CSO Meds, Supps, Fxn Foods, Cultures

Question 1

CYP3A4

Answer 1

Inducer = St. John’s wort

Inhibitor = grapefruit juice

Question 2

Busulfan

Answer 2

Avoid aspirin-containing OTC medications

Question 3

Xeloda / Capecitabine

Answer 3

Caution with warfarin
Vitamin B6 – may help prevent/reduce hand-foot syndrome

Question 4

Cetuximab / Erbitux

Answer 4

Watch Mg and Ca closely!

Question 5

Cisplatin / Platinol

Answer 5

HYDRATION! to prevent renal toxicity
Watch RENAL fxn and lytes (mg, ca, na, K+)

Question 6

Cyclophosphamide / Cytoxan

Answer 6

HYDRATION! Educate pts to empty bladder every 2-3 hours during night
Increases the effect of anti-coagulants

Question 7

Dasatinib

Answer 7

Avoid CYP3A4 inducers and inhibitors

Question 8

Erlotinib

Answer 8

Avoid CYP3A4 inducers and inhibitors

Question 9

Flurouracil / 5-FU / Adrucil

Answer 9

Only IV bolus infusions
Melt ICE CHIPS in mouth 10-15 min before and after = to prevent oral mucositis
Vit B6 may help reduce hand-foot syndrome

Question 10

Imatinib / Gleevac

Answer 10

Avoid CYP3A4 inducers and inhibitors

Question 11

Melphalan

Answer 11

Premedicate with antinausea 1 hour before oral dose
Small frequent meals

Question 12

Methotrexate

Answer 12

• *Avoid folic acid** and it’s derivatives during methotrexate drug therapy
• *Avoid ETOH** = increases liver toxicity.

Question 13

Procarbazine / Hydrochloride / Mutalane

Answer 13

• *Low Tyramine** diet during and 2 weeks after = Tyramine can cause HTN or intracranial hemorrhage
• *Avoid ETOH**

Question 14

Tamoxifen / Nolvadex

Answer 14

Avoid antacids within 2 hours
Avoid CYP3A4 inducers and inhibitors

Question 15

Thalidomide / Thalomid

Answer 15

Avoid barbiturates and ETOH

Question 16

Vinblastine / Velban / Vincristine

Answer 16

Avoid CYP3A4 inducers and inhibitors
Can cause constipation = may need stool softeners / laxatives

Question 17

Zometa / Zoledronic Acid

Answer 17

Calcium 500 mg and Vitamin D 400 IU

Question 18

Aloe

Answer 18

May cause diarrhea. May be useful for constipation.
Aloe may delay radiation dermatitis in H&N patients.

Question 19

Alpha -lipoic acid

Answer 19

Antioxidant important for energy production that is naturally synthesized in the body.
May improve insulin sensitivity, reduce neuropathic symptoms and triglycerides and improve QOL.
Examples: Spinach, broccoli, brewer’s yeast

Question 20

Black Cohosh

Answer 20

Supresses symptoms (eg. HOT FLASHES) associated with menopause and cancer treatment
Insufficient evidence to support the use of black cohosh in cancer treatments.

Question 21

Coenzyme Q10

Answer 21

Antioxidant
May reduce renal toxiticity and cardiotoxicity of doxyrubicin.
May have pro-coagulant effects. Can influence efficacy of warfarin. And thus, CONTRAIDICATED IN PATIENTS WHO TAKE WARFARIN!

Question 22

Curcumin

Answer 22

Found in tumeric
Inhibits proliferation of breast cancer cells.
May act to enhance apoptosis.
Enchances anticancer effects of 5-FU and the combination of 5-FU and cisplatin.
Some are combined with piperine (black pepper spice) to improve absorption.

Question 23

Flaxseed

Answer 23

Source of Alpha-Linolenic Acid (Omega-3 fatty acid). Rich in lignans
Soluble and insoluble fibers
Has phytoestrogenic and antioxidant properties. May enhance effects of Tamoxifen.
May affect absorption of some drugs. Medications should be taken 1-2 hours before or after consuming flaxseed.
May help reduce tumor growth in breast cancer
May help lower PSA and slow growth of prostate cancer cells.

