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NAPLEX 2024 > 80. Dietary Supplements, Natural + Complementary Medicine > Flashcards

80. Dietary Supplements, Natural + Complementary Medicine Flashcards

1
Q

____ establishes standards for dietary supplements

A

The United States Pharmacopeia (USP)

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2
Q

T/F: supplements have to be approved by the FDA before being on the market

A

False - safety is the manufacturer’s responsibility, would have to be proved “unsafe” by FDA in order to be taken off the market

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3
Q

What enzymes does St. John’s Wort affect?

A

SJW induces CYP3A4, 2C19, 2C9, and 1A2, and P-gp (decreases level of other drugs)

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4
Q

What are some interactions to be careful of when using St. John’s Wort?

A
  1. CYP450 and P-gp inducer = decreases level of other drugs
  2. serotonergic (do NOT use with MAOi, SSRIs, or SNRIs)
  3. Photosensitivity and sun protection needed (caution with diuretics, retinoids, quinolones, sulfamethoxazole, tetracyclines, and transplant drugs)
  4. may lower seizure threshold (caution with bupropion, quinolones, tramadol, PCN, and carbapenems or hx of seizures)
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5
Q

Which supplements increase risk of bleeding?

A

5Gs: garlic, ginger, ginko, ginseng, and glucosamine
Fish oils (at higher doses )
Vit E
Dong quai
Willow bark (a salicylate) - do not use with other anticoags

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6
Q

What supplements increase risk of liver toxicity?

A

Black cohosh (used for menopausal symptoms)
Kava (used for stress/anxiety)
Others: Chaparral, comfrey, green tea “extracts”

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7
Q

Which supplements increase risk of cardiac toxicity?

A

Ephedra - removed d/t cardiac toxicity
Bitter orange (citrus aurantium or synephrine) replaced ephedra in many products (stimulants with dose-dependent cardiac toxicity, increase BP and HR, reports of MI, stroke, and arrhythmias)

Yohimbe (used for libido and ED) - increases BP, HR, and risk of seizures

Others:
DMAA (dimethylamylamine, amphetamine derivative for body-building ,increases BP and HR)
Licorice (contains glycyrrhizin, artificially flavored licorice do NOT have this compound, glycyrrhizin in large amounts can lower K and increase BP)

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8
Q

What affects does caffeine have on the heart?

A

May increase BP and HR

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9
Q

Commonly used supplements for Anxiety

A

Valerian
Passionflower
Kava
St. John’s wort

Others: chamomile, 5-hydroxytryptophan (5-HTP)

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10
Q

Commonly used supplements for ADHD

A

Omega-3 fatty acids

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11
Q

Commonly used supplements for cold sores

A

L-lysine

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12
Q

Commonly used supplements for colds and flu

A

Echinacea
Zinc
Vit C

Others: eucalyptus oil (nasal congestion/allergies), probiotics

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13
Q

Commonly used supplements for dementia/memory

A

Ginkgo
Vitamin E

Others: Vit D, acetyl-L-carnitine, vinpocetine (memory, neuroprotection, weight loss)

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14
Q

Commonly used supplements for depression

A

St. John’s wort
SAMe (S-adenosyl-L-methionine) (for depression, osteoarthritis)
Valerian
5-HTP

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15
Q

Commonly used supplements for DM

A

Alpha lipoic acid (diabetic neuropathy, memory, neuroprotection)
Chromium
Cassia cinnamon

Others: Mg, American ginseng, Panax ginseng

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16
Q

Commonly used supplements for HLD

A

Red yeast rice (contains a natural form of lovastatin)
Omega-3 fatty acids
Others: Garlic (controversial benefit; small decrease TC and LDL), Plant sterol, fibers (barley, psyllium, oat bran), artichoke extract

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17
Q

Commonly used supplements for dyspepsia

A

Calcium
Magnesium

Others: peppermint, chamomile

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18
Q

Commonly used supplements for energy/weight loss

A

Bitter orange (synephrine)
Caffeine
Guarana, green tea powder (contains caffeine)

