't figure out what. Another is that item that you collect and it sits in the bottom left. You don't "use" it but you can only have one? Those also have cryptic upgrades...
http://platinumgod.co.uk/
and then there's the wikis
http://bindingofisaac.wikia.com/wiki/The_Binding_of_Isaac_Wiki or http://bindingofisaacrebirth.gamepedia.com/Binding_of_Isaac:_Rebirth_Wiki
Just please understand that these sites come with a hefty spoiler warning and that they're of course still working out what all the new items exactly do since the game is still so new.