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Pharm Exam 1 > Herbal and Dietary Supplements > Flashcards

Herbal and Dietary Supplements Flashcards

1
Q

Definition of herbal supplements

A

Supplements sold to and consumed by the general population that include plants, plant components,
plant extracts and drinks, tablets, and capsules manufactured from plant sources

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2
Q

What are dietary supplements?

A
  • Intended to supplement dietary intake
  • contains one or more of the following: vitamin, mineral, herb botanical or amino acid
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3
Q

Roughly ____% of the general population use an herbal or dietary supplement of some sort

A

20-50

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4
Q

What is a mistake providers can make regarding supplements?

A

Many providers forget to ask if a patient is
taking a supplement or herbal medication

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5
Q

T/F Herbal supplements can react with
medications that you will be prescribing

A

T

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6
Q

1962

A

Botanicals are not considered drugs

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7
Q

1973

A

Standard identification of vitamins and minerals only. If the dosing exceeds 150% of recommended daily dosing it is then considered a drug

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8
Q

1977

A

Prohibiting the FDA from regulating vitamins and minerals as prescription drugs.

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9
Q

1990

A

Nutrition Labeling and Education Act (NLEA) - Nutrition facts must be on box, declaring all ingredients

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10
Q

1994

A

Dietary Supplement Health and Education Act (DHSEA) - Senator Orrin Hatch (Utah) & Tom Harkin (Iowa)
- Dietary supplements are food (not medicine - therefore do not need to register with the FDA)

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11
Q

Criticism for the DHSEA of 1994

A
  • Does not require that the supplement demonstrate safety prior to marketing or implementation on the market
  • Herbs and supplements do not have to demonstrate efficacy prior to being put on the market
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12
Q

1998

A

1998 - The Natural Product Association (NPA) good manufacturing practice (GMP) certification program (TruLabel) is formed
- Tests and maintains a minimum standard

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13
Q

2007

A
  • Required manufacturers to evaluate identity, purity, strength and composition.
  • Required to submit ALL side effects of the FDA
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14
Q

T/F Research to prove that a supplement is safe
is not required prior to a dietary supplement
being put on the market (unlike drugs)

A

T

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15
Q

Manufacturers may make three types of claims for their herbal or dietary supplements

A

1) health claims
2) structure/function claims
3) nutrient content claims.

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16
Q

If the manufacturer does make a claim, it must be followed by the statement:

A

“This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

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17
Q

Factors for variability in dietary supplements (3)

A
  1. Constituents
  2. Contamination
  3. Standardization
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18
Q

Constituents

A

The parts of the dietary supplement
■ Remember dietary supplements can be a mixture
■ Some ingredients may conflict with others
■ Some ingredients may be synergistic with others
■ Even the way supplements are stored over time
can affect them

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19
Q

Contamination

A

Supplements can contain contaminants from the
environment, whether known or not known.
■ Heavy metals: lead, mercury
■ Processing and packaging
■ Mixing of other active ingredients

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20
Q

Standardization

A

Sometimes the active ingredient is unknown.
○ Variable consistency of known active ingredients.
■ Example - Ginseng products contained 10-300% of what was labeled
■ Example - Echinacea showed ≤ 50% of what was labeled.
○ FDA encouraging labeling standards.

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21
Q

In 1998, the NIH established _____ (the National
Center for Complementary and Integrative Medicine)

A

NCCIM

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22
Q

Due to its many nutrients, which can satisfy almost all needs of the human body, acai is currently
referred to as _____

A

super food

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23
Q

Acai mechanism of action & suggested use

A

Antioxidant properties and strong nutritional value
○ Evidence: No well-done scientific studies with significant evidence
○ Often used for anti-inflammatory reasons, fever, pain, flu, etc.