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19
Q

Commonly used supplements for erectile dysfunction

A

Ginseng
L-arginine
Yohimbe

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20
Q

Commonly used supplements for HF, heart health

A

Coenzyme Q10 (ubiquinone, used adj with HF meds
Hawthorn
Omega-3 fatty acids

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21
Q

Commonly used supplements for HTN

A

Omega-3 fatty acids
L-arginine
Coenzyme Q10
Garlic (controversial benefit; small decrease in SBP)
Other: fiber (psyllium, oats, and wheat bran), potassium

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22
Q

Commonly used supplements for GI health

A

Fibers (for diarrhea, constipation; examples: psyllium (in Metamucil, barley, oat bran))
Chamomile
Probiotics
Others: peppermint, horehound (GI health, constipation), wheatgrass (GI health, detox)

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23
Q

Commonly used supplements for inflammation

A

Omega-3 fatty acids
Flax seeds/oil (converted to DHA and EPA
Tumeric

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24
Q

Commonly used supplements for insomnia/sleep

A

Melatonin (nightly, help prevent/treat jet lag (0.5-2mg taken pre-flight and higher doses such as 5mg post-flight)
Valerian
Chamomile
Others: lemon balm, passionflower, Coenzyme Q10 (if d/t HF), 5-HTP and L-trptophan

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25
Q

Commonly used supplements for Liver disease

A

Milk thistle

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26
Q

Commonly used supplements for menopause

A

Black cohosh
Dong quai
Evening primrose oil
Soy, red clover

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27
Q

Commonly used supplements for migraine prophylaxis

A

Feverfew
Butterbur
Magnesium
Riboflavin (vit B2)
Others: Coenzyme Q10, guarana (for caffeine) or other caffeine sources

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28
Q

Commonly used supplements for Motion sickness

A

Ginger
Peppermint

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29
Q

Commonly used supplements for Osteoarthritis

A

Glucosamine (best evidence with sulfate salts)
Chondroitin
SAMe (used for depression, osteoarthritis)
Tumeric (decrease inflammation/pain)

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30
Q

Commonly used supplements for Osteoporosis

A

Calcium
Vit D
Soy
Other: ipriflavone

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31
Q

Commonly used supplements for prostate health

A

Saw palmetto (used often, may be ineffective)
Lycopene
Others: Pygeum, pumpkin seed (contains beta-sitosterol)

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32
Q

Commonly used supplements for UTI

A

Cranberry
Others: yogurt, probiotics

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33
Q

Commonly used supplements for skin conditions

A

Tea tree oil (for acne, dandruff, fungal infections)
Others: alo vera, topica vit D, biotin

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34
Q

Commonly used supplements for weight loss

A

Garcinia cambogia

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35
Q

Safety issues with 5-HTP

A

Serotonergic - increased risk with other serotonergic meds

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36
Q

Safety issues with bitter orange (synephrine component)

A

Stimulant; dose-related increased BP, HR, arrhythmia risk

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37
Q

Safety issues with Black cohosh

A

May be hepatotoxic
Do NOT use with meds for HF: ACEi/ARBs, BB, amiodarone

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38
Q

Safety issues with caffeine (includes guarana, green tea powder)

A

Increased BP and HR
others: dizziness, agitation, irritability

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39
Q

Safety issues with chamomile

A

Allergic reactions (uncommon), cross-sensitivity with other members of Asteraceae family (e.g. ragweed, asters, chrysanthemums, artichoke)

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40
Q

Safety issues with chondroitin

A

Increased risk of bleeding at higher dose, increases INR with warfarin

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41
Q

Safety issues with dong quai

A

Increased bleeding risk

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42
Q

Safety issues with Echinacea

A

Controversial safety with autoimmune disorders
Use cautiously with other members of Asteraceae family (e.g. ragweed, asters, chamomile, chrysanthemums, artichoke)

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43
Q

Safety issues with feverfew

A

Mouth ulceration (inflammation of oral cavity/tongue)
Increased bleeding risk

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44
Q

Safety issues with fibers (barley, psyllium, oat bran)

