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DEMS IV > supplements in metabolic disease > Flashcards

supplements in metabolic disease Flashcards

1
Q
  1. Define complementary and alternative medicine (CAM).
A
  • Complementary Medicine = Medicine is used together with conventional western medicine.
  • Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
  • Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
  • Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
  • Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
  • Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.
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2
Q
  1. Explain the purpose of Dietary Supplement and Health Education Act (DSHEA) 1994.
A

Evaluates vitamins, herbals, aa and other botanicals and regulates supplements more like food rather than meds. Products cannot be put on the same shelf as OTC or meds. Prior to 1994 all products were grandfathered in

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3
Q

responsibilities of manufacturers of supplements

A

Ensure product is safe and product label is truthful and not misleading. Do NOT need to register or get FDA approval

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4
Q

responsibilities of FDA in supplements

A

Take action in product is unsafe once on the market. Monitor safety (adverse event reporting system), product labeling, claims, package inserts and accompanying literature.

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5
Q
  1. Distinguish a higher quality supplement due to product labeling.
A

• Required Disclaimer – “This statement has not been evaluated by the FDA. This products is not intended to diagnosed, treat, cure, or prevent disease” • Structure-function claim – What the product can be used for • Follow Good Manufacture Practices • Supplement seal of Approval (GMP’s, CL, USP, NSF)

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6
Q

List CAMs used for dyslipidemia

A

fish oil/omega 3 fatty acid (very safe and effective) , plant sterols and stanols (very safe and effective), fiber (very safe and effective),

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7
Q

fish oil indications and MOA

A

Indicated for hypertriglyceridemia. Decreases hepatic secretion of of VLDL-C, increase VLDL-C clearance, reduces TG transport. Omega 3 fatty acids compete with arachidonic acid in the cycloxygenase and lipoxygenase pathways

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8
Q

Fish oil efficacy

A

Decreases TG by 20-50%. If TG >500mg/dl, decreases by 45%. If TG is 200-499mg/dl and fish oil is combined with statin, TG decreases by 30%. Neutral effects on LDL-C

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9
Q

Fish oil doses

A

Primary prevention: 500 mg qd or 2 fishy meals a week. Secondary prevention (CHD): 1000 mg qd

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10
Q

Fish oil adverse effects and DDIs

A

Adverse rxns: fish taste, GI upset, heartburn, belching. DDI: Antihypertensives, contraceptives, Orlistat, Anticoagulants/Antiplatelets.

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11
Q

Fish oil herb interactions

A

garlic, ginger, ginkgo and ginseng

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12
Q

fish oil safety

A

generally recognized as safe (GRAS)

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13
Q

Which fish should be avoided in pregnancy

A

shark, swordfish and tilefish

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14
Q

Fiber benefits

A

FDA permits health claims: 51% whole grain reduce risk of heart disease.

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15
Q

Blond Psyllium benefits

A

decreases total cholesterol 3-14% and LDL-C 5-10%

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16
Q

Niacin benefits

A

Decreases LDL 5-25% and TG 20-50%. Increases HDL 15-35%. May lower risk of scondary MI but no significant decrease in all cause mortality.

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17
Q

Niacin side effects

A

HA, GI, flushing, increase blood glucose and uric acid. Monitor LFT due to hepatotoxicity risk

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18
Q

Efficacy of niacin

A

IM > LA > ER

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19
Q

MOA of plant sterols vs stanols

A

sterols: Inhibits about 50% intestinal absorption of cholesterol. Stanols: Inhibits dietary and biliary cholesterol

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20
Q

Plant sterols efficacy

A

Decreases total cholesterol, and LDL. NO effect on HDL. Takes 2-3 weeks to be effective, and cholesterol levels rise back to baseline 2-3 weeks after stopping.

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21
Q

Plant stanols efficacy

A

Decreases LDL 10-15%. When combined with statin therapy, decreases total cholesterol 3-11% and LDL 7-16%. Takes 2-3 weeks to be effective, and cholesterol levels rise back to baseline 2-3 weeks after stopping.

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22
Q

Plant sterols adverse rxns

A

•Nausea, indigestion, diarrhea, constipation & gas

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23
Q

Plant stanols adverse rxns

A

diarrhea and steatorrhea

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24
Q

Plant sterols and stanols interactions

A

Herbs: Beta carotene and Vit. E. Drugs: Zetia®

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25
Q

Plant sterols vs stanols efficacy

A

equally effective

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26
Q

Atkins diet

A

high fat, low carb (max 40 g per day). First 10 days of ketosis result in rapid weight loss

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27
Q

macrobiotic diet

A

•Low fat, emphasizing whole grains, vegetables & restricting fluid intake

28
Q

Ornish diet

A

Only 10% calories from fat. Allow fruits and veggies

29
Q

south beach diet

A

low carb, glycemic index, allow good carbs and fats, limit bad saturated and trans fats

30
Q

zone diet

A

•40 % carbohydrates, 30 % protein, and 30 % fat

31
Q

Mediterranean diet

A

whole grains,fruits and veggies, olive oil, fish and seafood, lean meats, herbs and spices, fresh unprocessed foods, portion control, healthy lifestyle, glass of wine with meal

32
Q

ephedra MOA

A

•Ephedrine and pseudoephedrine are non-selective alpha and beta receptor agonists which stimulate nervous system

33
Q

ephedra efficacy

A

•Weight loss of 0.9 kg/month up to 6 months with ≤ 30 % of dietary fat intake with moderate exercise

