Dietary supplements and vitamins Flashcards
most common condition treated with supplements
back pain
Dietary supplements include
vitamins, minerals, and amino acids
herbals or botanicals
dietary substance for use by man to supplement the diet by increasing the total dietary intake
DSHEA
dietary supplement regulatory body. NOT as strict as the FDA
are supplements considered medications
NO
Do dietary supplement manufacturers need to be registered with the FDA
NO
Are supplement manufacturers responsible for the safety/efficacy of their product
YES - no required to submit safety data review to the FDA
What is GMP
good manufacturing practices. Required under DSHEA
What do GMP prevent
wrong ingredients
too much/too little of product
contamination
DOES NOT apply to raw ingredient suppliers
What are NDI’s
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
Manufacturers must include the following statement
This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease
Labeling requirements
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
What is the role of the FTC
to oversee advertising of supplements. Enforcement priorities Health and safety Treat/cure a serious disease Children Outright false claims Widespread or severe consumer injury
Dietary supplement quality assurance tips
bottles should have expiration date and lot number
use product within 1-2 years
gray color or “bite” on tongue - probably expired
Co-Q10
Ubiquinone
Fat soluble
acts as antioxidant
some deficiency associated with cardiac disease
Cranberry extract
unprocessed juice contains anthocyanin dyes
Proanthocynidins may inhibit E.coli from adhering site -> limit UTI
may lower urine pH
Echinacea
purple coneflower
flower most important part
MUST be used in warm water
Fish oil (omega-3)
EPA and DHA
food source: fatty fish 2-3x/week
Garlic
Alliin cconverted to allicin - allicin is the active ingredient
Ginko Biloba used to tx
alzheimer's - antioxidant/neuroprotective asthma anxiety claudication tinnutis and vertigo
Ginsing used to tx
memory stress insomnia diabetes impotence
Glucosamine and Chondroitin
found in chitin - yeast, fungi, arthropods, invertebrates
Melatonin used to tx
jet lag
insomia
Pre/Probiotics
Pre: nondigestible food - usually carbohydrates
Pro: live, should be refrigerated. “Friendly” bacteria
can help defend from infections
NOT FDA regulated
St. John’s Wort
Used for depression pain anxtiety insomnia
Black Cohosh used for tx of
menopausal sx
cardiovascular - hypercholesterol
peripheral arterial disease
DO NOT use Echinacea in what pt population
immunocompromised - HIV/AIDS, MS
Pts cannot process it and it can make condition worse
What is fish oil used to treat
improve joint stiffness
decrease: CVD risk, TG, V-LDL
Prescription fish oil
Lovasa
Fish oil ADR
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)
Garlic used to treat
everything - called the panacea
Garlic MOA
allicin reduces activity of thiol group of some enzymes that synthesize lipids
Garlic ADR
N/V
heartburn
increased risk for bleeding
bad breath and body odor
Garlic counseling
enteric coated helps prevent alliin destruction in GI
should be stopped 14 days PRIOR to any surgery
Ginkgo biloba ADR
strong allergen N/V dizziness bleeding headaches seizures heart palpitations
Gingo Biloba ADR
ASA and Coumadin - bleeding risk
Antidepressants - increased SE
Gingko biloba counseling
Monitor for bruising and bleeding especially if taken with ASA, warfarin or antiplatelets
may interact with antidepressant medications
Ginsing ADR
headache alterations of BP, tachycardia anorexia bleeding large doses: CNS stimulation, N/V caution with CVD and diabetes
Glucosamine used to tx
osteoarthritis
wound healing polymer –> not as good as zinc and vit C
Glucosamine ADR
potential bronchopumonary issues
generally well tolerated
chondroitin combo can be problematic
black cohosh ADR
usually well tolerated N/V dizziness nervous system disturbances DO NOT USE IN PREGNANCY
Black cohosh MOA
binds to estrogen receptors to suppress LH
How do probiotics work
outcompete pathogenic bacteria
improve intestinal barrier function
hydrogen peroxide from lactobacilli effective agains vaginal pathogens
melatonin MOA
hormone of darkness - won’t work if you take it during day
Melatonin ADR
sedation
can aggravate depression
Melatonin DDI
Nefidepine
Fluvoxamine
St John’s Wort MOA
5HT, dopamine, NE reuptake inhibition
