Dietary Supplements Flashcards
What are considered dietary supplements?
Vitamins, minerals, fiber, fatty acids, herbs, and amino acids
What are some disadvantages to dietary supplement use?
Little Testing
Unsubstantiated therapeutic claims
Why don’t dietary supplements have to go through the same testing as medication?
The U.S. Food and Drug Administration considers these substances “Foods.”
Why aren’t dietary supplements sometimes considered for the cause an issue during anesthesia?
Nearly 70% of patients taking a dietary supplement did not provide that information during a routine anesthetic assessment.
What are the two types of interactions between dietary supplements and medications?
Pharmacokinetic Interactions
Pharmacodynamic Interactions
Define Pharmacokinetic Interactions between dietary supplements and medications.
These are interactions that result from alterations to the cytochrome P450 (CYP450) pathway by the dietary supplement (Enzyme induction or inhibition)
Define Pharmacodynamic interactions between dietary supplements and medications.
These interactions result from the interplay of the effects caused by the dietary supplement and the medication.
Similar effects cause an additive effect
Opposing effects cause a reduction in effect
Define Pharmacodynamic interactions between dietary supplements and medications.
These interactions result from the interplay of the effects caused by the dietary supplement and the medication.
Similar effects cause an additive effect
Opposing effects cause a reduction in effect
When does the ASA recommend discontinuing supplements prior to anesthesia?
The American Society of Anesthesiologists recommends discontinuation 2-3 weeks prior to surgery
When can supplements be restarted after surgery?
Dietary supplements should not be restarted until all medications have been discontinued and a period equal to five half-lives of the discontinued medications has elapsed.
What is the function of vitamin D?
Maintains plasma concentrations of calcium and phosphate for optimal neuromuscular function and bone mineralization
What can occur if a patient has a Vitamin D deficiency?
Leads to poor intestinal absorption of calcium and phosphate
Causes stimulation of PTH to restore the plasma concentration causing osteomalacia
What is the function of Vitamin K?
Essential for biosynthesis of clotting factors: converts glutamic acid residues to gamma-carboxyglutamic acid residues in Factors II, VII, IX, and X
What can occur if a patient has a deficiency of Vitamin K?
Hypoprothrombinemia
When should an anesthetic provider be concerned with serum Vitamin K levels?
Order coags and LFTs on a patient with liver impairment
What is the function of thiamine?
Metabolism of carbohydrates, alcohol, and amino acids
What can deficiencies of Thiamine lead to?
Mild: Beriberi-loss of appetite, skeletal muscle weakness, decreased BP, and hypothermia
Severe: Wernicke-Korsakoff Syndrome-memory impairment, encephalopathy that can occur as a result of chronic alcohol dependence
What is the Thiamine deficiency related to?
Chronic alcohol abuse
What is the function of Vitamin B12?
Metabolic processes, DNA synthesis, myelin synthesis, decreases blood homocysteine levels
What is the function of Vitamin B12?
Metabolic processes, DNA synthesis, myelin synthesis, decreases blood homocysteine levels
What can a deficiency of B12 lead to?
Megaloblastic anemia, peripheral neuropathies, and gastrointestinal symptoms
Prevents synthesis of adequate supplies required for DNA synthesis
What is the function of folic acid?
DNA synthesis, decreases blood homocysteine levels
What can a deficiency of folic acid lead to?
Megaloblastic anemia, birth defects
What birth defect is folic acid related to?
Spina bifida
When does the ASA recommend discontinuing herbal supplements prior to surgery?
The American Society of Anesthesiology recommends all herbal medication to be discontinued 2-3 weeks before surgery
How can herbal supplements affect anesthesia?
Increased surgical bleeding Heart and blood pressure effects Respiratory complications, MI or Stroke Renal disturbances Reactions with sedatives Changes in the body’s interactions with other medications Higher anesthetic consumption Delayed recovery from anesthesia
What is the most popular herbal remedy used in US?
Echinacea
What do people typically take Echinacea for?
Improves immune system
Used to prevent and treat viral, bacterial, and fungal infections
What is the mechanism of action of Echinacea?
Modulates cytokine signaling; stimulates macrophages and NK cells
What population should Echinacea be used with caution?