A

GI effects (e.g.. bloating, cramping, flatulence)

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45
Q

Safety issues with garlic, ginger, ginko, ginseng, glucosamine

A

Increased risk of bleeding

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46
Q

Safety issues with Hawtorn

A

Positive inotrope
Avoid concurrent use with digoxin (Additive effect), decreases BP

47
Q

Safety issues with Kava

A

Avoid d/t hepatotoxicity

48
Q

Safety issues with L-arginine

A

May decrease BP and increase dizziness
Caution for additive effect with BP lowering drugs
Avoid concurrent use with nitrates (L-arginine converts into nitric oxide)

49
Q

Safety issues with Melatonin

A

When used chronically for sleep, endogenous melatonin can be decreased = dependency

50
Q

Safety issues with omega-3 fatty acids

A

Increase bleeding risk with high doses
May increase LDL

51
Q

Safety issues with passionflower

A

QT prolongation

52
Q

Safety issues with potassium

A

K levels should be measured in lab and dosed accordingly (not with OTC supps)

53
Q

Safety issues with probiotics

A

Separate use from oral abx
Safety concern with use of live bacteria in immunocompromised states

54
Q

Safety issues with red yeast rice (contains natural form of lovastatin)

A

CYP450 inhibitors will increase red yeast rice levels
Red yeast rice decreases coenzyme Q10 which may increase myopathy risk
Do NOT use with statins

55
Q

Safety issues with SAMe

A

Serotonergic - increased risk with other serotonergic drugs
Increased bleeding risk
Do NOT use in bipolar disorder d/t increased risk manic behavior

56
Q

Safety issues with Soy, red clover

A

Soy may increase breast cancer risk in postmenopausal women who are not producing estradiol

57
Q

Safety issues with St. John’s Wort

A

Many drug interactions - Induces CYP450 and P-gp
Serotonergic
Photosensitivity

58
Q

Safety issues with Valerian

A

Sedation
CNS depressant

59
Q

Safety issues with vitamin C (ascorbic acid)

A

Nephrolithiasis with high doses
False-negative stool occult blood 48-72 hrs after ascorbic acid ingestion

60
Q

Safety issues with vitamin E (alpha-tocopherol)

A

Do NOT exceed 400 IU daily
Bleeding risk
CVD risk

61
Q

Safety issues with Yohimbe

A

Increased BP and HR
Seizure risk

62
Q

Safety issues with Zinc

A

Nasal products can cause loss of smell

63
Q

Vitamin A name

64
Q

Vitamin B1 name

65
Q

Vitamin B2 name

A

Riboflavin

66
Q

Vitamin B3 name

67
Q

Vitamin B6 name

A

Pyridoxine

68
Q

Vitamin B9 name

A

Folic acid

69
Q

Vitamin B12 name

70
Q

Vitamin C name

A

Ascorbic acid

71
Q

Vitamin D2 name

A

Ergocalciferol

72
Q

Vitamin D3 name

A

Cholecalciferol

73
Q

Vitamin E name

A

Alpha-tocopherol

74
Q

____ vitamin deficiency is common in alcoholism and can cause ____ encephalopathy

A

Thiamine (vit B1)
Wernicke’s

75
Q

S/sx of Wernicke’s

A

Mental confusion, ataxia, tremor, vision changes

76
Q

As the symptoms of Wernicke’s fade, ___ syndrome tends to develop which is permanent neurologic damage

A

Korsakoff syndrome

77
Q

What type of med can contribute to calcium deficiency?

A

Anticonvulsants

78
Q

The American Academy of Pediatrics (AAP) recommends vitamin D for infants and children in certain situations. What are they?

A
  1. exclusively breastfed babies or drinking less than 1 L of baby formula - need 400 IU of vit D
  2. older children who do not drink at least 4 cups of vit D fortified milk
79
Q

All women of childbearing age should obtain ____ of folic acid

A

400mcg/day

80
Q

During pregnancy, folate requirements increase to ____ per day

A

600 mcg/day

81
Q

When should patients start taking folic acid?

