Dietary Suppl. Natural and Complementary medicine Flashcards
define alternative vs complementary vs. conventional medicine vs. natural medicine
alternative - is medicine used when conventional medicine is not
conventional medicine is prescriptions
complementary medicine is when health practices like dietary supp. and chiropractors are used along with conventional medicine
natural medicine means herbs (plant products), vitamins, minerals and any substance derived from nature (not synthetic)
Who regulates rules for dietary supplements and what are the rules
FDA (law) requires supplements to have good manufacturing practices and report adverse events. FDA can remove supplement from shelves if its found to be unsafe.
The United States Pharmacopeia (USP) tests and confirms for good manufacturing practices and can put a seal/sticker on bottles as a verification (choose to use these)
Dietary Supplement Health and Education Act of 1994 (DSHEA) requires that manufacturers ensure safety of products before they are marketed
What proof is not required for supplements to have and what claims can they make on labeling
Proof of safety and efficacy are not required by law before marketing for supplements (for drugs, they are required before marketing)
Health claims about the supp. usefulness, treatment, cure, or mitigate in certain diseases is not allowed (ex: treats arthritis). Drug claims are based on FDA approval.
Health claims about function and structures are allowed (ex: supports strong joint function) BUT they must state a disclaimer that says “The FDA has not evaluated the claim”
What is the reference for natural medicine
Natural Medicines Database
The USP
What are the four areas of major concern we need to look out for in patients on supplements
interactions with rx
increased bleeding risk
hepatotoxicity
cardiotoxicity
Folic acid 600 mcg DFE is equivalent to how many mcg of folic acid daily
360 mcg of folic acid daily (this is the recommended daily allowance for women of child bearing age.
what is RDI or RDA
recommended daily intake or recommended daily allowance (listed on the bottles for dietary supp)
Random fact: metoprolol treatment in HF patients must be immediate release or extended release?
extended release
What are the concerns with a patient on St. John’s wort
St. John’s is an inducer of CYP 3a4, 2C9, 2c19, and 1A2 and Pgp, which causes lower levels of drugs/low efficacy . NEVER use with Oral contraceptives, transplant drugs, or warfarin (never allow any supplements with a patient on warfarin)
It’s serotinergic, so it can lead to serotonin syndrome - NEVER use with MOA inhibitors like linezolid (isocarboxazid, phenelzine, selegiline, and tranylcypromine) - these are drugs for depression and parkinsons disease. NEVER use with SNRIs or SSRIs
Photosenstivity occurs, so use sun protection (esp. with other photosensitivity drugs like: sulfamethoxazole, retinoids, diuretics, quinolones, tetracyclines, and transplant drugs)
Lower seizure threshold and increase exacerbation of seizures. (esp. with other drugs that lower the seizure threshold: bupropion, quinolones, tramadol, penicillin, carbapenems)
Which natural medicines increase bleeding risk
The five G’s: ginko - for memory, garlic, ginger, gensing, and glucosamine (decreasing platelet aggregation and increase bleed risk)
Fish oils at higher doses
Vitamin E - antioxidant for vision, skin, brain etc.
Dong quai - menstrual and menopausal use
Willow bark (a salicylate) - never use use with anticoags