Question 24

Garlic

Answer 24

May stimulate apoptosis.
Shows potential as anticancer treatments, however insufficient evidence.
May interfere with activity of some meds, particularly ANTICOAGULANT DRUGS.

Question 25

Ginger

Answer 25

May help with nausea, heartburn, anorexia, diarrhea, gas.
Clinical studies recommend safe daily dose of 1 gm

Question 26

Glutamine

Answer 26

Most abundant non-essential AA in the body. Involved in cell replication for rapid cell turnover in the GI mucosa and immune system.
Reduces severity of stomatitis in HNC.
May reduce degree of mucositis, stomatitis, esophagitis, diarrhea.
Essential for gut health. Reduce inflammation 2/2 to chemo.
Gets depleted with stress such as major surgery, sepsis and cancer
Contraindicated in those taking A_nti-Seizure_ medications and Lactulose.

Question 27

Green Tea

Answer 27

Contains Polyphenol “EGCG” which is composed of catechins.
Demonstrated to inhibit tumorigenesis
Higher consumption linearly reduced Prostate cancer.
Can reduce the toxicity of doxorubicin and idarubicin.

Question 28

Omega-3 Fatty Acids - EPA, DHA

Answer 28

LCFA. Found in fatty fish. Sold as fish oil supplements
May reduce inflammation.
Up to 3gm daily are considered SAFE.
MAY INCREASE BLEEDING risk if taken in high doses, > 4 grams of EPA and DHA.
WHEL study showed consuming more than 73 gm / Day of EPA and DHA from food reduced breast cancer events and all-cause mortality.
May reduce the severity of chemo-induced Oral and Esophageal Mucositis.

Question 29

Quercetin

Answer 29

Flavanoid found in foods (citrus fruits, apples, onions, tea) and sold as a diet supplement.
Can bind to iron and thus, may cause Iron Deficiency!

Question 30

Reishi mushroom

Answer 30

Usually dried and taken as an extract.
Potential for enhancing tumor response and stimulatng host immunity.
Most studied mushroom for it’s Hepatoprotective effects.

Question 31

Resveratrol

Answer 31

Considered to be a Phytoestrogen

Induces re-differentiation and apoptosis.

Potential radiosensitizer of breast cancer cells.

1 gm/kg may help prevent bone loss caused by methotrexate.

Found in grapes. Skins of grapes rich in Reveratrol.

Question 32

St. John’s Wort

Answer 32

Avoid St. John’s Wort with all concurrent chemotherapy due to the possible effects on enzyme induction for multiple enzymes.

Is a bush. Has yellow flowers that are used as herbal remedies.

May interact with Warfarin.

May have the potential to improve anticancer effects. BUT currently still insufficient data.

Induces cytochrome P-450 (CYP) 3A4 which results in lower plasma of drugs that are CYP3A4 substrates.

Question 33

Turkey Tail mushroom

Answer 33

Seen in ancient Chinese medicine.

Numerous studies confirm inibits the growth of cancer cells, as well as decreases cancer treatment-related adverse effets such as fatigue, loss of appetite, nausea, vomiting, and pain.

Appears to protect against the adverse effects of radiation.

Generally safe and very well tolerated.

Common dosage = 3 gm extract daily.

Question 34

Vitamin D

Answer 34

Fat-Soluble Vitamin

Anti-Inflammatory, Immunomodulatory, Bone Protective and AntiCancer effects. Helps regulate genes that influence cell proliferations, differentiation and apoptosis.

Helps with controlling factors that may protect against Colon Cancer.

Important for overall health, including cancer prevention.

25-Hydroxyvitamin D - has longer half-life than 1,25 Dihydroxyvitamin D (15 DAYS vs. 15 hours).

Bioavailability of Vitamin D3 (cholecalciferol) is greater than Vitamin D2 (ergocalciferol)

UI level = 4,000 IU / day

Ideal blood maintenace level of 25-hydroxyvitamin D = 40-60 ng/mL.

