11 - Supplements Flashcards
Definition(s) of a dietary supplement
- A product (excluding tobacco) intended to supplement the diet with ingredients of vitamins, minerals, amino acids, herbs or other botanicals
- A substance to increase the total dietary intake
- A concentrate, metabolite, constituent, extract, or combination of any ingredients
Dietary supplements must be in what form(s)?
Must be in the form of a capsule, powder, or softgel
Are dietary supplements considered a drug or food?
Neither - it is it’s own category
When are supplements required?
When they’re deficient in a vitamin (ex. people take Vitamin D in winter)
How do taking dietary supplements affect people?
- Improve quality of life
- Improve self-esteem
- Promote a healthy life style
- Alternative treatment/medicine
- Active role in self health management
List some ingredients in dietary supplements
- Vitamins
- Minerals
- Amino acids
- Other natural chemicals from (plants, animals, extracted or semi-synthetic)
Infusion
pouring hot water over an herb (ex. tea)
Decoction
boiling of herb (softens plant material ex. root or bark)
Water-based processes will only be used for ______ agents
hydrophillic
For lipophilic agents, _____ has been used (hydroalcoholic extracts)
alcohol
Describe herbs
- from natural plants
- raw or processed ingredients
- for daily intake
- better health benefits
- in the form of medicines
- specially labelled
- available as supplements
What is included under “Natural Health Products” (NHPs) ?
- Vitamins & Minerals
- Herbal remedies
- Homeopathic medicines
- Traditional medicines
- Probiotics
- Other products (amino acids, fatty acids, etc.)
NHPs are ____
OTC
What are some dilemmas with NHPs/supplements?
- Food or medicine?
- Are they necessary?
- Are they safe?
- Can they be used with Rx meds?
What are some pros about NHPs/supplements?
- OTC availability
- Wide range of indications
- Use without consultation
What is a functional food?
A food that can potentially provide benefits
- Food with health benefits
- Foods for daily intake
- In the form of foods
- Labeled as foods
- Available as foods
What is the difference between a functional food and a nutraceutical?
A functional food is similar to a conventional food (i think it’s like how an orange can provide you with vitamin C)
A nutraceutical is isolated from a food and sold in dosage forms (so like a vitamin C tablet?)
Describe functional foods & nutraceuticals
Food components that provide demonstrated physiological benefits or reduce risk of chronic diseases, above and beyond their basic nutritional functions
Define “Alternative medicine” and list some examples
All other approaches and techniques that were not taught in “traditional” medical schools and residencies, but are practiced for healthcare improvement or disease treatment
Examples:
- hypnosis
- meditation
- chiropractice/massage
- acupuncture
- traditional medicine
What are some Use Concerns ?
- boundary not well-defined, terminology, interchangeable
- constant regulatory changes based on different situations and requirements
- lack of post-marketing surveillance of safety, efficacy, adverse effects, etc.
- inappropriate usage due to OTC status
- interactions with conventional medications is possible, information is deficient
Beta-carotene (vitamin A precursor):
Benefits?
44% reduction in the risk of precancerous colon tutors in subjects who neither drink nor smoke
Beta-carotene (vitamin A precursor):
Signs of too much?
- headache
- hair loss
- muscular stiffness
- fatigue
- liver damage
Vitamin B:
Benefits?
- B12 reduces depression
- B6/12 reduces risk of breast cancer and slows progression of Alzheimer’s disease
Vitamin C/Vitamin E:
Benefits?
cut stroke risk by 70% and 20%
Vitamin D:
Benefits?
reduced incidence of precancerous growths in colon, reduced fractures in people over 65 years
Vitamin D:
Signs of too much?
- nausea
- vomiting
- diarrhea
- excessive urination and thirst
Vitamin C:
Signs of too much?
- UTI
- kidney/bladder stones
Calcium:
Signs of too much?
- impaired absorption of iron and zinc
- calcium deposits in tissues
Folic Acid:
Signs of too much?
- loss of appetite
- nausea
- sleep disturbances
List some dosage forms that dietary supplements come in
- Tablets (regular or coated)
- Chewable tablets
- Capsules
- Oral liquids
- Gummies
What are some important things to look at when buying supplements?
- Important elements: A, B groups, D, Cu, Zn, Mg, Fe, I, Se, Cr
- % of recommended daily intake
- Possible extra doses
- Watch for marketing scams “natural”, “super potency”, “senior formula” (those words don’t necessarily mean anything)
Generic or brand better?
Equal in quality
- may have different excipients
- brand is more expensive
Take supplements with ____ for better absorption
food
Not everyone needs a multivitamin/supplement. List some special populations that do need supplements and why
1) People over 65: they have lower absorption so may need supplements
2) Pregnant women or women who may become pregnant: for healthy babies/pregnancy
3) Vegetarians & people on special diets: To counteract diet imbalance
4) People with low-income: to supply extra nutrients in a diet which is lacking
____ administration is the only administration for supplements in Canada
Oral - some countries have parenteral administration of herbs but not Canada
Describe the formulation modification of dietary supplements
- Identification/separation of effective active ingredients
- Elimination of unnecessary or less important components
- Formulation of conventional solid dosage forms (tablets and capsules)
- Improvement of bioavailability and bioequivalence
Adverse effects:
Ginseng
- hypertension
- euphoria
- nervousness
- insomnia
- skin eruption
- edema
- diarrhea
Adverse effects:
Ginkgo
- gastric distrubance
- headache
- dizziness
Adverse effects:
Valerian
- headache
- excitability
- insomnia
- uneasiness
- cardiac distrubance
- ataxia
- hypothermia
Adverse effects:
Saw palmetto
- nausea
- stomach upset
Long-term safety/toxicity data is _____
deficient/lacking
What is some information required for Licensed NHPs
- product name
- product license holder
- NPN (natural product number) or DIN-HM
- product’s medicinal ingredients
- product’s non-medicinal ingredients
- product’s dosage form
- product’s recommended use or purpose
- relevant risk info
Is the labelling good on dietary supplements?
NO - HCPs are extremely important in providing info
- There is lots of incorrect/misleading info on labels
- Insufficient info on labels
- NO universally-acepeed labelling systems
- Info on drug-supplement interactions is limited and individual assessment for each combo is required
Describe a pharmacist’s roles in Supplements:
Knowledge base
active ingredients, indications, dosage forms, recommended doses, potential side effects/interactions
Describe a pharmacist’s roles in Supplements:
Product choice
brands, similarity, difference, preference
Describe a pharmacist’s roles in Supplements:
Patient counselling
all kinds of questions related to patient’s conditions, extremely important in use of supplements by patients and consumers
Describe a pharmacist’s roles in Supplements:
Attitudes
positive, encouraging, unbiased
Describe a pharmacist’s roles in Supplements:
Information collection
use of supplements and prescriptions, health conditions, physician’s input
Describe a pharmacist’s roles in Supplements:
Guidelines
discussion with physicians, no recommendation to patients with serious medical conditions, selection of quality brands, start with lower doses, follow-up with patients
