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Ocular pharm '22 > Supplements > Flashcards

Supplements Flashcards

1
Q

Vitamin A -

A
  • (RDA [ug/d] = 900 (3000 IU) ♂ vs 700 (2300 IU) ♀)
  • Fat soluble forms exhibit highest bioavailability
  • Role in vision and cell growth/differentiation
  • High dosing (15000 IU) for retinitis pigmentosa
  • Deficiency: xerophthalmia
  • Role in xanthophyll transport to the retina
  • Vit A toxicity associated with papilledema
  • Reported risk of cancer in (former) smokers and alcoholics taking high dose vitamin A
    *
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2
Q

Vitamin C

A
  • (RDA [mg/d] = 90 ♂ vs 75♀)
  • Collagen synthesis, wound healing & capillary integrity
  • May impair hepatic acetaminophen metabolism -> toxicity (high doses)
  • Risk of blood thinning effects
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3
Q

Is Vitamin A fat or water soluble?

A

Fat soluble

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4
Q

Vitamin A deficiency relating to the eye

A

xerophthalmia (impared goblet cell function)

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5
Q

Vitamin A dosing for retinitis pigmentosa

A

1500 IU

(RDA [ug/d] = 900 (3000 IU) ♂ vs 700 (2300 IU) ♀)

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6
Q

What role does Vit A play in the eye

A

Role in xanthophyll transport to the retina

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7
Q

Vit A toxicity associated with

A

Papilledema

Reported risk of cancer in (former) smokers and alcoholics taking high dose vitamin A

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8
Q

Vitamin E

A
  • Fat soluble vs water soluble acetate or succinate
  • Deficiency: opthalmoplegia (palsy of extra ocular muscle)
  • Platelet inhibition at high doses (>1000mg); hemorrhagic stroke
  • Risk of prostate cancer; recommend adding 200 ug selenium
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9
Q

Deficiency of Vit E relating to the eye

A

Opthalmoplegia

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10
Q

Zinc

A
  • (RDA [mg/d] = 11 ♂ vs 8 ♀)
  • Supports antioxidant enzymes
  • Decreased in macular degeneration
  • Zinc deficiency mimics Vit A deficiency owing to Zn-dependent conversion of Retinol -> Retinal
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11
Q

Copper

A
  • (RDA [ug/d] = 900)
  • Important role in critical enzyme function
  • Absorption is decreased by excessive Zn ingestion; Cu supplementation is required with concomitant Zn administration to prevent Cu-deficiency anemia
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12
Q

Carotenoids

Lutein and Zeaxanthin

A
  • 2 of the 3 naturally occurring pigments found in the human retina giving it an orange/yellow color
  • Antioxidants
  • Anti-inflammatory
  • Filter harmful blue and UVA light
  • RDA is 5 mg lutein + 1 mg zeaxanthin (5:1)
  • Reduce glare disability and discomfort
  • Reduce photo-stress recovery times (regaining sight post bleach)
  • Increase contrast sensitivity (e.g. enhance vision in foggy conditions)
  • Increase chromatic contrast threshold (e.g. tennis ball visualization)
  • Increase visual range
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13
Q

Where is Lutein, meso-zeaxanthin concentrated in the Macula

A

Lutein: In the periphery

Meso-zeaxanthin: In the fovea

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14
Q

Ratio of lutein to zeaxanthin and mesozeaxanthin

A

Lutein 50%, zeaxanthin 25% and mesozeaxanthin 25%

(relates to RDA)

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15
Q

With what can you measure the macular pigment optical density (MPOD) and why

A

Maculoscope

Reduced MPOD is a suggested risk factor for macular degeneration

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16
Q

Can Beta-carotine be used as a supplement for macular degeneration

A

Beta-carotene (a vitamin A precursor) supplements have been suggested to compete with lutein and zeaxanthin for macular pigmentation

17
Q

Omega 3

A

Ω3 Fatty Acids (AI [mg/d] 1600 ♂ vs 1100♀)

  • Anti-inflammatory
  • Antioxidant
  • Blood thinner- bleeding risk
  • Cholesterol lowering effects are mixed
  • Help with dry eyes
  • Short chain ALA18C is plant-derived and has 5% bioavailability in humans
  • Long chain EPA20C & DHA22C are found in eggs & cold-water oily fish
  • Grass-fed animals have Ω6:Ω3 ratios of 2:1
  • Grain-fed animals have Ω6:Ω3 ratios of 4:1
  • Concerns of fish oil contamination w/ heavy metals are unfounded; metals bind to proteins
  • Some fish however have been found with high levels of mercury and potentially other heavy metals
  • Products treated by molecular distillation under vacuum offer the lowest risk of contamination by fat-soluble pollutants

Bioavailability by Formulation and Structure

  • Triglyceride (glyceryl) esters > Fish Body Oil > Free Fatty Acid > Ethyl Esters

DHA>EPA>ALA

Ratio of Ω6 to Ω3

  • Dietary Ω6 intake averages 11x that of omega-3; largely due to its over-abundance in most meats and some oils
  • Ideal ratios should be between 1:1-1:4 suggesting that intake of Ω3 should exceed Ω6
  • Acceptable intake level of Ω3 is 1600 mg/d men vs 1100 mg/d women
18
Q

