Nutraceuticals Flashcards
Which is more common: supplements or vitamins?
supplement use is much more common than vitamin. Women are more likely to take than men
What is most common reason for taking a supplement?
weight loss and heart problems equal. Followed by digestion, pain and allergies
What is DSHEA?
established standards for supplement industry. Pretty lax rules of self-regulation. If adverse effects occur, must report to FDA
What kind of ADE do kava-kava and comfrey have?
serious liver damage
Are supplments regulated by FDA?
only if there is an adverse effect. Otherwise no.
Are supplements required to be standardized in US?
no. no legal or regulatory definition exists in US. Even if label says standardized, doesnt mean it’s quality
Do nutritional support statments on packages need FDA approval? Do health claims?
no.
Health claims do however need approval.
What is the general rule for surgery and supplements?
stop them 2 weeks ahead of surgeries
Are most people willing to disclose supplement use?
Yes. 92% are but ONLY if asked
What is ephedra for and what is its possible toxicity?
for weight loss.
Cardiovascular toxicity
What is kava-kava for and what is its possible toxicity?
sleeping aid/antianxiety.
hepatotoxicity
Which herbals are natural salicylates?
WILLOWBARK
What is licorice for and what is its possible toxicity?
peptic ulcer, flavoring agent.
Psuedo-hyper aldosteronism
How does licorice cause pseudo-hyperaldosteronism?
it is metabolized to glycrhizzin, which promotes salt and water retention by kidney. Occurs despite normal aldosterone levels.
Which herbals have antiplatelet function?
garlic, ginkgo biloba
What can bitter orange do to CYP?
inhibit CYP3A4
What can echinacea do to CYP?
Inhibit CYP1A2, inhibit ntestinal 3A4, and induce normal CYP3A4
What can ginkgo biloba do to CYP?
INhbiit CYP1A2 and 2D6
What can ginseng do to CYP?
inhibit CYP 2D6
What can st. John’s wort do to CYPs?
induce CYP 1A2, 3A4, and 2C9
Which common drugs rely on CYP1A2?
duloxetine, fluvoxamine, frovatriptan, mexiletine, olanzapine, ropinirole, tacrine, tizanidine, zileuton
Which common drugs rely on CYP2D6?
amitriptyline, codeine, desipramine, dextromethorphan, metorolol, oxycodone, tamoxifen, timolol
Which common drugs rely on CYP3A4?
verapamil, cyclosporine, protease inhibitors, midazolam, simvastatin, atorvastatin, tacrolimus, tamoxifem, triazolam
Which common drugs rely on CYP2C9
ARBs, NSAIDs, oral hypoglycemics and warfarin
What are the interactions of echinacea and Ginseng?
antagonize immunosuppressants like azathioprine, corticosteroids, cyclosporine and tacrolimus
What are the interactions of pomegranate juice?
effective for treating prostatic cancer. increase in mean PSA doubling time (15 months to 54 months) Good thing.
Inhbiits CYP3A4 and can cause rhabodmylysis with statins
What can taking > 1 g of Vit C per day for many months cause?
oxalate crystal deposition causing tubulointerstitial nephritis, predominantly in distal tubules
What can excessive vitamin A cause?
N/V, headache, dizziness, blurred vision, clumsiness, birth defects, liver problems, osteoporosis
What can excessive vitamin D levels cause?
N/V, poor appetite, constipation, weight loss, constipation, weakness, weight loss, confusion, arrhythmia, Ca and P deposits in soft tissues
What can excessive vitamin E or K do?
antagonize warfarin anticoagulant
Is there evidence that multivitamins are helpful?
no
Is there evidence that Coenzyme Q10 or melatonin can help prevent alzeimers by antioxidation?
no
Is there evidence omega-3 fatty acids help?
yes. they decrease BP. Increase HDL and LDL (not good) and decrease risk of MI and dementia
What does Coenzyme Q10 (ubiquinone) do?
potent antioxidant. Lowers both systolic and diastolic BP. Improves HDL and exercise tolerance. Prevents statin-induced myopathy.
Can reduce warfarin activity though.
What does melatonin do?
serotonin derivative produced in pineal gland.
Useful for resetting jet-lag. Prescription form = ramelteon used for insomnia.
metabolized by CYP 1A2. May interact with Nifedipine.
Can cause psychosis and antagonise SSRIs.
Decreases M/F fertility and breast milk production.
What do beta-sitosterols do?
good evidence that they decrease BPH symptoms without shrinking prostate
What does echinacia do?
no evidence for therapy
Where is zinc found and what does it do?
beef, fish, spinach. Important cofactor for many enzymes, including SOD involved in protein and carb metabolism. Increases healing of gastric ulcers.
What does garlic do?
evidence that it lowers cholesterol
What does ginseng do?
MAY provide benefit for CV. Decreases LDL and blood sugar, boost immune system and antimicrobial agents. Enhances response to flu vaccine
Which supplement is good for jet lag?
melatonin
What natural supplement is good to combine with antidepressants?
folic acid
OR
omega3FA boosts effectivness but may trigger mania in bipolar
What supplement can be given with AchE inhibitors like donepezil?
Ginkgo Biloba
What supplement can be given as a sleep aid in children with ADHD?
valerian
What supplment works for mild depression?
St. John’s wort
What mineral should be supplmented in HIV patients?
selenium
What mineral should be supplemented in 3rd world childhood diarrhea?
zinc
What mineral can interact with BBs, insulin or NSAIDs?
chromium can enhance them or these drugs can increase chromium’s absorption
Where is chromium obtained and what does it do?
broccoli. Enhances insulin, carb fat and protein metabolism
Where is selenium found and what does it do?
brazil nuts. Important for antioxidant