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24
Q

Black cohosh mechanism of action and suggested use

A

● Proposed Mechanism of Action:
○ Remains unclear; No apparent dietary impact
● Suggested Uses:
○ Breast cancer, infertility, postmenopausal hot flashes (most
popular use), menstrual-related migraines, osteoarthritis,
rheumatoid arthritis
○ Evidence is generally weak. Only short-term use advised
Contraindication: allergy or hypersensitivity interactions, lots of potential drug interactions

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25
Q

Known side effects and adverse reactions of black cohosh

A

Abdominal pain, bleeding, bradycardia, bruising, constipation, diaphoresis, dizziness, headaches, “heaviness in legs,” increased risk of stroke and hormone-sensitive cancers, hepatotoxicity,

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26
Q

Black cohosh: concerns for drug interactions

A

Because it is a known CYP450 enzyme player, there are lots of drug interactions possible, most notably with antiseizure medications, analgesics, anesthetics, and anticoagulants.

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27
Q

Uses and indications for calcium

A

Antacid, bone stress injury prevention, calcium deficiency, cancer, colorectal cancer, growth (low birth weight infants), hyperkalemia, hyperparathyroidism, HTN, lead toxicity (acute
symptom management), magnesium toxicity, rickets, osteoporosis, PMS, preeclampsia

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28
Q

Contraindications for calcium

A

Ventricular arrhythmias, hypercalcemia, hypophosphatemia, renal stones, sarcoidosis

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29
Q

Vitamin D

A

● Ergocalciferol (D2), Cholecalciferol (D3).
● Protective of bone health/growth and required to absorb calcium.
○ Often provided together with Calcium in supplement form

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30
Q

Evidence based uses for Vitamin D

A

Osteoporosis, osteomalacia, hyperparathyroidism, diabetes, depression, psoriasis (topical preparation), acute infection

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31
Q

Known Side Effects and Adverse Reactions of Vitamin D

A

None unless reach toxic levels. Toxicity occurs at levels > 150 ng/mL - hypercalcemia, nephrocalcinosis, early aging, fatigue, nausea

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32
Q

Echinacea and mechanism of action

A
  • Native American medicinal plant; part of Daisy family
    ● Proposed Mechanism of Action:
    ○ No consensus on primary active ingredient or
    mechanism of action.
    ○ Seems to somehow boost immune function, reduce pain and inflammation
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33
Q

Suggested use and contraindications for Echinacea

A

Suggested Uses:
○ Shorten duration of URI (common cold) and UTI infections, wound healing, yeast infections, immune system support.
○ Evidence: NCCIH-funded studies showed no benefit; Other studies suggest reduction in duration of symptoms
● Contraindications:
○ Not to be used along with Amoxicillin.
○ Contraindicated in ragweed, daisy, or marigold hypersensitivity

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34
Q

Ephedra synthetic version is called

A

pseudoephedrine

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35
Q

The alkaloid ____ was banned in US in 2004

A

ephedrine (component from the stem of ephedra)

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36
Q

Ephedra mechanism of action

A

○ Ephedrine acts as a direct agonist of 𝞪 and 𝞫-adrenergic receptors, stimulating the release of norepinephrine.
○ Acts as an amphetamine-like stimulant

37
Q

Suggested uses for Ephedra

A

○ No FDA approved uses!
○ Uses included appetite suppression, weight loss, fatigue treatment, athletic performance, decongestant, asthma, sexual arousal.
○ Evidence: Supports appetite suppression and weight loss effects.
■ However, evidence shows risk outweighs the benefits

38
Q

Known side effects and adverse reactions of ephedra

A

Excessive adrenergic stimulation, HTN,
Seizure, Tachycardia, MI, CVA, excessive CNS
stimulation, anxiety, sleeplessness, psychosis
Concern for drug interactions: QT prolonging drugs (risk of ventricular arrythmias)

39
Q

Fish oil (omega-3)

A

●Omega-3 fatty acids have been shown to be beneficial for general health and some medical conditions; must be obtained from the diet
● Omega-3 sources: Herring, halibut, salmon, mussels, tilapia, flax, hemp, walnuts, pecans, hazelnuts
Mechanism of action