Risk factors for macular degeneration

A
  • Smoking
  • Ultraviolet light
  • Poor Diet: High BMI and carbohydrate intake
  • Light Eyes
  • Aging
  • Family history: 50% lifetime risk of morbidity exists for patients with an affected relative vs a 12% to those without affected relatives
  • Ethnicity: Caucasian > African Americans
  • Macular drusen
  • Co-morbidities: HTN
19
Q

Basic formulation of macular degeneration suplements

A

Vitamin C 500 mg

Vitamin E 400 IU

Zinc 80 mg (zinc oxide) (or 25mg according to newer studies)

Copper 2 mg (cupric oxide)

Lutein 10 mg

Zeaxanthin 2 mg

20
Q

Sources of AMD supplements

A
21
Q

Vitamin B

A
  • B vitamins (6, 9 and 12) are known to lower homocysteine protein levels, reducing inflammation
  • Early studies suggest that B vitamins can lower the risk of developing macular degeneration
  • Riboflavin (B2) is a potent antioxidant that is associated with a reduced risk of cataracts
  • Niacin (B3) is a key vitamin cofactor of mitochondrial metabolic pathways and a powerful antioxidant associated with reduced risks of glaucoma
  • Thiamine (B1) also plays a role in mitochondrial activity and is associated with reduced risks of cataracts and diabetic retinopathy
22
Q

Which B vitamin is associated with a reduced risk for cataracts

A

B2 riboflavin

23
Q

Ginkgo Biloba effects on open angle glaucoma

A
  • Some literature refers to the neuroprotective role of Ginkgo Biloba thru its ability to improve cerebral blood flow
  • Mitochondrial antioxidant
  • Risk of blood thinning effects, hyphema, retinal hemorrhage
24
Q

Marijuana effects on open angle glaucoma

A

• IOP lowering effects have never been proven to be therapeutically viable

25
Q

Which antioxidant supplements are thought to reduce age related cataract progression

A
  • Vitamin A
  • Vitamin C
  • Vitamin E
  • Vitamin B Complex
  • Omega 3 fatty acids § Lutein & Zeaxanthin
26
Q

What supplement can be used to treat KERATOCONUS (KC)

A
  • 1 in 500-2000 of people develop KC
  • Characterized by corneal ectasia, KC is often diagnosed in adolescence
  • As KC advances, vision diminishes, and the use of specialty contact lenses is a common non-surgical option
  • Studies show that cross-linking between cornea collagen fibrils increases with age due to oxidative reactions
  • In patients with diabetes, these oxidative reactions are also known to be enhanced, rendering them less susceptible to KC
  • Once patients reach an age of 40-50 years, their cornea is 35 thought to have undergone its maximum crosslinking potential
  • In April 2016, the FDA approved corneal crosslinking with Vit B2 and UV light for progressive KC, and 3 months later the procedure was approved for corneal ectasia
  • Topical application of Photrexa® (Avedro Inc) to the eye is done after removing (epi-off) the epithelium
  • The eye is then exposed to KXL® UVA light for up to 30 min leading to the production of ROS
  • Covalent cross-links formed between amino terminals of the collagen side chains as well as to proteoglycans of the extracellular matrix provide enhanced mechanical strength and long lasting stabilization1
  • Corneal thickness must exceed 400um in order to avoid endo damage
27
Q

What supplements can be used for retinitis pigmentosa

A

As a degenerative, hereditary eye disease, the onset of RP sight deterioration can vary from one affected individual to the next

Vitamin A
• 15,000 IU of Vitamin A taken by adults with early or mid-stage RP

• Intracranial hypertension is linked to large doses of retinoids used inbtreatment of acne, psoriasis or to induce leukemia remission

Bilberry Fruit
• It has been suggested that pilots in WWII consumed bilberry jam to enhance night vision

28
Q

Which supplements can be used against dry eye

A

Ω3 Fatty Acids

  • Particularly useful in the most susceptible population
  • AAO and AOA recommend Ω3 fatty acid for healthy tear film production
  • Triglyceride (glyceryl) esters > Fish Body Oil > Free Fatty Acid > Ethyl Esters
  • DHA>EPA>ALA

Vitamin A

• Vitamin A deficiency can result in xerosis of the conjunctiva and cornea, and alopecia of the eyelashes

29
Q

Which antioxidants can be used against diabetic retinopathy

A

Bilberry fruit

  • Properties linked to tannin content

Resveratrol

  • Acts as an agonist of PPAR gamma, a nuclear receptor targeted in some DM-2 therapeutics

Vitamin B1 (Thiamin)

  • A 2009 clinical study linked vitamin B1 supplementation to a reduction in albuminuria which is ai indication of diabetic retinopathy in Type 2 Diabetes

Vitamin D

  • Deficiency is more common in non-insulin dependent diabetics and is lowest in those with diabetic retinopathy

Lutein & Zeaxanthin

Ocular pharm '22 (7 decks)

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