4_3CAMTop10 Flashcards
How does glucosamine work its magic?
1) decreases chondrocyte breakdown; 2) decreases damage to cartilage matrix; 3) increases formation and repair of cartilage; 4) inhibit cytokine-stimulated production of inflammatory mediators
What are the uses of glucosamine?
1) mild-moderate knee OA (A); 2) general OA (B); 3) TMJ arthritis (PE); 4) RA - not as effective
What were the results of the GAIT trial?
glucosamine for knee OA: less effective if older, heavier, or chronic disease (worn-down cartilage and bone-on-bone)
What are the ADRs of glucosamine?
1) GI upset, 2) heartburn, 3) diarrhea; 4) may increase blood sugar as an amino sugar
Who is allergic to glucosamine?
those with shellfish allergy - use veggie-based product
What are sources of glucosamine?
1) marine exoskeletons; 2) in vivo glycoprotein produced by cartilage, synovial space
What are sources of chondroitin?
1) bovine/pork/shark cartilage; 2) a glycosaminoglycan in cartilage and CT
How does chondroitin work its magic?
1) inhibits synovial enzymes to decrease cartilage destruction; 2) increases H2O retention and elasticity in cartilage
What are the uses of chondroitin?
1) arthritis; 2) dry eye
What is methylsulfonylmethane (MSM)?
an odorless metabolite of DMSO occurring naturally in green plants
What is the normal dosage for glucosamine/chondroitin?
g/c 500/400 mg/day in 3 divided doses for 3 months; decrease when OA/RA is under control according to weight; do not increase after 3 months if no effect
How is chondroitin supplied?
as sulfate of HCl form; Mn may be included
What is the RDA of Managenese?
1.8-2.3 mg/day
What is the function of Mn in chondroitin?
aids in bone formation
How much Mn may be supplied in glucosamine/chondroitin products?
> 11 mg/day
What are the considerations for Mn in chondroitin?
not dangerous if
How is chondroitin used for cataract surgery?
a viscoelastic agent; also as a preservative medium for cornea transplantation
What did a 2011 study find regarding chondroitin use for OA?
800 mg QD for 3 months decreased hand pain and morning stiffness; but modest effect if used without glucosamine
What are the ADRs for chondroitin?
GI upset, nausea, diarrhea
What are chondroitin’s interactions?
anticoagulants (inc. INR at high doses)
What are the uses for methylsulfonylmethane?
1) OA, 2) maybe for allergic rhinitis, 3) absorption vehicle for topical preparations
What are the ADRs for methylsulfonylmethane?
garlic taste in mouth
What is the dosing regimen for melatonin?
2-3 mg Qday 30-60 min before bedtime; use x4 days after long flight
How is melatonin supplied?
1) pure form, 2) with valerian (sleep aid), 3) with B6 (Trp synthesis)
What are ADRs of melatonin?
drowsiness for 6h; vivid dreams but no hangover effect
What are the uses of melatonin?
distrubed sleep-wake cycles (autism, DM, schizophrenia, Alzheimers, Parkinsons, blindness)
What are the sources of melatonin?
1) synthesized from Trp in pineal gland; 2) supplements from synthetic or plant extracts
What are other names for CoQ-10?
1) idebenone; 2) mitoquinone; 3) ubiquinone
What are sources of CoQ-10?
1) dietary chicken, beef; 2) synthetic; 3) in vivo production of ubiquinol esp. in heart, liver, pancreas
What are the uses of CoQ10?
1) CVD, 2) T2DM, 3) migraine, 4) parkinsons, 5) statin myopathy, 6) anti-aging ingredient, 7) sun protection
What is the usual dose for CoQ-10?
100-200 mg/day
What is the CoQ-10 dose in parkinsons?
300-1200 mg/day
Why is CoQ-10 beneficial in statin myopathy?
(conflicting evidence). Statins decrease in vivo production of ubiquinol
How is CoQ-10 supplied?
in various dosage forms with variable F; can buy pure form; range of cost
What are ADRs of CoQ-10?
1) Gi upset, 2) nausea/vomiting, 3) rash, 4) HA, 5) anorexia; 6) heartburn
What are CoQ-10’s interactions?
1) can decrease BP; 2) decrease warfarin effect
What are counseling points for high doses of CoQ-10?
1) safe if
What are other names for echinacea?
1) purple coneflower, 2) American coneflower, 3) black susan
What are the sources of echinacea?
it’s a North American plant: 1) leaves of E. purpurea, 2) root of E. angustifolia
How does Echinacea work its magic?
immune system modulator
What are the uses of echinacea?