Question 35

Islam/Halal

Answer 35

Meats should be slaughtered under Halal guidance; pork is not allowed. Generally, foods that are kosher are also accepted under Halal. The major exception is alcohol, which is banned under Halal. For strict observers, this may mean not eating foods cooked with vanilla extract. There are numerous guidelines for fasting, particularly during Ramadan.

Ramadan , also spelled Ramazan, Ramzan, Ramadhan or Ramathan, is the ninth month of the Islamic calendar, observed by Muslims worldwide as a month of fasting (sawm), prayer, reflection and community.

Question 36

Judaism/Kosher

Answer 36

This extremely complex set of guidelines includes restrictions on how meat is slaughtered, which animals/birds/seafood may be eaten (most famously pork and shellfish are not allowed), the part of the animal that can be eaten, who makes certain foods, combinations of foods, avoiding contamination, what can be eaten on religious holidays, and more. Many non-Jewish people prefer foods labeled kosher because they believe them to be cleaner / more strictly prepared.

Kosher Food Categories

It starts out simple. Kosher foods fall into three categories: meat, dairy, and “pareve,” sometimes spelled “parve.”

Meat. Kosher meat comes from animals that have split hooves – like cows, sheep, and goats – and chew their cud. When these types of animals eat, partially digested food (cud) returns from the stomach for them to chew again. Pigs, for example, have split hooves, but they don’t chew their cud. So pork isn’t kosher.

Jewish dietary law governs the method of slaughter and processing and the slaughterhouse equipment. Meat isn’t kosher if the animal died naturally. Certain parts of an animal, including types of fat, nerves, and all of the blood, are never kosher.

Dairy. All dairy products, like milk, butter, yogurt, and cheese, must come from a kosher animal. All ingredients and equipment used to produce it have to be kosher, too.

Pareve. This is the category for kosher foods that aren’t meat or dairy. It covers everything from eggs and fish to fruits, vegetables, pasta, coffee, and packaged foods.

There are multiple layers of laws beneath these three. Here are just a few:

You can’t eat milk and meat products at the same time, put them on the same dishes, or prepare or eat them with the same utensils. You also have to wait a certain amount of time to eat milk after meat and vice versa.

Fish is kosher if it has both fins and scales, like salmon, bass, or trout.

Sea creatures that don’t have fins and scales aren’t kosher. This includes shellfish, crabs, shrimp, and lobster.

Only a few cheeses are kosher. Cheeses must be made with rennet from kosher animals, vegetables, or from microbial sources in order to be considered kosher. In addition, animal-based rennet can only be considered kosher if the source-animals were slaughtered according the traditional Jewish method of ritualistic slaughtering.

Question 37

Hinduism

Answer 37

A lactovegetarian diet is followed by many Hindus – no meat, poultry or fish, no eggs, but milk products are allowed and encouraged. Beef is prohibited, as the cow is considered sacred. Brahmins may have restrictions on who prepares their food and how it is stored. There are many fasting days and periods in the calendar, with restrictions such as eating only plant foods.

Question 38

Christianity

Answer 38

Catholicism: Devout Catholics fast on holy days and periods.

Eastern orthodox

Practicing orthodox Christians follow a number of fasts. Weekly fasts include abstention from meat, fish, eggs, dairy, and sometimes other foods such as olive oil and alcohol as well. Other fasts are longer and exclude some or all of the foods avoided in the weekly fasts.

Seventh-Day Adventist:Seventh-Day Adventists are LACTO-OVO-vegetarians – they avoid meat, poultry and fish but eat milk and egg products. Alcohol is also prohibited.

Question 39

Mormonism

Answer 39

Mormonism prohibits alcohol and caffeine (in coffee, tea, chocolate etc.).

Question 40

Oxaliplatin / Eloxatin

Answer 40

To prevent pharyngolaryngeal dysesthesia, minimize exposure to cold for up to 5 days post-treatment.