A

at least 1 month before pregnancy
continue for first 2-3 months of pregnancy (probably will be throughout pregnancy)

82
Q

Prescription prenatal vitamins usually contain ___ of folate

A

1000 mcg (1mg) of folate

83
Q

___ and __ contain the potassium-sparing progestin drospirenone, with ethinyl estridiol and levomefolate

A

Beyaz
Safyral

84
Q

Vit E in foods is considered healthy, but excess intake of supplements can be a health risk, particularly ____ risk
patients should NOT exceed ___ daily

A

CV risk
400 IU daily

85
Q

American Academy of Pediatrics (AAP) recommendations for Iron: 0-4 months

A

Not required

86
Q

American Academy of Pediatrics (AAP) recommendations for Iron: 4-6 months

A

Formula - not needed (usually in formula)
Breastfed babies need 1mg/kg/day from 4-6 months until consuming iron-rich foods

87
Q

American Academy of Pediatrics (AAP) recommendations for Iron: 6-12 months

A

Need 11 mg/day of iron
Food sources preferred, supplement prn

88
Q

American Academy of Pediatrics (AAP) recommendations for Iron: 1-3 years

A

Need 7 mg/day of iron
Food sources preferred, supplement prn

89
Q

Preterm (<37 weeks) breastfed infants should receive ___ of elemental iron supplementation from age ___ to ___

A

2mg/kg/day
age 1-12 months

90
Q

Adolescent girls are at risk of ___ once menstruation begins.

91
Q

What formulation are Fer-In-Sol supplements?

A

Iron supplement drops

92
Q

What formulation are Feosol supplements?

A

Tablets and caplets

93
Q

When would you use Poly-Vi-Sol supplements?

A

Vitamin drops with iron - use if both vit D AND iron are needed

94
Q

Antiepileptics (includes carbamaepine, lamotrigine, oxcarbazepine, phenobarbital/primidone, phenytoin, topiramate, valproic acid/divalproex, zonisamide) can cause ___ nutrient depletion

A

Calcium (supplementation usually required, with vit D if needed)

95
Q

Amphotericin B can cause ___ nutrient depletion

96
Q

Isoniazid can cause ___ nutrient depletion

97
Q

Loop diuretics can cause ___ nutrient depletion

98
Q

Metformin can cause ___ nutrient depletion

99
Q

Methotrexate can cause ___ nutrient depletion

100
Q

Orlistat can cause ___ nutrient depletion

A

Beta-carotene, fat-soluble vitamins

101
Q

PPIs can cause ___ nutrient depletion

A

Mg, Vit B12 (>2 yrs of treatment)

102
Q

Acetazolamide can cause ___ nutrient depletion

A

Calcium, K

103
Q

Sulfamethoxazole can cause ___ nutrient depletion

104
Q

___ supplement is recommended in patients with alcohol use disorder

A

Vitamin B1, folate

105
Q

___ supplement is recommended in patients with goiter

A

Iodine (iodized salt)

106
Q

___ supplement is recommended in patients with microcytic anemia

A

Ferrous sulfate

107
Q

___ supplement is recommended in patients with macrocytic anemia

A

Vit B12 and/or folate

108
Q

___ supplement is recommended in patients with pregnancy

A

Folate, calcium, vit D, pyridoxine (nausea)

109
Q

___ supplement is recommended in patients with osteopenia/osteoporosis

A

Calcium, vit D

110
Q

___ supplement is recommended in patients with CKD

111
Q

Patient brings in a Rx for orlistat. Which vitamins should the patient take while on this medication?

A

Vitamin A, D, E, and K (fat soluble vitamins)

112
Q

T/F: all agents used to increase bone density should be taken with supplemental calcium and vit D

A

True - they require adequate calcium and vitamin D intake

113
Q

___ supplement is recommended in patients with scurvy

114
Q

___ supplement is recommended in patients with Crohn’s Disease (possibly ulcerative colitis)

A

Patient-specific, depends on levels; can require iron, zinc, folate, calcium, vit D, B vitamins

NAPLEX 2024 (74 decks)

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