complementary meds

Question 1

dietary supplement health & education act

Answer 1

1994

IDs dietary supplements as food supplements and established good manufacturing practices

Question 2

dietary supplement & non-prescription drug consumer protection act

Answer 2

2006

requires manufacturers, packers, & distributers to report serious adverse effects

Question 3

reliable online resources for supplements

Answer 3

USP (seal of approval)
consumer lab (seal of approval)

NIH office of dietary supplements
national center for complementary and alternative medicine

natural medicine comprehensive database
US FDA center for food safety and applied nutrition
natural medicine quality standards
facts & comparisons review of natural products

Question 4

co-enzyme Q10

Answer 4

antioxidant & may maintain muscle function

may decrease serum levels in Parkinson’s disease, decrease BP, lower mortality in HF

HELP W MYALGIAS

AE - well tolerated - GI upset, irritability, dizziness, HA, may decrease effects of warfarin

Question 5

echinacea

Answer 5

used to improve the immune system, anti-inflammatory, common viruses 1-2 weeks

AE - minimal, unpleasant taste, GI upset, rash, avoid in autoimmune disease

Question 6

fish oil

Answer 6

omega 3 fatty acids EPA & DHA

anti-inflammatory, reduction in VLDL, antithrombotic, anti-arrhythmic

used for elevated triglycerides, some HDL, pregnancy for fetal brain development, anti-inflammatory in arthritis, Alzheimer’s

AE - dyspepsia, belching, BLEEDING

Question 7

garlic

Answer 7

inhibit HMG-CoA reductase

used to decrease total cholesterol and triglycerides, possible cancer prevention

AE - bleeding, odor, nausea

Question 8

ginko biloba

Answer 8

improves circulation & perfusion to vital organs

role in dementia and peripheral vascular disease

AE - well tolerated, bleeding

Question 9

ginseng

Answer 9

many effects

possible modulation of immune function, increase levels of catecholamines, antioxidant activity, HPA system, analgesia, vasoregulatory effects, cardioprotective, antiplatelet, improved glucose homeostasis, anti-cancer

most often used to improve physical and mental performance, decrease BG, prevention of cold?

AE - estrogenic - vaginal bleeding mastalgia, insomnia, HTN, bleeding

Question 10

glucosamine

Answer 10

stimulates cartilage to synthesize components of connective tissue

used to improve symptoms of osteoarthritis - mobility, ROM, strength

AE - well tolerated, use sulfate salt, avoid in shellfish allergy?, GI upset, bleeding

Question 11

melatonin

Answer 11

improves circadian rhythm sleep disorders in blind children and adults

decrease sleep latency in primary insomnia

AE - well tolerated, daytime drowsiness, BLEEDING (possibly)

Question 12

milk thistle

Answer 12

anti-inflammatory properties, regenerate liver tissue

used to limit liver injury from toxins, adjunct to chemo, hepatitis tx, stimulate prolactin/lactation

AE - well tolerated, laxative

Question 13

red yeast rice

Answer 13

inhibits HMG-COa reductase

role in hyperlipidema

AE - myalgias, elevated LFTs

Question 14

saw palmetto

Answer 14

role in urinary obstruction associated with BPH, improve sexual function but decrease libido

AE - well tolerated, GI upset, back pain, fatigue, HA

Question 15

st. john’s wart

Answer 15

inhibition of serotonin/ne/da reuptake

used for depression tx, onset 2-4 weeks, dosed TID

AE - photosensitivity, serotonin syndrome, BLEEDING

drug interactions (2C9, 3A4) - digoxin, warfarin, DOACs, contraceptives

Question 16

probiotics mechanism

Answer 16

friendly bacteria to re-colonize areas of the body where bacteria would normally occur

attach to intestinal mucosa and prevent attachment of pathogenic bacteria

AE - flatulence, abx interactions, avoid in immunocompromised

Question 17

bacillus coagulans - flora3

Answer 17

not part of normal flora

used for rotovirus diarrhea, traveler’s diarrhea, abx associated diarrhe

IBs, IBD, C. diff, H. pylori, & prevent resp infections

not recommended at this time

Question 18

bifidobacteria (activa, align)

Answer 18

possibly effective for constipation, H. pylori, IBS, resp tract infections, rotaviral diarrhea, traveler’s diarrhea, UC

Question 19

lactobacillus (Culturelle)

Answer 19

likely effective for rotoviral diarrhea

possibly effective for ABX ASSOCIATED DIARRHEA, eczema & atopic disease, bacterial vaginosis, C. DIFF , H. pylori, INFANTILE COLIC, IBS, prevent resp tract infections, traveler’s diarrhea, UC

Question 20

saccharomyces

Answer 20

likely effective for abx associated diarrhea, diarrhea, acne, C. diff, h. pylori, HIV-related diarrhea, traveler’s diarrhea

Question 21

potentially harmful supplements

Answer 21

androsteneione, bitter orange, black cohosh, comfrey, chaparral, kava, organ/glandular extracts, yohimbe

Question 22

what is concerning about kava?

Answer 22

may cause elevated LFTs

Question 23

what is concerning about bitter orange?

Answer 23

synephrine - concern for tachyarrhythmias and HTN