OTC Flashcards
phytotherapy
-science of using plant-derived substances to treat and prevent illness
-not always an identified active ingredient
-long history in EU
What are the four classes of herbs
-Class 1: herbs safely consumed
-Class 2: some restrictions apply
-Class 3: only to be used under supervision of expert
-Class 4: insufficient data for classification
What is the difference between a health claim and a structure-function claim?
-health claim: describes the relationship between substance and disease condition
-structure-function claim: most common; won’t claim to prevent disease; notes physiological effect
What is the difference between a health claim and a qualified health claim?
-health claim is not approved by the FDA
-qualified health claim: based on emerging science; must be FDA-approved
What is the Dietary Supplement Health and Education Act of 1994?
-cannot claim to prevent or cure a condition
-must display disclaimer: “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease”
What are some problems surrounding dietary supplements?
-supplements not subject to same standards as OTC or prescription drugs
-dosage of active ingredient can vary from different plants, climates, environments etc.
-proof of safety or efficacy is not required
-discrepancy between label and what is actually inside
What is an example of an FDA warnings?
-consumers warned to immediately stop the use of LipoKinetix which caused serious liver injuries
-not listed on the bottle
What was the result of a study of 20 multivitamins?
-some contained led
-some contained more or less than the labelled amount
-some took longer than allowed to disentigrate
What is echinacea?
-source: purple cornflower
-content: flavonoids, phenols, iron, K+, vit A, C, E
-indication: stop flu or cold
-action: works on macrophages
-cautions: avoid if immunocompromised, not for continuous use
What is the MOA of echinacea?
-natural antibiotic
-suppress virus activity, stimulate the immune system, activate T-cells
-topical or oral
What are the contraindications of echinacea?
-not for pregnant or breastfeeding
-not for immunocompromised pt; can accelerate progression of conditions
-treatment restricted to 8 weeks at a time
What class is echinacea?
class 2
What is garlic?
-source: garlic plant
-indication: to lower serum cholesterol and triglycerides
-action: when crushed = activates sulfur-containing compounds
-cautions: allergies, GI symptoms, interact with anticoagulants
What is the MOA of garlic?
-inhibits platelet aggregation
-prevents clotting
-suppress mobilization of intraplatelet Ca = inhibits cyclooxygenase activity = decreases thromboxane A2
-antioxidant properties
-interact with GP2b/3a receptors = reduce platelet binding to fibrinogen
-effects mostly only studied in vitro
What are the general steps to primary and secondary hemostasis?
-primary: aggregation = platelet aggregation -> clotting -> clot
-secondary: coagulation = thrombin -> fibrin -> clot
What is Gingko biloba?
-source: gingko tree
-indication: improve circulation, mental decline
-action: antiox effect, inhibit platelet aggregation
-cautions: GI issues, allergy, increase MAOI effects
What class is Gingko?
class 2d
What is a major adverse effect of gingko?
-doubled risk of hemorrhaging
What is St. Johns Wort?
-source: perennial herb
-indication: for mild-moderate depression
-action: stimulates neurons, increase reuptake of NT
-class 2d
What is Monoamine oxidase ?
-highest in liver, GI, CNS
-met of noradrenaline and dopamine from nerve terminals
What are Monoamine oxidase inhibitors?
-drugs that prevent met of noradrenaline and dopamine
-used in Parkinson’s disease (decrease in dopamine) to increase dopamine
What is the cheese effect?
-people on MOA inhibitors ate cheese and some died
-hypertensive crisis = BP increases
-increased tyramine in gut from cheese -> increased levels in blood -> enter neuron -> lots of tyramine and adrenaline in neuron and can’t be degraded because MAO inhibitors prevent it -> tyramine displaces noradrenaline -> neurons get overexcited
What foods contain high amounts of tyramine?
-cheese, meat, red wine, beer
What is tyramine/amphetamine?
-resembles noradrenaline
-displaces NA from vesicles to cytosol
-no direct action on adrenoceptors
What acts on the adrenergic receptor?
