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5112 > Dietary supplements and vitamins > Flashcards

Dietary supplements and vitamins Flashcards

1
Q

most common condition treated with supplements

A

back pain

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2
Q

Dietary supplements include

A

vitamins, minerals, and amino acids
herbals or botanicals
dietary substance for use by man to supplement the diet by increasing the total dietary intake

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3
Q

DSHEA

A

dietary supplement regulatory body. NOT as strict as the FDA

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4
Q

are supplements considered medications

A

NO

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5
Q

Do dietary supplement manufacturers need to be registered with the FDA

A

NO

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6
Q

Are supplement manufacturers responsible for the safety/efficacy of their product

A

YES - no required to submit safety data review to the FDA

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7
Q

What is GMP

A

good manufacturing practices. Required under DSHEA

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8
Q

What do GMP prevent

A

wrong ingredients
too much/too little of product
contamination
DOES NOT apply to raw ingredient suppliers

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9
Q

What are NDI’s

A

New Dietary Ingredients - any new active ingredient in dietary supplement marketed after Oct 15, 1994. Must demonstrate safety to FDA.
Problem: NO authoritative list of these ingredients

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10
Q

Manufacturers must include the following statement

A

This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease

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11
Q

Labeling requirements

A

A descriptive name of the product stating that it is a supplement
The name and place of business of the manufacturer, packer, or distributor
A complete list of ingredients and the net contents of the product
A nutrition label in the form of a supplement facts panel
Directions for use

Botanical products must also include the part of the plant used in the product

Labeling is not required to have lot numbers, expiration dates, or contraindications

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12
Q

What is the role of the FTC

A 
to oversee advertising of supplements.
Enforcement priorities
Health and safety
Treat/cure a serious disease
Children
Outright false claims
Widespread or severe consumer injury
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13
Q

Dietary supplement quality assurance tips

A

bottles should have expiration date and lot number
use product within 1-2 years
gray color or “bite” on tongue - probably expired

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14
Q

Co-Q10

A

Ubiquinone
Fat soluble
acts as antioxidant
some deficiency associated with cardiac disease

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15
Q

Cranberry extract

A

unprocessed juice contains anthocyanin dyes
Proanthocynidins may inhibit E.coli from adhering site -> limit UTI
may lower urine pH

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16
Q

Echinacea

A

purple coneflower
flower most important part
MUST be used in warm water

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17
Q

Fish oil (omega-3)

A

EPA and DHA

food source: fatty fish 2-3x/week

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18
Q

Garlic

A

Alliin cconverted to allicin - allicin is the active ingredient

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19
Q

Ginko Biloba used to tx

A 
alzheimer's - antioxidant/neuroprotective
asthma
anxiety
claudication
tinnutis and vertigo
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20
Q

Ginsing used to tx

A 
memory
stress
insomnia
diabetes
impotence
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21
Q

Glucosamine and Chondroitin

A

found in chitin - yeast, fungi, arthropods, invertebrates

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22
Q

Melatonin used to tx

A

jet lag

insomia

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23
Q

Pre/Probiotics

A

Pre: nondigestible food - usually carbohydrates
Pro: live, should be refrigerated. “Friendly” bacteria
can help defend from infections
NOT FDA regulated

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24
Q

St. John’s Wort

A 
Used for 
depression
pain
anxtiety
insomnia
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25
Q

Black Cohosh used for tx of

A

menopausal sx
cardiovascular - hypercholesterol
peripheral arterial disease

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26
Q

DO NOT use Echinacea in what pt population

A

immunocompromised - HIV/AIDS, MS

Pts cannot process it and it can make condition worse

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27
Q

What is fish oil used to treat

A

improve joint stiffness

decrease: CVD risk, TG, V-LDL

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28
Q

Prescription fish oil

A

Lovasa

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29
Q

Fish oil ADR

A

fish breath/belching - take at night, coated, or with meal to alleviate
monitor for increased bruising or bleeding, especially with ASA or Plavix (limit to 3g or less)

