Herbals

Question 1

What populations can benefit from taking vitamin A supplements, besides in deficiency?

Answer 1

None

Question 2

What populations can benefit from taking vitamin D supplements, besides in deficiency?

Answer 2

Older adults/Institutionalized
Exposure to limited sunlight
Dark skinned individuals
Obese Individuals
Individuals with GI disorders

Question 3

What populations can benefit from taking vitamin E supplements, besides in deficiency?

Answer 3

None

Question 4

What populations can benefit from taking vitamin K supplements, besides in deficiency?

Answer 4

All newborns given IM vitamin K @ birth to prevent hemorrhagic disease of the newborn

Question 5

What populations can benefit from taking vitamin C supplements, besides in deficiency?

Answer 5

None

Question 6

What populations can benefit from taking vitamin B1 (thiamine) supplements, besides in deficiency?

Answer 6

Chronic alcoholics: Wernicke-Korsakoff Syndrome (Vision changes/ataxia/memory loss)
~20% Fatal if untreated

Question 7

What populations can benefit from taking vitamin B12 (cobalamin) supplements, besides in deficiency?

Answer 7

The elderly (poor absorption)
Vegans & Vegetarians
Alcoholics
Pernicious anemia
GI malabsorption disorders

Question 8

What populations can benefit from taking vitamin B9 (folate) supplements, besides in deficiency?

Answer 8

Women of childbearing age to prevent neural tube defects

Question 9

Is melatonin proven effective for insomnia/jet lag or changing sleep patterns?
For cognitive impairment?

Answer 9

+/-

No

Question 10

What meds should melatonin not be combined with?

Answer 10

Anti-seizure meds or warfarin

Question 11

Is glucosamine/chondroitin proven effective for OA?

Answer 11

No

Question 12

What are fish oils proven effective for?

Answer 12

Decrease CVD, BP, HR
Decrease CHD death
Decrease sudden cardiac death

Question 13

Is co-enzyme Q proven effective for heart conditions, CHF/Angina, HTN/diabetes, or migraines?

Answer 13

No, only useful in very rare genetic CoQ deficiency.

Question 14

Bitter Orange (ephedra replacement):
Common uses?

Adverse effects?

Major drug interactions?

Answer 14

Nausea, constipation, weight loss

^HR, ^BP. Stroke, MI (esp. w/caffeine)

MAOI (contains tyramine metabolites), inhibits gut 3A4

Question 15

Ephedra (banned in US):
Common uses?

Adverse effects?

Major drug interactions?

Answer 15

Colds/fever/flu, weight loss

^ risk CVD, stroke. Death.

Additive effect w/stimulants

Question 16

Ginger:
Common uses?

Clinical trial evidence?

Adverse effects?

Major drug interactions?

Answer 16

GI upsets/nausea, CVD/Inflammation, RA

Yes: for nausea

^ risk of bleeding

Anticoagulants

Question 17

Hawthorn:
Common uses?

Clinical trial evidence?

Adverse effects?

Major drug interactions?

Answer 17

Heart disease, CHF/HTN, angina

YES: mild heart failure

None

Digoxin/Nitrates, BP meds

Question 18

Horse chestnut:
Common uses?

Clinical trial evidence?

Adverse effects?

Major drug interactions?

Answer 18

Chronic venous insufficiency, varicose veins, hemorrhoids

Yes!

Raw seed contains poisonous esculin toxin, which may exacerbate kidney disease

Anticoagulants

Question 19

Kava:
Common uses?

Clinical trial evidence?

Adverse effects?

Major drug interactions?

Answer 19

Insomnia, anxiety, depression, ADHD

YES

Liver damage (potentially serious), muscle spasms

Additive effect w/sedatives. ^ acetaminophen toxicity

Question 20

St. John’s Wort:
Common uses?

Clinical trial evidence?

Adverse effects?

Major drug interactions?

Answer 20

Depression/anxiety, sleep disorders, heart palpitations, wound healing, chronic fatigue, migraine

YES

Photosensitization
SEROTONIN SYNDROME [with SSRI, MAOI, TCA etc]
May induce mania in bipolar, depressed/psychotic
Potential for birth defects

Antidepressants
Increased expression 3A4/2C19:
Decreased OCT, cyclosporin, statins, HIV PI, and more

Question 21

Thunder God Vine: (not on list)
Common uses?

Clinical trial evidence?

Adverse effects?

Answer 21

RA, obesity

Yes

Yes

Question 22

Supplements that are contraindicated w/anticoagulants? (4)

Answer 22

Ginger
Horse Chestnut
Melatonin (warfarin)
Vitamin K