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ANTI-viral Dx > Dietary Supplements > Flashcards

Dietary Supplements Flashcards

1
Q

How common is the use of dietary and herbal medications in the US?

A
  • 50% >20 used dietary supplemets, alternative stuff
    • 33% take TOGETHER with prescription meds
  • 30 billion spent
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2
Q

What is a dietary supplement?

A
  • supplements diet
  • contains (concentrate, metabolite, constituent, extract):
    • vitamins
    • herbs or other botanicals
    • amino acids
    • COMBO
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3
Q

Dietary Supplement Health and Education (DSHE) Act 1994

A
  • 1994 Act of Congress
    • restricted FDA’s ability to regulate the industry…as long as manufacturers made NO CLAIMS a/b their products:
      • treating
      • preventing
      • curing dz
  • supplements=food supplements NOT drugs
  • places burden on FDA to prove that supplement is unsafe/ineffective
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4
Q

Regulation and Role of FDA…Wild Wild West

A
  • makers NOT required to prove EFFICACY and SAFETY of a product prior to marketing
    • just need adequate evidence…which they dont have to give to the FDA
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5
Q

Safety?

A
  • ingredient sold pre-Oct 15 1994 is considered to be safe based upon their prior use by humans
  • post 10/15/94 safety testing is not reliably enforced
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6
Q

What are the three types of claims that the DSHE act allows regarding dietary supplements and herbal medications?

A
  1. Nutrient claim
  2. health claim
  3. structure-function claim
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7
Q

DSHE-allowed: Nutrient Claim (1/3)

A
  • relative amt of a nutrient or dietary ingredient in a product
  • limite to nutrients that have FDA-established DC:
    • vitamins, minerals, dietary fiber, AA
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8
Q

DSHE-allowed: Health Claim (2/3)

A
  • VERY restrictive
  • ability of dietary supplement ingredient to reduce r/o dz or health condition
  • must be:
    • pre-approved by FDA
      • Ex: vit/folate/mineral/fish oils
    • based on significant scientific agreement
    • evidence-based w/ strong evidence (RCT)
      • Ex: folate-NTD; Ca/Vit D-osteoporosis
      • Ex text: “adequate ca as pt of a healthy diet MAY help REDUCE the r/o osteroporosis”
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9
Q

DSHE-allowed: Structure-Function Claim (3/3)

A
  • most dietary supplements and herbals
  • how the dietary supplement may affect or maintain nml body structure/fxn:
    • CANNOT imply that supplement will affect a dz or condition
    • claim does NOT need FDA approval, BUT claim must be provided within 30 days of marketing
  • Ex good: antioxidants help maintain cell integrity
  • Ex good: Echinea supports the bodys immune system
  • Ex bad: antioxidants prevent the onset of ca
  • Ex bad: Echinea is useful in preventing colds
  • ***product label must contain the following statement: “this product has not been evaluated by the FDa. This product is no tintended to diagnose, treat, cure or prevent any diseases”
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10
Q

DSHE modification in 2007

A
  • companies must now inform the FDA of any serious SE
  • Manufacturers responsible for Good Manufacturing Practices (GMP)
    • ensure QUALITY of manufacturing PROCESS
    • supplements shouldn’t contain contaminants or impurities
    • supplements should be accurately labeled
    • lies, fairytales, and fallicies
  • >70% supplements are mislabeled
  • 50% dx recalls due to dietary supplements
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11
Q

Why are dietary supplements basically useless in the genpop (3)?

A
  • body only needs LOW LEVELS
  • typically in HEALTHY DIET
  • supplements dont replace fresh fruit/veggies (balanced diet)
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12
Q

Who may benefit from vitamin and mineral supplements?

A
  • pregnant/nursing
  • vegetarians/vegan
  • crash dieters/chronic low-cal diet (bariatric sx)
  • elderly (disabled or chronically ill)
  • malabsorption problems (diarrhea, celic dz)
  • food allergies (lactose intolerant)
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13
Q

Excessive intake of vitamins and minerals can be toxic

A
  • U-shaped curve for micronutrients and health
  • risk assoc w/ BOTH insufficient and xs intake
    • Vit D/Ca insufficiency=INC r/o osteoporosis
    • Vit D/Ca overconsumption=INC r/o CVD & overall mortality
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14
Q

Vit A <nah></nah>

A
  • Deficiency: uncommon
  • Supplementation (other than deficiency): not recommended
  • Toxicity (PC CHAT):
    • painful joints
    • coma
    • chronic: INC ICP
    • hyper-vitaminosis A
    • acute: nausea/vision
    • Teratogenic
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15
Q

Vit D <nd></nd>

A
  • Deficiency:
    • overt-rare: rickets.osteomalacia
    • some SUBclinical deficieny (po folk)
  • Supplementation (other than deficiency): <biologi>
    </biologi><ul>
    <li>blk</li>
    <li>institutionalized</li>
    <li>obese</li>
    <li>limited sunlight</li>
    <li>old</li>
    <li>Gi d/o</li>
    </ul></biologi>
  • Toxicity <hv>:
    </hv><ul>
    <li>damage: heart, blood vessels, kidney</li>
    <li>N/V/weight loss</li>
    <li>HYPERcalcemia</li>
    <li>vascular tissue calcification</li>
    </ul></hv>
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16
Q

