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Dietary Supplements Flashcards

1
Q

Complementary medicine refers to…

A

health practices (eg. dietary supplements and acupuncture) that are used with conventional medicine

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2
Q

Dietary supplements are regulated by the…

A

Dietary Supplement Health and Education Act (DSHEA) of 1994

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3
Q

Adverse events from supplements can be reported to the…

A

FDA’s Safety Reporting Portal

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4
Q

FDAble is…

A

a searchable database of adverse events caused by dietary supplements, medications, devices and tobacco products

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5
Q

Good manufacturing practices (GMPs) and adverse event reporting are…

A

required by law

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6
Q

Manufacturers cannot make claims that…

A

the product treats or cures a condition

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7
Q

Four areas of concern are supplements…

A

that interact with Rx drugs, increased bleeding risk, or cause heart/liver toxicity

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8
Q

St. John’s Wort (for depression) has several important drug interactions:

A
  • Induces CYP450 3A4, 2C19, 2C9, 1A2, and P-gp, which lowers levels of other drugs (~75%)
  • Do not combine with many drugs (OCs, warfarin, transplant drugs)
  • serotonergic (do not use with MAO inhibitors)
  • causes photosensitivity (counsel)
  • may lower the seizure threshold
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9
Q

Increase bleeding risk: “5 Gs”

A
  • 5 Gs: garlic, ginger, gingko biloba, ginseng, glucosamine
  • fish oils (at higher doses)
  • vitamin E
  • dong quai
  • willow bark (salicylate); do not use with anticoagulants
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10
Q

Liver toxic

A
  • black cohosh (used for menopausal symptoms)
  • kava (for stress/anxiety)
  • chaparral, comfrey
  • green tea “extracts”
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11
Q

Heart toxic

A
  • ephedra (removed from market). Bitter orange replaced ephedra in many products. It contains Synephrine, an isomer of phenylephrine. (stimulants, increase BP and HR)
  • DMAA (dimethylamylamine) is an amphetamine derivative that is used in body-building/performance-enhancement products.
  • Licorice contains glycyrrhizin (can lower K and increase BP)
  • Yohimbe is used to increase libido and for ED (raises BP, increases HR, and has a risk of seizure)
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12
Q

caffeine (in excess); aka yerba mate; guarana

A

can raise BP and increase HR

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13
Q

B vitamins

A 
B1- thiamine
B2- riboflavin 
B3- niacin
B6- pyridoxine
B9- folic acid 
B12- cobalamin
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14
Q

The American Academy of Pediatrics (AAP) makes the following recommendation for vitamin D:

A
  • Exclusively breastfed infants or babies drinking <1 L of baby formula need 400 IU of vitamin D daily. Ex. Poly-Vi-Sol
  • Older children who do not drink at least 4 cups of vitamin D fortified milk also need vitamin D supplementation
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15
Q

All women of childbearing age should obtain…

A

400 mcg/day of folic acid. Folate should be taken at least 1 month before pregnancy and be continued for the first 2-3 months of pregnancy.

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16
Q

During pregnancy, folate requirements increase to 600 mcg/day. Rx prenatal vitamins usually contain…

A

1,000 mcg, or 1 mg, of folate

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17
Q

Breastfed babies need 1 mg/kg/day from 4-6 months old and until…

A

consuming iron-rich foods.

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18
Q

Alcoholism. Recommend supplementing with…

A

vitamin B1 (thiamine), folate

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19
Q

microcytic anemia. Recommend supplementing with…

A

ferrous sulfate

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20
Q

macrocytic anemia. Recommend supplementing with…

A

vitamin B12 and/or folate

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21
Q

Pregnancy. Recommend supplementing with…

A

folate, Ca, Vitamin D, pyridoxine (Vit B6) for nausea

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22
Q

osteopenia/osteoporosis/osteomalacia (Rickets)

A

Ca, Vitamin D

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23
Q

CKD

A

Vitamin D

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24
Q

Scurvy

25
Q

Crohn’s Disease (and possibly UC)

