DLA4- Botanicals, Nutritional Supplements

Question 1

list the types of dietary supplements

Answer 1

• Botanicals
• Phytochemicals
• Nutraceuticals

Question 2

Dietary Supplement Regulation:

• (1) essential goal of 1994 legislation
• (2) essential goal of 2006 legislation

Answer 2

1- FDA approval required for any Claims of healing or preventing diseases

2- AEs must be reported to FDA

Question 3

why do physicians need to know about dietary supplements

Answer 3

• possible drug interactions – especially if patient is taking drug with narrow therapeutic index
• before surgery

Question 4

list some common drugs with narrow therapeutic indexes

Answer 4

Carbamazepine, Phenytoin; anti-epileptics

Cyclosporin; immunosuppressant

Digoxin; CHF, AFib

Levothyroxine; T4 replacement

Warfarin; anti-coagulant

Question 5

list the many mechanisms of toxicity from dietary supplements

Answer 5

i) improper / nontraditional processing: eg. green tea extract –> hepatitis
ii) misidentification of ingredients
iii) adulterants- heavy metals like male enhancement supplements
iv) allergic rxns: many have sulfur
v) herb-drug interactions: St. John’s wort –> induces P-450

Question 6

(1) is a common supplement that induces P450 system in liver and is used to treat (2)

Answer 6

1- St. John’s wort

2- mild depression

Question 7

what are the main medical arguments against herbal supplements

Answer 7

• effects are largely unknown
• little scientific data on herbs
• safety is not heavily regulated by FDA

natural doesn’t equal safer