Vit E

A
  • Deficiency: uncommon
  • Supplementation (other than deficiency): not recommended
  • Toxicity:
    • INC all causes of mortality
    • INC bleeding with anticoagulants
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17
Q

Vit K <babies></babies>

A
  • Deficiency: common in NBN (VKDB)
  • Supplementation (other than deficiency):
    • NBN given IM Vit K @ birth to prevent hemorrhagic dz of the NBN
  • Toxicity: rare
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18
Q

Vit C

A
  • Deficiency: uncommon
  • Supplementation (other than deficiency): not recommended
  • Toxicity: GI issues + kidney stones
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19
Q

Vit B1

A
  • Deficiency: poor countries Beriberi
  • Supplementation (other than deficiency):
    • chronic alcholics: WKS (psychotic encephalopathy)
      • vision changes/ataxia/memory loss
  • Toxicity:
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20
Q

Vit B12 <gvape></gvape>

A
  • Deficiency: common: 2-15%
  • Supplementation (other than deficiency):
    • elderly (poor absorption)
    • vegan/veggies
    • alcoholics
    • pernicious anemia
    • GI malabsorption d/o
  • Toxicity:
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21
Q

Folate

A
  • Deficiency: uncommon
  • Supplementation (other than deficiency): childbearing women, prevent NTD
  • Toxicity:
22
Q

Melatonin

A
  • Purported Use:
    • insomnia/jet lag: +/-
    • sleep patterns: +/-
    • cognitive impairment: NO
  • Clinical Evidence
  • Toxicity: dont combine w/ anti-seizure meds or warfarin
23
Q

Glucosamine/Chondroitin

A
  • Purported Use: osteoarthritis
  • Clinical Evidence: NOOOOO
  • Toxicity
24
Q

**FISH OILS**

A
  • Purported Use:
    • DECCCC:
      • CVD
      • CHD death
      • sudden Cardiac death
      • BP/HR
  • Clinical Evidence: YASSSSS
  • Toxicity
25
Q

Co-enzyme Q10

A
  • Purported Use <mhhc>:
    </mhhc><ul>
    <li>heart conditions</li>
    <li>CHF/angina</li>
    <li>high BP/diabetes</li>
    <li>migraine</li>
    </ul></mhhc>
  • Clinical Evidence: +/-
    • only for rare genetic deficiency in CoQ10 biosynthetic enzymes
  • Toxicity
26
Q

Multivitamins

A
  • each constituent: 100%-150% RDA
  • benefit those with:
    • poor nutrition
    • low cal diet
    • v/v+age>50-Vit B12
    • PM women-Vit D & Ca
27
Q

Historical use of Herbal medications

A
  • 3000BC sumerian clay tablets
  • 2700 BC Han dynasty
  • 1900 BC turmeric (anti-inflamm/anti-microbial) India
  • 1500 BC saw palmetto, garlic, junier: Egypt
  • 500 BC St Johns Wort: Hippocrates
28
Q

Modern Use of Herbal Meds

A
  • health promotion, dz prevention (*chronic dz: RA, memory, fatigue, energy, immune system)
  • shit outcomes with conventional for serious illness
  • limited availability of conventional
  • SE/risks of conventional
  • thoughts natural “safer”/superior
29
Q

Physicians attitude to dietary supplements and herbal meds

A
  • 50% physicians never ask pts about herbal med use
  • 70% think public havemisplace faith in herbal meds
30
Q

Pt attitudes to dietary supplements and herbal meds

A
  • MAJORITY of pts DO NOT TELL their doc:
    • no reason for doc to know
    • doc never asked
    • embarassed
    • think safe/effective
31
Q

Reasons physicians should discuss dietary supplement usage with their patients

A
  • herbs are pharmalogically active
  • certain dietary supplements have well-established toxic effects:
    • heptatotoxiity: comfrey/kava
    • nephrotoxic: aristolochic acid (chinese herbs)
    • CV (+ death): ephedra/bitter orange
  • uncover unspoken medical concerns
  • ***Potential for serious herb-drug interactions:
    • St. JW induces CYP450 enzymes=DEC levels of certain drugs
    • =clinical failure of HIV PI, OCP, cyclosporin (transplant rejection)
32
Q

Quality and Efficacy of Herbal Meds

A
  • diff pharm with diff plant parts
  • closely related may have diff ingredients/contaminants
  • harvest/storage/processing techniques may be diff
  • many cases of mislabeling
  • recent study using fingerprinting:
    • 2/44 herbal supplements had 100% authentic, rest were contaminated, had filler, mislabeled
33
Q

Problems with Herbal Standardization, Purity, Efficacy

A
  • diff prep=diff activity
  • contamination: lead, mercury, arsenic
  • few high quality clinical trials
34
Q