Caution use in patients with asthma and atopic or allergic rhinitis due to possible allergic and anaphylactic reactions
What is garlic used to treat?
Hypertension, hyperlipidemia, atherosclerosis, diabetes, infections, and tumors
What is the mechanism of action of Garlic?
Cysteine found in garlic decreases thromboxane formation and alters arachidonic acid metabolism; inhibits platelet aggregation
What medication should be used with caution if a patient is taking garlic?
Can potentiate anti-platelet effects of aspirin and NSAIDs
What is ginger used to treat?
Used as an anti-inflammatory, anti-emetic, and GI stimulant
What is the mechanism of action of ginger?
Inhibits thromboxane synthetase enzyme; inhibits peripheral and central serotonergic pathways
What should be considered, especially to by the surgeon if the patient has taken ginger?
Consideration for bleeding especially when used with NSAIDs and Warfarin
What should be considered, especially to by the surgeon if the patient has taken ginger?
Consideration for bleeding especially when used with NSAIDs and Warfarin
What is Gingko used to treat?
Used to treat peripheral vascular disease and dementia by protecting vascular walls and nerve cells
What is the mechanism of action of Gingko?
Free radical scavenger; inhibits platelet activating factor; effects vasoregulation, modulation of neurotransmitter, and receptor activity
What medication interactions are we concerned with if a patient has taken Gingko?
Avoid use in combination with NSAIDs, Aspirin, and Warfarin due to risk for bleeding
What is the most expensive herbal supplement used world wide?
Ginseng
What is Ginseng used for?
Immunomodulation, mood enhancement, and aphrodisiac effects
What is the mechanism of action of Ginseng?
Mild sympathomimetic effects; neuroprotective effects due to inhibition of sodium channels in the CNS; hypoglycemic activity; interferes with platelet aggregation
What medication should be avoided with Ginseng use?
May interact with monoamine oxidase inhibitors (MOAIs) causing tremors and mania
Use with caution in combination with NSAIDs and Warfarin due to increased risk of bleeding
What medication should be avoided with Ginseng use?
May interact with monoamine oxidase inhibitors (MOAIs) causing tremors and mania
Use with caution in combination with NSAIDs and Warfarin due to increased risk of bleeding
What medication should be avoided with Ginseng use?
May interact with monoamine oxidase inhibitors (MOAIs) causing tremors and mania
Use with caution in combination with NSAIDs and Warfarin due to increased risk of bleeding
What is Kava used to treat?
Used as an anxiolytic and sedative
What is the mechanism of action of Kava?
Potentiates gamma-aminobutyric acid (GABA) transmission
What is St Johns Wart used to treat?
Used as an antidepressant and for other mood disorders
What is the mechanism of action of St Johns Wart?
Inhibits serotonin, norepinephrine, and dopamine reuptake by neurons
What are some anesthetic I’m
Induces hepatic cytochrome P450 CYP3A4 increasing the metabolism of drugs such as Alfentanil, Midazolam, and Lidocaine
Induces cytochrome P450 2C9 causing reduction in effects of Warfarin and NSAIDs
What are some anesthetic implications for St Johns Warts?
Induces hepatic cytochrome P450 CYP3A4 increasing the metabolism of drugs such as Alfentanil, Midazolam, and Lidocaine
Induces cytochrome P450 2C9 causing reduction in effects of Warfarin and NSAIDs
What is Valerian used to treat?
Used as an anxiolytic and sedative
What is the mechanism of action for Valerian?
Inhibits GABA breakdown and reuptake
Why can’t a patient abruptly stop taking Valerian?
Taper dose during discontinuation due to risk of benzodiazepine-like withdrawal
What is an anesthetic complication of taking Valerian?
Reduces anesthetic agent requirements
What is Coenzyme Q10 used to treat?
Hypertension, Heart Failure, Ischemia Heart Disease, and Prevention of Statin-Induced Myopathy
What are some anesthetic indications for CoQ10?
Shares a structural similarity to vitamin K and may alter the action of warfarin
What is glucosamine used to treat?
Pain associated with knee osteoarthritis
What are some anesthetic complications of CoQ10?
May increase INR in patients taking warfarin leading to increased risk for bleeding and bruising.