Possible antagonism of BZD, GABA receptors
St John’s Wort DDI
Potent inducer of CYP 34A 4,5, & 7» 1A2, 2C9
Inducer of P-glycoprotein efflux pump
Serotonin syndrome with SSRI’s
St John’s Wort DDI
Potent inducer of CYP 34A 4,5, & 7» 1A2, 2C9
Inducer of P-glycoprotein efflux pump
Serotonin syndrome with SSRI’s
Fat soluble vitamins
ADEK
may be toxic at excessive doses
Water soluble vitamins
C, B
usually non-toxic
Vitamin A
essential for normal growth and reproduction
Prescription: acitretin, tazarotene, isotretinoin
Vit A deficiency vs toxicity
deficiency: rare
Toxicity: megadoses - caution in pregnant women
Vit A dosing
UL 3mg/day
Treatment/prevention of vitamin A deficiency
Recommend a nonprescription MVI within the DRI*
Vit D
calcium homeostasis
reduces risk of fracture, CVD, some cancers
seen as D3 -> D2 is prescription only and wrong answer on test
Vit D in Kidney
25-dihydroxycholecalciferol (kidney)
Vit D dosing
watch food intake
Seniors: 800 iu/day
Vit E
Tocopherol
studied for: alzheimer’s and wound healing
Deficiency rare
Toxicity unknown
Vit K
***Phytonadione (vitamin K1) Menaquinone (vitamin K2) Menadione (synthetic vitamin K3) promotes clotting often used to lower INR
Vit B1
Thiamine
Low B1 - don’t make acetyl CoA
Vit B1
Thiamine
Low B1 - don’t make acetyl CoA
Thiamine deficiency
mainly found in alcoholics
causes beriberi - peripheral neuritis, weakness, wernicke’s encephalopathy
Toxicity is rare
Vit B2
Riboflavin needed for CYP P450 vision mucous membranes skin, nails, hair
Riboflavin deficiency and toxicity
deficiency common in alcoholism -> 5 or more drinks in one sitting
sensitivity to light, ocular fatigue, blurred vision
ADR: can discolor urine
Vitamin B3
Niacin
Vitamin B3
Niacin - can be synthesized in vivo from dietary tryptophan
Niacinamide is active form of niacin
Vit B3 uses
hyperlipidemia -> lower TG, TC, LDL-c, and increase HDL-c
Vit B3 deficiency and toxicity
deficiency rare - occurs in alcoholics, malnutrition
sx: three D: diarrhea, dermatitis, dementia
toxicity: N/V, hepatoxicity, flushing - decreases if taken with aspirin or ibuprofen
Vit B6
Pyridoxine cofactor for numerous enzymes useful for: carpal tunnel PMS depression migraine
Vit B6 used as adjunctive tx for
LTBI (latent TB) treated with isoniazid
Pyridoxine deficiency and toxicity
deficiency:
caused by alcoholism, severe diarrhea, drugs (INH and Hydralazine)
toxicity: peripheral neurpathy
Vit B12
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
Vit B12 deficiency and toxicity
deficiency: caused by reduced absorption, reduced intrinsic factor
sx: macrocytic/megaloblastic anemia
pernicious anemia
toxicity: essentially non-toxic
Folic acid
Conversion of homocysteine to methionine
- Conversion of serine to glycine - Histadine metabolism - Synthesis of purines
folic acid deficiency and toxicity
deficiency: can be drug induced via methotrexate and phenytoin.
deficiency can cause neural tube defects
toxicity: may counteract antiepileptic drugs
Vitamin C
ascorbic acid
aids in absorption of iron from food
can be used to prmote healing
keeps stomach and urine acidic
Vit C deficiency and toxicity
deficiency: scurvy
toxicity: at upper limits - GI issues
Should deficient patients take multivitamin or targeted vitamin
specific to their deficiency
Should deficient patients take multivitamin or targeted vitamin
specific to their deficiency
calcium
99% found in bones/teeth
deficiency often comes with age and increases chance of osteoporosis and fractures
8oz of milk contains 300mg
calcium deficiency and toxicity
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
calcium formulations
carbonate - 40% Ca, causes most constipation
Citrate - 21%, best tolerated
Calcium dosing
caltrate 600 +D (carbonate) 600mg Citracal + D (citrate): 315mg Os-Cal 500 + D (carbonate): 500mg Posture (tribasic phosphate): 600mg Tums 500 (carbonate): 500mg
max Ca absorption
500 mg/dose
Iron
incorporated into RBC
assists oxygen and electron transport
dietary sources: red meats and leafy green veg
Iron deficiency and toxicity
deficiency - caused by inadequate dietary intake, malabsorption, pregnancy, NSAIDS, Steroids, anticoag.
toxicity: GI issues, black/tarry stools
Who is at risk for iron deficient anemia
pregnant women, menstruating women, vegetarians,
Which is better absorbed: ferrous or ferric
ferrous
iron formulations
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