34
Q

ephedra adverse reactions

A

Dizziness, anxiety, insomnia, HA, dry mouth, N/V, heartburn, tachycardia, palpitations, & elevated BP. Seizures, cardiomyopathy, MI, arrhythmias & sudden death

35
Q

ephedra uses

A

risk outweighs benefits-

36
Q

Bitter orange MOA

A

•Contains 1-6% of synephrine which is related to ephedrine

37
Q

Bitter orange adverse effects

A

Dizziness, anxiety, insomnia, HA, dry mouth, N/V, heartburn, tachycardia, palpitations, & elevated BP. Seizures, cardiomyopathy, MI, arrhythmias & sudden death

38
Q

Bitter orange uses

A

There is no evidence that this supplement is safer than ephedra, yet it is generally recognized as safe (GRAS). Manufactures use it instead of ephedra

39
Q

Benefits of calcium

A

Patients will low calcium intake often gain more weight and have a higher BMI.

40
Q

Calcium adverse rxns

A

belching and flatulence

41
Q

Alli (orlistat) MOA

A

•Reversible inhibitor of pancreatic & gastric lipase

42
Q

Alli adverse reactions

A

•HA, oily spotting, abdominal discomfort, gas, fecal urgency, steatorrhea & liver related events. Risk of liver injury

43
Q

Alli DDI

A

•Anticoagulants, amiodarone, levothyroxine, & vitamins

44
Q

Alli uses

A

FDA approved for long term weight loss. Patients with BMI of 27 or more have seen benefits.

45
Q

Hoodia gordonii efficacy

A

Side effects (nausea and skin sensation, elevated BP, pulse, HR, bilirubin, alk phosph) and does not change body weight, body fat or energy intake

46
Q

Chromium MOA

A

Might reduce oxidative stress. Low levels are associated with impaired glucose and insulin so may be used for diabetes. Decreases fasting blood glucose, A1C and total cholesterol

47
Q

compare types of chromium

A

Chromium 0 has no activity. Chromium III found in food and supplements. Chromium VI used in welding industries & carcinogenic

48
Q

Chromium adverse rxns

A

•HA, insomnia, irritability, mood changes & sleep disturbance. Vomiting, diarrhea, hemorrhage. Caution in renal dysfunction

49
Q

chromium DDI

A

Herbs: bilberry, brewer yeast, iron, Vit. C & zinc. Drugs: insulin, levothyroxine, NSAIDs & corticosteroid. Disease: diabetes, renal dysfunction

50
Q

forms of chromium

A

•Picolinate, nicotinate, polynicotinate and chloride

51
Q

Vanadium MOA

A

Activates insulin receptor proteins, stimulates glucose oxidation & transport. Liver: stimulates glycogen synthesis. Adipose: inhibits lipolysis. Skeletal muscle: promotes glucose uptake

52
Q

Vanadium efficacy

A

High does of 100 mg qd may improve insulin sensitivity and possibly reduce blood glucose levels. Effective in Type 2 but not Type I diabetes

53
Q

Vanadium adverse rxns

A

•GI upset, kidney toxicity, fatigue, lethargy & tongue discoloration. Risk of bleing when used in combo with RX, OTC or supplments

54
Q

vanadium interactions with herbs, drugs, labs and diseases

A

Herbs: garlic, ginger, ginkgo & ginseng. Drugs: anticoagulants & antiplatelets. Labs: blood glucose & serum creatinine. Disease: diabetes & renal dysfunction

55
Q

List dietary herbs used for diabetes

A

bitter melon, cassia cinnamon (caution in liver dz), magnesium (decreases risk for T2DM), prickly pear cactus, stevia, chia, fruit

56
Q

Garlic indications and MOA

A

HTN and hyperlipidemia. Allicin is th active ingredient and it inhibits hepatic cholersterol synthesis and activates production of endothelium derived relaxation factor to relax smooth muscle and vasodilation

57
Q

garlic adverse rxns

A

•Halitosis, body odor, heartburn, and GI upset

58
Q

garlic interactions- drugs, herbs, diseases

A

drugs: Anticoagulant, antiplatelet, CYP3A4 and 2E1. Herbs: ginger, ginkgo and Vit E. Diseases: diabetes, HIV or AIDs

59
Q

garlic clinical pearls

A

Fresh garlic needs to sit for 10 mins after being chopped up. Discontinue 2-3 weeks prior to surgery. Products marketed as odorless may not contain allicin

60
Q

CoQ 10 indications

A

CHF (possibly effective), Preventing statin-induced myopathy (Insufficient Reliable evidence)

61
Q

CoQ10 MOA

A

Has antioxidant properties to stop damage and give energy to cells. Cofactor in metabolic pathways

62
Q

CoQ10 efficacy

A

No evidence when taken as monotherapy, possibly useful with prescription treatment for HF. No significant benefit for myopathy or statin tolerability

63
Q

CoQ10 adverse rxns

A

GI upset, heartburn, appetite loss

64
Q

CoQ10 interactions- drugs, labs, diseases

A

drugs: anticoagulants. Labs: Increases T4/T8 ratio. Diseases: may lower BP, cigarette smoking may deplete body stores

65
Q

Meds that can lower CoQ10 levels

A

statins, beta blockers, diuretics

66
Q

list CAMs that are proved effective

A

EPA, fish oils, fiber, niacin, plant sterols and stanols,

DEMS IV (26 decks)

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