40
Q

Mechanism of action for Fish oil

A

○ Vasodilator and inhibitor of platelet
aggregation.
○ Decreases VLDLs, LDLs, and triglycerides (inhibition of hepatic triglyceride synthesis).
○ Weakly assists chemotaxic (aid in
inflammatory responses)

41
Q

Suggested use for fish oil

A

Evidence: CAD, HTN, hyperlipidemia, rheumatoid arthritis (RA), and post-MI

42
Q

Conraindication for fish oil

A

Doses > 3g in DM patients (interacts with
medications)

43
Q

Known side effects and adverse reactions for fish oil

A

Abdominal pain, bleeding, fishy aftertaste, halitosis, heartburn, hemorrhagic stroke (large doses), gas, loose stools (large dose)

44
Q

Drug interactions for fish oil?

A

Anticoagulants/antiplatelet drugs (↑ risk of
bleeding), antidiabetic agents (↑ risk of
hypoglycemia), antihypertensives (↑ risk of
hypotension), contraceptives (altered effect)

45
Q

Flaxseed is actually a strong source of _____ fatty acids, as well as _____

A

Omega-3; fiber

46
Q

The Evidence for flaxseed is most supportive of its use in ______

A

Diabetes management and treatment of elevated cholesterol

47
Q

Contraindications for flaxseed

A

Bowel obstruction, pregnancy & children (insufficient information),
dehydration, immature seeds (toxic)

48
Q

Side effects and adverse reactions of flaxseed

A

Diarrhea, abdominal pain, hypoglycemia, hypotension, headaches, possible increased risk of prostate cancer (?), hormone changes (?)

49
Q

drug interactions with Flaxseed

A

Is believed to possibly cause decreased absorption of oral medications when given at the same time as the oil

50
Q

Suggested uses for Garlic

A

○ Dyslipidemia, antiatherogenic, antibacterial, anti-HTN, anticancer.
○ Evidence: Mild antilipidemic effect, insufficient data on all other
claims. Mayo Clinic gives it a “green light” for evidence and risk

51
Q

Known side effects and adverse reactions for Garlic

A

○ Diaphoresis, dizziness, mild abdominal pain
○ Generally well tolerated with low side effect profile

52
Q

Drug interactions with Garlic

A

Potentiate other anticoagulants, discontinue before oral or general surgery. Can cause marked reduction in levels of anti-AIDS/HIV medication

53
Q

Ginger may act as a peripheral _____ agonist, but is mostly unknown

A

serotonin

54
Q

Suggested uses for Ginger

A

○ Antiemetic, nausea reduction,
dysmenorrhea, arthritis.
○ Evidence: Supports pregnancy-induced
nausea, other uses are not supported.

55
Q

Side effects and adverse reactions for ginger

A

○ No major side effects reported
○ Like Garlic, Ginger has a Mayo Clinic “green light”
due to fairly strong evidence supporting antiemetic
use and low side effect and contraindication
profile

56
Q

Antiplatelet activity may potentiate other
anticoagulants and antiplatelet drugs with which supplement

A

Ginger

57
Q

Suggested uses for Ginko Baloba

A

Evidence: Intermittent effects on claudication, mixed support for cognitive impairment. Not a “brain booster” as once thought
○ Commonly used for memory preservation, cognitive impairment,
dementia, Alzheimer’s disease, Cerebrovascular and peripheral
vascular disease, sexual dysfunction, tinnitus

58
Q

Suggested uses for Ginseng

A

Evidence: Few studies, most claims are not
supported, possible improved mental function

59
Q

Known Side Effects and Adverse Reactions for Ginseng

A

○ Generally well tolerated. May cause headaches,
GI upset, insomnia
○ Gets the Mayo Clinic “green light”

60
Q

Mechanism of action for Glucosamine-Chondroitin

A

Believed to be prominent precursors in the biochemical synthesis of the building blocks of joint cartilage

61
Q

There is some evidence supporting use for severe knee osteoarthritis, but other studies disagree - Which supplement?