Aloe Vera

A
  • Common Use <low>:
    </low><ul>
    <li>laxative (some)</li>
    <li>OA</li>
    <li>wound healing</li>
    </ul></low>
  • CTE:
  • SE: stomach cramps
  • DDI:
35
Q

**BITTER ORANGE**

(Pseudophedrine and ephedrine same)

A
  • Common Use:
    • N
    • constipation
    • weight loss
  • CTE:
  • SE:
    • INC HR/BP
    • stroke/MI (espec w/ caffeine)
  • DDI: MAOI (contains tyramine metabolites); inhibits gut 3A4
36
Q

Black cohosh

A
  • Common Use: menopausal s/s
  • CTE:+/-
  • SE: estrogenic-may worse breast ca
  • DDI:
37
Q

Cranberry

A
  • Common Use: UTI
  • CTE: +/-
38
Q

Echinacea

A
  • Common Use: colds/flu; immune booster
  • SE: exacerbate a/i/d
  • DDI: inhib 3A4
39
Q

**EPHEDRA (banned in US)**

A
  • Common Use:
    • cold/fever/flu
    • **weight loss
  • SE: INC reisk CVD/stroke/death
  • DDI: additive effects with stimulants
40
Q

Fever-few

A
  • Common Use: fever/HA/MA
  • CTE:+/-
  • SE:
    • withdrawal syndrome w/ chronic use: rebound HA/jt pain
    • Ci in pregnancy (early contractions)
  • DDI: inhib 1A2, 2C9, 2C19
41
Q

Garlic

A
  • Common Use: high cholesterol, high BP
  • CTE:=+/-
  • SE:INC bleeding risk
  • DDI:
    • ANTIcoagulants
    • DEC:
      • Saquinavir
      • Isoniazid
      • NNRTI
      • OCP
42
Q

Ginger

A
  • Common Use: upset tum, N, morning sickness
  • CTE: +/- N
  • SE: INC bleeding risk
  • DDI: anticoagulants
43
Q

Ginkgo

A
  • Common Use:
    • memory loss
    • sex dysfunction
    • HA/fatigue
    • tinnitus
  • CTE: +/-
  • SE:
    • INC bleeding risk
    • unsafe preg
    • uncooked: seizure toxin
  • DDI: ANTI coags
44
Q

Ginseng

A
  • Common Use:
    • INC mental/physical performance
    • immune booster
    • erectile dysfunction
    • lower BG
  • CTE:+/-
  • SE:
    • Teratogenic
    • contraindic in Breast ca
    • estrogenic
    • birth defects
  • DDI:
    • INC effects of insulin/sulfonylureas
    • ANTagonize ANTicoags
45
Q

**HAWTHORN**

A
  • Common Use:
    • heart dz
    • CHF/high BO
    • angina
  • CTE: yes for mild HF
  • DDI:
    • digoxin/nitrates
    • BP meds
46
Q

**HORSE CHESTNUT**

A
  • Common Use:
    • chornic venous insufficiency
    • varicose veins
    • hemorrhoids
  • CTE: YES
  • SE:
    • raw seeds: poisonous ESCULIN toxin
    • may exacerbate kidney dz
  • DDI: ANTIcoags
47
Q

**KAVA**

A
  • Common Use:
    • insomnia/anxiety
    • depression
    • ADHD
  • CTE: YES
  • SE:
    • liver damage
    • muscle spasms
  • DDI:
    • additive effects with sedatives
    • INC acetominophen toxicity
48
Q

Milk Thistle

A
  • Common Use:
    • liver protection; jaundic/cirrhosis
    • high cholesterol
    • diabetes
  • DDI: inhibits UGT
49
Q

Saw Palmetto

A
  • Common Use: BPH
  • CTE:+/-
  • DDI: inhibits UGT, 3A4, 2D6, 2C9
50
Q

***SJW***

A
  • Common Use:
    • Wound healing
    • heart palpitations
    • anxiety/depression
    • sleep d/o; chronic fatigue
    • MA
  • CTE: YES
  • SE:
    • photosensitization
    • SEROTONIN SYNDROME (w/ SSRI, MAOI, TCA)
    • induce mania in bipolar
    • depressed/psychotic
    • teratogenic
  • DDI:
    • Anti-depressants (serotonin syndrome)
    • INC expression 3A4/SC19
    • DEC:
      • Statins/HIV PI
      • OCP
      • Cyclosporin
51
Q

***VALERIAN***

A
  • Common Use (SAD):
    • sleep d/o
    • anxiety
    • depression
  • CTE: +/-
  • SE: drowsiness
  • DDI: additive effets on other sedatives (BZ/barbs/Kava)
52
Q

Yohimbe (congo and maui)

A
  • Common Use:
    • sexual dysfxn
    • erectile dysfxn
    • athletic performance
    • weight loss
  • CTE: +/-
  • SE:
    • INC: BP/HR/anxiety
    • insomnia
    • kidney failure
  • DDI: INC SE MAOIs

ANTI-viral Dx (2 decks)

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