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30
Q

Garlic used to treat

A

everything - called the panacea

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31
Q

Garlic MOA

A

allicin reduces activity of thiol group of some enzymes that synthesize lipids

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32
Q

Garlic ADR

A

N/V
heartburn
increased risk for bleeding
bad breath and body odor

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33
Q

Garlic counseling

A

enteric coated helps prevent alliin destruction in GI

should be stopped 14 days PRIOR to any surgery

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34
Q

Ginkgo biloba ADR

A 
strong allergen
N/V
dizziness
bleeding
headaches
seizures
heart palpitations
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35
Q

Gingo Biloba ADR

A

ASA and Coumadin - bleeding risk

Antidepressants - increased SE

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36
Q

Gingko biloba counseling

A

Monitor for bruising and bleeding especially if taken with ASA, warfarin or antiplatelets
may interact with antidepressant medications

37
Q

Ginsing ADR

A 
headache
alterations of BP, tachycardia
anorexia
bleeding
large doses: CNS stimulation, N/V
caution with CVD and diabetes
38
Q

Glucosamine used to tx

A

osteoarthritis

wound healing polymer –> not as good as zinc and vit C

39
Q

Glucosamine ADR

A

potential bronchopumonary issues
generally well tolerated
chondroitin combo can be problematic

40
Q

black cohosh ADR

A 
usually well tolerated
N/V
dizziness
nervous system disturbances
DO NOT USE IN PREGNANCY
41
Q

Black cohosh MOA

A

binds to estrogen receptors to suppress LH

42
Q

How do probiotics work

A

outcompete pathogenic bacteria
improve intestinal barrier function
hydrogen peroxide from lactobacilli effective agains vaginal pathogens

43
Q

melatonin MOA

A

hormone of darkness - won’t work if you take it during day

44
Q

Melatonin ADR

A

sedation

can aggravate depression

45
Q

Melatonin DDI

A

Nefidepine

Fluvoxamine

46
Q

St John’s Wort MOA

A

5HT, dopamine, NE reuptake inhibition

Possible antagonism of BZD, GABA receptors

47
Q

St John’s Wort DDI

A

Potent inducer of CYP 34A 4,5, & 7» 1A2, 2C9
Inducer of P-glycoprotein efflux pump
Serotonin syndrome with SSRI’s

48
Q

St John’s Wort DDI

A

Potent inducer of CYP 34A 4,5, & 7» 1A2, 2C9
Inducer of P-glycoprotein efflux pump
Serotonin syndrome with SSRI’s

49
Q

Fat soluble vitamins

A

ADEK

may be toxic at excessive doses

50
Q

Water soluble vitamins

A

C, B

usually non-toxic

51
Q

Vitamin A

A

essential for normal growth and reproduction

Prescription: acitretin, tazarotene, isotretinoin

52
Q

Vit A deficiency vs toxicity

A

deficiency: rare
Toxicity: megadoses - caution in pregnant women

53
Q

Vit A dosing

A

UL 3mg/day
Treatment/prevention of vitamin A deficiency
Recommend a nonprescription MVI within the DRI*

54
Q

Vit D

A

calcium homeostasis
reduces risk of fracture, CVD, some cancers
seen as D3 -> D2 is prescription only and wrong answer on test

55
Q

Vit D in Kidney

A

25-dihydroxycholecalciferol (kidney)

56
Q

Vit D dosing

A

watch food intake

Seniors: 800 iu/day

57
Q

Vit E

A

Tocopherol
studied for: alzheimer’s and wound healing
Deficiency rare
Toxicity unknown

58
Q

Vit K

A 
***Phytonadione (vitamin K1)
Menaquinone (vitamin K2)
Menadione (synthetic vitamin K3)
promotes clotting
often used to lower INR
59
Q

Vit B1

A

Thiamine

Low B1 - don’t make acetyl CoA

60
Q

Vit B1

A

Thiamine

Low B1 - don’t make acetyl CoA

61
Q

Thiamine deficiency

A

mainly found in alcoholics
causes beriberi - peripheral neuritis, weakness, wernicke’s encephalopathy
Toxicity is rare