A

Glucosamine-Chondroitin

62
Q

Which supplement is Contraindicated if allergic to shellfish

A

Glucosamine-Chondroitin

63
Q

Which supplement s believed to have a calming effect similar to a benzodiazepine medication?

A

Kava

64
Q

Mayo Clinic states it is a “supplement to avoid”

A

Kava

65
Q

Suggested uses for Kava

A

○ Anxiety, sleep disturbances, depression
○ Evidence: Supports anxiolytic effect, comparable to buspirone

66
Q

Side effects and adverse reactions of Kava

A

Serious hepatotoxicity, even known to cause death

67
Q

_____ is Usually supplied by a balanced diet, found abundantly in the body

A

Magnesium

68
Q

_____ is a cofactor in more than 300 enzyme systems that regulate diverse biochemical reactions in the body, including protein synthesis,
muscle and nerve function, blood glucose control, and blood pressure regulation.

A

Magnesium

69
Q

Suggested uses for Magnesium

A

○ Several uses: Ventricular arrhythmias (like Torsades), asthma, anxiety,
COPD, CAD, leg cramps, muscle spasm, preterm labor (tocolysis),
preeclampsia, RLS, migraines, HTN, constipation, Mag replacement
○ Evidence: Mild evidence for HTN, preeclampsia, constipation, low Mag

70
Q

Contraindications for magnesium

A

Heart block, coma, myocardial damage

71
Q

Hormone produced in the pineal gland of the brain, synthesized from the amino acid tryptophan

A

Melatonin

72
Q

Suggested uses for Melatonin

A

○ Insomnia, jet lag, other sleep disorders, arthritis, benzodiazepine withdrawal, cancer, headache syndromes, fatigue, stress, dementia, seasonal depression.
○ Evidence: Moderate evidence for insomnia, jet lag, sleep disorders

73
Q

Mechanism of action for red yeast rice

A

Red Yeast Rice contains several compounds that seem to lower cholesterol levels. One is monacolin K, which is the same ingredient
found in the cholesterol drug Lovastatin.

74
Q

Which supplement shows evidence for hypercholesterolemia

A

Red yeast rice

75
Q

Which supplement Should not be taken at the same time as Statins?

A

Red yeast rice

76
Q

Taking _____ along with other cholesterol-lowering medications increases risks of DDIs significantly, especially Statins.

A

Red Yeast Rice

77
Q

Contraindications for Red yeast rice

A

○ Abnormal LFTs, other liver dysfunction
○ Should not be taken at the same time as Statins

78
Q

Mechanism of action for St. John’s wart

A

Inhibition of norepinephrine, dopamine, and serotonin reuptake, possible suppression of ACTH and cortisol secretion

79
Q

Which supplement is effective in mild to moderate depression

A

St. John’s wart

80
Q

Drug interactions for St. John’s wart (There are LOTS)

A

Most notably antidepressant medications, birth control pills,
anticoagulants, antiseizure medications, some asthma medications,
and all corticosteroids.

81
Q

This supplement may interact with dihydrotestosterone to inhibit production, inhibit binding, increase clearance

A

Saw Palmetto

82
Q

While study results are contradictory, recent meta-analysis suggests that ______ does not have beneficial effects on BPH

A

saw palmetto

83
Q

Pregnant women should avoid contact with this supplement

A

Saw palmetto

84
Q

Which supplement is Believed to be an antioxidant with anti-inflammatory (COX inhibition)
properties.

A

Tumeric

85
Q

Some evidence to suggest _____ can lower cholesterol, decrease joint pain associated with arthritis, and treat dyspepsia

A

Tumeric

86
Q

Contraindications for Tumeric

A

Gastric ulcer, bile duct obstruction

87
Q

Supplement that is Likely helpful for insomnia, may have slight positive effects on anxiety, menstrual cramps, and menopausal symptoms

A

Valerian Root

88
Q

Medscape cites 66 serious interactions, many of them also used for anxiety, sleep, and tremors for this supplement

A

Valerian Root

Pharm Exam 1 (7 decks)

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