A

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

26
Q

acetazolamide can deplete…

27
Q

antiepileptics can deplete…

28
Q

amphotericin B can deplete…

29
Q

Isoniazid can deplete…

A

vitamin B6 (pyridoxine)

30
Q

Loop diuretics can deplete…

31
Q

Metformin can deplete…

A

Vitamin B12

32
Q

Methotrexate can deplete…

33
Q

Orlistat can deplete…

A

beta-carotene, fat-soluble vitamins (supplement)

34
Q

PPIs can deplete…

A

Mg, vitamin B12 ( >2 years of tx)

35
Q

Sulfamethoxazole can deplete…

36
Q

chondroitin safety issue

A

bleeding risk at higher doses; increased INR with warfarin

37
Q

dong quai safety issue

A

increased bleeding risk (eg. with concurrent use of anticoagulants, antiplatelets, salicylates)

38
Q

echinacea safety issue

A

controversial safety issue with autoimmune disorders; use cautiously with other members of Asteraceae family

39
Q

evening primrose oil; provides essential fatty acids (gamma-linoleic acid, or GLA)

A

Provides essential fatty acids, anti-inflammatory

40
Q

feverfew (for migraines) safety issue

A

Mouth ulceration (inflammation of the oral cavity/tongue); increased bleeding risk (eg. with concurrent use of anticoagulants, antiplatelets, salicylates)

41
Q

Fibers (barley, psyllium, oat bran) safety issue

A

GI effects, if the body is not used to fiber intake

42
Q

Garcinia cambogia safety issue

A

may be serotonergic

43
Q

Hawthorn (for heart health) safety issue

A

positive inotrope; avoid concurrent use with digoxin (additive effect), decrease BP; caution for additive effect with BP-lowering drugs

44
Q

L-arginine (for HTN) safety issue

A

L-arginine converts into nitric oxide (NO), decreases BP, and increases dizziness. Avoid concurrent use with nitrates

45
Q

Melatonin (for sleep) safety issue

A

when used chronically, endogenous melatonin can be decreased, resulting in dependency for sleep

46
Q

Omega-3 fatty acids, “fish oils”. safety issue

A

Increased bleeding risk with high doses, can increase LDL

47
Q

Passionflower (for anxiety) safety issue

A

QT prolongation; avoid with QT risk/other drugs

48
Q

Probiotics safety issue

A

Separate use from oral antibiotics, safety concern with use of live bacteria in immune-compromised states

49
Q

Red yeast rice (contains a natural form of lovastatin) safety issue

A

CYP450 inhibitors (eg. amiodarone) will increase red yeast level; decreases coenzyme Q10, which may increase myopathy risk; do not use with statins

50
Q

SAMe (used for depression, osteoarthritis) safety issue

A

Serotonergic, increased risk with other serotonergic drugs. Increased bleeding risk, do not use in bipolar due to increased risk manic behavior

51
Q

Soy, red clover, panax ginseng mild phyto-(plant) estrogens (for menopause) safety issue

A

Soy might increase breast cancer risk in postmenopausal women, wo are not producing estradiol

52
Q

Valerian (for anxiety) safety issue

A

sedation, CNS depressant; risk with concurrent CNS depressants

53
Q

vinpocetine (for memory) safety issue

A

semi-synthetic and derived from a plant product; FDA issued a warning for fetal harm

54
Q

vitamin C safety issue

A

False-negative stool occult blood 48-72 hours after ascorbic acid ingestion

55
Q

vitamin E safety issue

A

Do not exceed 400 IU daily; bleeding risk, CVD risk

56
Q

yohimbe (for libido and ED) safety issue

A

increased BP, HR, seizure risk

57
Q

zinc safety issue

A

nasal products can cause loss of smell

58
Q

Iron-only supplements

A
  • Fer-In-Sol Iron Supplement drops

- Feosol tablets and caplets

59
Q

Poly-Vi-Sol Vitamin D drops with iron

A

use if both vitamin D and iron are needed

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