1) common cold, 2) vaginal yeast infection
How is echinacea taken for cold?
as prophylaxis throughout the season or at first symptoms for 7-10 days
How is echinacea taken for vaginal candidiasis?
as an adjuct to antifungal - can reduce recurrence
How does echinacea affect a cold?
decrease symptoms 10-30% but not preventive
What is the dosage of echinacea?
1) 900 mg dried extract, 2) 3-4 mL alcohol tincture at 5x concentration
What substances may be combined with echinacea?
goldenseal and elderberry
What is goldenseal?
a topical antibacterial
What is elderberry?
an immunomodulator
Who is allergic to echinacea?
those with allergic reaction to asteracaea/compositae family (ragweed, chrystanthemums, daisies, marigolds)
What are echinacea’s interactions?
decrease effects of immunosuppressants; 1A2 and 3A4 inhibitor
What are the ADRs of echinacea?
1) GI, 2) fever, 3) dizziness, 4) HA, 5) rash
How long can echinacea be used?
safe if less than 12 weeks
How does cranberry work its magic?
prevents bacterial adherence to bladder wall
What is the dosage for cranberry?
300-400 mg BID or 8-16 oz pure juice QD
At what dosage does cranberry have ADRs?
> 8-16 oz/day of juice
What are the hi-dose ADRs of cranberry?
anticoagulant, decreased effect of alkaline drugs (antidepressants and pain meds)
What are the active principles of garlic?
alliin and allicin
What is allicin?
the active biological ingredient; sulfur containing AA derivative in garlic that has a significant odor
What are the uses (PE) for garlic?
1) HTN, 2) atherosclerosis, 3) GI cancers - fresh garlic only; 4) tick bites; 5) tinea
For what conditions does garlic have IE?
1) BPH; 2) colds; 3) corns; 4) pre-eclampsia; 5) prostate cancer; 6) warts
What is the dosage of garlic?
3.6-5.4g allicin; 4g=1 clove of fresh; 8mg oil; 600-1200 mg extract - TID for HTN!
What are the interactions of garlic?
1) may induce CYP450 system - inc. bleeding of anticoags; inc. metabolism of NNRTIs and Pis; 2) EC garlic may be more effective
Who is allergic to garlic?
those with allergy to lily
What are garlic’s ADRs?
odor, heartburn, GI upset
What are the sources of ginseng?
roots of: 1) American (WI and Ontario); 2) Panax (Asian and Korean); 3) Siberian (Devil’s bush and Eleuthern)
What is an adaptogen?
substance that increases resistance to stress
What is a tonic?
substance that increases well-being and immune function
What are the proposed benefits of ginseng?
1) adaptogen, tonic, energy; 2) T2DM for reduced post-prandial blood sugar; 3) cold/flu prevention
What is the active component of ginseng?
ginsenoside
What is the dose of ginseng?
100 mg extract BID; 1-2g powder Qday x 2-3 weeks
How does ginsenoside content vary among ginseng sources?
Asian = 1.5%; American = 2%
How is ginseng supplied?
powder and extract
What information should be provided in a ginseng supplement?
1) type, 2) plant part, 3) amount, 4) dosage form
What are ginseng’s interactions?
1) decreases warfarin effect, 2) stimulants, 3) hypoglycemics
When is ginseng contraindicated?
1) pregnant/breastfeeding; 2) breast cancer; 3) insomnia
What are other names for Ginkgo?
fossil tree, maidenhair tree, silver apricot
How long does the ginkgo tree live?
1000 years
What is the most commonly adulterated top-10 supplement and why?
ginkgo - hard to find
What part of the ginkgo tree is used?
leaf extract (Chinese may use fruit)
What components of ginkgo have a biological effect?
1) flavonol glycosides (antioxidant); 2) terpene lactones (vasodilators)
How does ginkgo work its magic?
1) decreased platelet activation, 2) decreased amyloid effects; 3) increased endothelin; 4) increased prostacycling; 5) increased hippocampal excitability via GABA receptors
What are the uses of ginkgo?
1) age-related memory impairment and cognitive function; 2) PVD; 3) dementia; 4) glaucoma; 5) diabetic retinopathy; 6) PMS; 7) Raynauds; 8) vertigo
What is the dosage of ginkgo?
increased until 120-600 mg/day in divided doses
What are the ADRs of ginkgo?
HA, N/V/D, allergic dermatitis; uncooked seeds/pulp = neurotoxic;
What are the functions of ginkgo seeds?
need to be cooked! Antibacterial and antifungal
What are the interactions of ginkgo?
1) anticoags - increased bleeding; 2) decreased effect of anti-epileptics; 3) variable effects on CYP450 system