62
Q

Vit B2

A 
Riboflavin
needed for CYP P450
vision
mucous membranes
skin, nails, hair
63
Q

Riboflavin deficiency and toxicity

A

deficiency common in alcoholism -> 5 or more drinks in one sitting
sensitivity to light, ocular fatigue, blurred vision
ADR: can discolor urine

64
Q

Vitamin B3

A

Niacin

65
Q

Vitamin B3

A

Niacin - can be synthesized in vivo from dietary tryptophan

Niacinamide is active form of niacin

66
Q

Vit B3 uses

A

hyperlipidemia -> lower TG, TC, LDL-c, and increase HDL-c

67
Q

Vit B3 deficiency and toxicity

A

deficiency rare - occurs in alcoholics, malnutrition

sx: three D: diarrhea, dermatitis, dementia
toxicity: N/V, hepatoxicity, flushing - decreases if taken with aspirin or ibuprofen

68
Q

Vit B6

A 
Pyridoxine
cofactor for numerous enzymes
useful for:
carpal tunnel
PMS
depression
migraine
69
Q

Vit B6 used as adjunctive tx for

A

LTBI (latent TB) treated with isoniazid

70
Q

Pyridoxine deficiency and toxicity

A

deficiency:
caused by alcoholism, severe diarrhea, drugs (INH and Hydralazine)
toxicity: peripheral neurpathy

71
Q

Vit B12

A 
Cyanocobalamin
fat, protein, carb metabolism
found in protein
Maturation of RBC in conjunction with folic acid
requires intrinsic factor to be absorbed
metformin causes deficiency
72
Q

Vit B12 deficiency and toxicity

A

deficiency: caused by reduced absorption, reduced intrinsic factor
sx: macrocytic/megaloblastic anemia
pernicious anemia
toxicity: essentially non-toxic

73
Q

Folic acid

A

Conversion of homocysteine to methionine

- Conversion of serine to glycine
- Histadine metabolism
- Synthesis of purines
74
Q

folic acid deficiency and toxicity

A

deficiency: can be drug induced via methotrexate and phenytoin.
deficiency can cause neural tube defects
toxicity: may counteract antiepileptic drugs

75
Q

Vitamin C

A

ascorbic acid
aids in absorption of iron from food
can be used to prmote healing
keeps stomach and urine acidic

76
Q

Vit C deficiency and toxicity

A

deficiency: scurvy
toxicity: at upper limits - GI issues

77
Q

Should deficient patients take multivitamin or targeted vitamin

A

specific to their deficiency

78
Q

Should deficient patients take multivitamin or targeted vitamin

A

specific to their deficiency

79
Q

calcium

A

99% found in bones/teeth
deficiency often comes with age and increases chance of osteoporosis and fractures
8oz of milk contains 300mg

80
Q

calcium deficiency and toxicity

A

deficiency: caused by malabsorption, hypoparathyroidism, vit D deficiency, renal failure, inadequate intake. sx: convulsions, growth retardation, rickets
toxicity: above 2g/d
renal stones/damage
consipation

81
Q

calcium formulations

A

carbonate - 40% Ca, causes most constipation

Citrate - 21%, best tolerated

82
Q

Calcium dosing

A 
caltrate 600 +D (carbonate) 600mg
Citracal + D (citrate): 315mg
Os-Cal 500 + D (carbonate): 500mg
Posture (tribasic phosphate): 600mg
Tums 500 (carbonate): 500mg
83
Q

max Ca absorption

A

500 mg/dose

84
Q

Iron

A

incorporated into RBC
assists oxygen and electron transport
dietary sources: red meats and leafy green veg

85
Q

Iron deficiency and toxicity

A

deficiency - caused by inadequate dietary intake, malabsorption, pregnancy, NSAIDS, Steroids, anticoag.
toxicity: GI issues, black/tarry stools

86
Q

Who is at risk for iron deficient anemia

A

pregnant women, menstruating women, vegetarians,

87
Q

Which is better absorbed: ferrous or ferric

A

ferrous

88
Q

iron formulations

A

furmarate - 33%
gluconate - 12%
sulfate - 20%
polysacchrides combo is best absorbed with lead ADR but very expensive. Give is pt has hx of GI bleed or cannot tolerate sulfates

5112 (12 decks)

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