-adrenaline
-NOT tyramine
What is ginseng?
-source: ginseng plant
-indication: improve steroidlike components
-action: ginsenosides = enhance immune function
-cautions: class 2, contra with hypertension, overstimulation
What is hawthorn?
-source: native EU tree
-indication: improve blood flow
-action: dilates coronary vessels, strengthens heart contractions
-cautions: class 1
What is saw palmetto?
-source: palm tree
-indications: reduce the incidence of BPH
-action: not sure, mimics estrogen
-cautions: has phytoestrogens = interfere with hormone therapy
What is valerian?
-source: perennial herb
-indications: minor tranquilizer
-actions: GABA binding
-cautions: class 1, withdrawal symptoms
What happens when the drug tetracycline interacts with calcium and magnesium?
-increased absorption of unused drug
-decreases effect of drug
What happens when fluoroquinolones interact with calcium and magnesium?
-decreases drug effects
-increased unused drug absorption
What happens when tetracycline interacts with St. John’s wort?
increased photosensitivity
What happens when fluoxetine interacts with St. John’s wort?
CNS depression
What happens when antihistamine drugs interact with alcohol?
CNS depression
What happens when antihistamines interact with st. John’s wort?
serotonin syndrome and increased photosensitivity
What are omega-3 fatty acids?
-alpha linolenic acid = 18:3n-3
-required for health but not synth in humans
-derived from plants
What other two types of omega 3 FA can humans synthesize from ALA?
-eicosapentaenoic acid (EPA) = 20:5n-3
-docosahexaenoic acid (DHA) = 22:6n-3
-these are called marine-derived (in fish)
Is Omega-3 synthesized in humans?
-no, must be consumed
Eicosapentaenoic acid
20:5n-3
docosahexaenoic acid (DHA)
22:6n-3
What compound do preterm infants require and what is it for?
-DHA
-important in brain and retina development
-preterm infants can’t make enough = DHA must be in formula
What is the relationship between fish consumption and coronary heart disease?
-mortality from CHD and MI much lower in men that are 35g of fish daily than men who didnt
-even small increase in ALA intake = great decrease in acute MI risk
-inverse relationship with fish and sudden cardiac death
What is the issue with fish oils?
-you cannot reduce a whole food into a pill
What kind of cells are involved in inflammation?
-B cells and T cells
-part of the immune system
-in the blood
Can EPA and DHA aid in inflammatory diseases?
-benefits seen after 12 weeks of supplementation for rheumatoid arthritis
-benefits seen for ulcerative colitits = decreased infl. mediators, weight gain, decreased corticosteroid used
what supplement can be indicated for depression and bipolar disease and what evidence is there?
-omega-3 fatty acids (DHA, EPA)
-people with depression may have low levels of omega 3 in plasma and fat
-pt who took EPA and DHA experiences longer remission of bipolar disorder and less depression
does EPA and DHA prevent blood clotting?
yes
What are common adverse nutrient/drug interactions?
-calcium and antibiotics
-tyramine and MAO inhibitors
-Vit K and warfarin
-alcohol and stimulants
-grapefruit juice and statins
what do laxatives interact with and what is the effect?
-vit and minerals
-decrease nutrient absorption
what do diuretics interact with and what is the effect?
-minerals
-increases mineral loss in urine
What do antineoplastics interact with and what is the effect?
-folic acid, vit b
-decreases vitamin absorption
What do antihyperlipidemics interact with and what is the effect?
-fat sol vit (A, D, E, K)
-decrease vitamin absorption
What do acid blockers interact with and what is the effect?
-vit B12
-decrease vitamin absorption
How does coffee and tea interact with the body?
-interferes with iron
-caffeine binds to it
-in tea: tannin interferes
How does smoking interact with drugs?
-caffeine = increase clearance by 56%
-flecainide = increase clearance by 61%
-insulin =increase in insulin requirement
-propranolol = increase clearance by 77%
-theophylline= increase clearance by 58-100%, decrease half-life, increase Vd
-warfarin = INR prolonged
