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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
Black Cohosh used for tx of
menopausal sx cardiovascular - hypercholesterol peripheral arterial disease
26
DO NOT use Echinacea in what pt population
immunocompromised - HIV/AIDS, MS | Pts cannot process it and it can make condition worse
27
What is fish oil used to treat
improve joint stiffness | decrease: CVD risk, TG, V-LDL
28
Prescription fish oil
Lovasa
29
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)
30
Garlic used to treat
everything - called the panacea
31
Garlic MOA
allicin reduces activity of thiol group of some enzymes that synthesize lipids
32
Garlic ADR
N/V heartburn increased risk for bleeding bad breath and body odor
33
Garlic counseling
enteric coated helps prevent alliin destruction in GI | should be stopped 14 days PRIOR to any surgery
34
Ginkgo biloba ADR
``` strong allergen N/V dizziness bleeding headaches seizures heart palpitations ```
35
Gingo Biloba ADR
ASA and Coumadin - bleeding risk | Antidepressants - increased SE
36
Gingko biloba counseling
Monitor for bruising and bleeding especially if taken with ASA, warfarin or antiplatelets may interact with antidepressant medications
37
Ginsing ADR
``` headache alterations of BP, tachycardia anorexia bleeding large doses: CNS stimulation, N/V caution with CVD and diabetes ```
38
Glucosamine used to tx
osteoarthritis | wound healing polymer --> not as good as zinc and vit C
39
Glucosamine ADR
potential bronchopumonary issues generally well tolerated chondroitin combo can be problematic
40
black cohosh ADR
``` usually well tolerated N/V dizziness nervous system disturbances DO NOT USE IN PREGNANCY ```
41
Black cohosh MOA
binds to estrogen receptors to suppress LH
42
How do probiotics work
outcompete pathogenic bacteria improve intestinal barrier function hydrogen peroxide from lactobacilli effective agains vaginal pathogens
43
melatonin MOA
hormone of darkness - won't work if you take it during day
44
Melatonin ADR
sedation | can aggravate depression
45
Melatonin DDI
Nefidepine | Fluvoxamine
46
St John's Wort MOA
5HT, dopamine, NE reuptake inhibition | Possible antagonism of BZD, GABA receptors
47
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
48
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
49
Fat soluble vitamins
ADEK | may be toxic at excessive doses
50
Water soluble vitamins
C, B | usually non-toxic
51
Vitamin A
essential for normal growth and reproduction | Prescription: acitretin, tazarotene, isotretinoin
52
Vit A deficiency vs toxicity
deficiency: rare Toxicity: megadoses - caution in pregnant women
53
Vit A dosing
UL 3mg/day Treatment/prevention of vitamin A deficiency Recommend a nonprescription MVI within the DRI*
54
Vit D
calcium homeostasis reduces risk of fracture, CVD, some cancers seen as D3 -> D2 is prescription only and wrong answer on test
55
Vit D in Kidney
25-dihydroxycholecalciferol (kidney)
56
Vit D dosing
watch food intake | Seniors: 800 iu/day
57
Vit E
Tocopherol studied for: alzheimer's and wound healing Deficiency rare Toxicity unknown
58
Vit K
``` ***Phytonadione (vitamin K1) Menaquinone (vitamin K2) Menadione (synthetic vitamin K3) promotes clotting often used to lower INR ```
59
Vit B1
Thiamine | Low B1 - don't make acetyl CoA
60
Vit B1
Thiamine | Low B1 - don't make acetyl CoA
61
Thiamine deficiency
mainly found in alcoholics causes beriberi - peripheral neuritis, weakness, wernicke's encephalopathy Toxicity is rare
62
Vit B2
``` Riboflavin needed for CYP P450 vision mucous membranes skin, nails, hair ```
63
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
64
Vitamin B3
Niacin
65
Vitamin B3
Niacin - can be synthesized in vivo from dietary tryptophan | Niacinamide is active form of niacin
66
Vit B3 uses
hyperlipidemia -> lower TG, TC, LDL-c, and increase HDL-c
67
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
68
Vit B6
``` Pyridoxine cofactor for numerous enzymes useful for: carpal tunnel PMS depression migraine ```
69
Vit B6 used as adjunctive tx for
LTBI (latent TB) treated with isoniazid
70
Pyridoxine deficiency and toxicity
deficiency: caused by alcoholism, severe diarrhea, drugs (INH and Hydralazine) toxicity: peripheral neurpathy
71
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 ```
72
Vit B12 deficiency and toxicity
deficiency: caused by reduced absorption, reduced intrinsic factor sx: macrocytic/megaloblastic anemia pernicious anemia toxicity: essentially non-toxic
73
Folic acid
Conversion of homocysteine to methionine - Conversion of serine to glycine - Histadine metabolism - Synthesis of purines
74
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
75
Vitamin C
ascorbic acid aids in absorption of iron from food can be used to prmote healing keeps stomach and urine acidic
76
Vit C deficiency and toxicity
deficiency: scurvy toxicity: at upper limits - GI issues
77
Should deficient patients take multivitamin or targeted vitamin
specific to their deficiency
78
Should deficient patients take multivitamin or targeted vitamin
specific to their deficiency
79
calcium
99% found in bones/teeth deficiency often comes with age and increases chance of osteoporosis and fractures 8oz of milk contains 300mg
80
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
81
calcium formulations
carbonate - 40% Ca, causes most constipation | Citrate - 21%, best tolerated
82
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 ```
83
max Ca absorption
500 mg/dose
84
Iron
incorporated into RBC assists oxygen and electron transport dietary sources: red meats and leafy green veg
85
Iron deficiency and toxicity
deficiency - caused by inadequate dietary intake, malabsorption, pregnancy, NSAIDS, Steroids, anticoag. toxicity: GI issues, black/tarry stools
86
Who is at risk for iron deficient anemia
pregnant women, menstruating women, vegetarians,
87
Which is better absorbed: ferrous or ferric
ferrous
88
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

5112 (12 decks)

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