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My DEMS 4 > Supplements in Metabolic Disease > Flashcards

Supplements in Metabolic Disease Flashcards

1
Q

Integrative health

A

Healing oriented practice that incorporates the relationship between the provider and whole person (mind, body, and spirit)
-emphasizes evidence and makes use of all therapeutic approaches

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2
Q

What percentage of patients didn’t report CAM use to health care provider?

A

72%

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3
Q

Dietary supplement and health education act (DSHEA 1994)

A
  • regulate the evaluation of vitamins, herbals, aa, and other botanicals
  • Regulated herbal supplements more like food than medication
  • Products cannot be put on same shelf as OTC or meds
  • Prior to 1994: all grandfathered in.
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4
Q

DSHEA: Do manufacturers need to register or get FDA approval?

A

no

  • They are responsible to ensure product is safe
  • ensure product label information is truthful and not misleading
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5
Q

DSHEA: FDA action?

A
  • take action if product is unsafe once on market
  • monitors safety (ADR MedWatch reporting)
  • Monitors product information: labeling, claims, package inserts, accompanying literature
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6
Q

Adverse event reporting

A 
FDA medwatch reporting system
-voluntary
-submit online or by mail
What can be reported?
Regulated drug
Biologic
Medical device 
Dietary supplement
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7
Q

Labeling requirements

A

Required disclaimer (“This statement has not been evaluated…”)
-May include a structure function claim (claim for its use), not required
-Label contains a supplement seal of approval (GMPs, CL, USP, NSF) if applicable
-Manufacturer follows Good Manufacture Practices:
More stringent practices
Record keeping
Quality control
Testing
Production
Verify quality of raw materials
Increase inspecting of facilities by FDA inspectors
483 inspection report

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8
Q

Fish Oil/Omega 3 Indications

A

hypertriglyceridemia

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9
Q

MOA Fish oil/omega3

A
  • Decrease in hepatic secretion of VLDL-C, increase VLDL-C clearance, reduces TG transport
  • omega 3 FA compete with arachidonic acid in COX and lipoxygenase pathways
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10
Q

Fish oil/omega 3 efficacy

A 
Effects:
decrease TG 20-50%
Greater TG than 500? decrease by 45%
combo with statin in lvls 200-499, decrease by 30%
LDL-C neutral effects
Primary prevention (AHA rec): 500mg qd or 2 fishy meals/wk
secondary prevention 1000 mg qd
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11
Q

Fish oil/omega 3 adverse reactions, drug interactions, herb rxns

A

adverse: fish taste, gi upset, heartburn, belching

drug interactions: anithypertensives, contraceptives, orlistat

Herb interactions: garlic, ginger, gingko, ginseng

dosage: 1-4 g qd of DHA and EPA

Tx option for pts who cannot take niacin due to gout and flushing rxn

  • Limit to 12 oz per week in pregnancy
  • GRAS (generally recognized as safe)
  • **not effective in lowering TG or LDL-c
  • increase risk of bleeding in combo with rx, OTCs or other supplements
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12
Q

Fiber

A

FDA permits health claims: 51% whole grain reduce risk of heart disease
Whole wheat, whole oats, barley, corn

Blond psyllium: 10-12 g/d (decreases TGs and LDL-c modestly), more effective with food

Oat bran:
beta glucan (soluble fiber)
Delay food absorption

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13
Q

Niacin

A

-decreases LDL-c and TGs
-increases HDL-c 15-35%
-Might have decreased risk of secondary MI, but not all cause mortality
-SE: HA, GI, flushing, increase blood glucose, and uric acid
-Monitor: LFT (hepatotoxicity)
Products: IM Niacin is greater than LA Niacin greater than ER Niacin
-Inositol nicotinate (“no flush niacin”)

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14
Q

Plant sterols MOA, efficacy, adverse rxns, dosage

A

MOA: inhibits about 50% intestinal absorption of chol

Efficacy: decreases TG, LDL-C, no effect on HDL

Adverse rxns: nausea, indigestion, diarrhea, constipation, gas

Dosage:
800mg-6g qd 30 min bf low fat meals

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15
Q

Plant Stanols: MOA, efficacy, adverse rxns, dosage

A

MOA: inhibits dietary and biliary cholesterol
Efficacy: decreases LDLc (10-15%), w/ statins: decreases TG and LDLC

Adverse rxns: diarrhea, steatorrhea

Dosage: 800 mg-4g qd

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16
Q

Plant sterols and stanols interactions and pearls

A

interactions
Herbs: beta carotene and Vit E
Drugs: Zetia

Clinical pearls:
2-3 weeks bf effective
-if dc, cholesterol levels rise to baseline in 2-3 weeks
-sterols and stanols equally effective

17
Q

Ephedra MOA

A

Alkaloid constituents of the plant: ephedrine, pseudoephedrine, and small amount of phenylpropanolamine

Ephedrine and pseudoephedrine are non-selective alpha and beta receptors agonist which stimulate nervous system

18
Q

Ephedra use/efficacy, adverse rxns

A
  • weight loss

- 0.9 kg/mo up to 6 mo with

19
Q

Bitter orange: MOA, adverse effects, caution in?

A

MOA:
contains 1-6% of synephrine which is related to ephedrine
-Adverse effects: same as ephedra
-Caution in: HTN, CV pts

20
Q

Bitter orange clinical pearls

A
  • manufacturers switch to this after ban on ephedra
  • often contain caffeine
  • GRAS
  • no evidence that this supplement is safer than Ephedra!!
21
Q

Calcium

A
  • pts with low Ca intake often gain more weight and have a higher BMI
  • Efficacy: 800-1200 mg qd Ca supplement have been shown to increase weight reduction and body fat loss
  • 800-900 mg qd has shown wt loss of 8-9 kg

Adverse rxns: belching, flatulence

**supplement alone does not equal to a low fat dietary intake of calcium

22
Q

Alli (Orlistat) MOA, efficacy, adverse rxns

A
  • reversible inhibitor of pancreatic and gastric lipase
  • efficacy: FDA approved for long term weight loss
  • effects in BMI greater than 27

Adverse rxns:
HA, oily spotting, abdominal discomfort, gas, fecal urgency, steatorrhea & liver related events
Psyllium/Fibers 6g with dose or 12 qhs

23
Q

Alli: dosing, drug interactions, clinical pearls

A
  • 60mg tid with each meal that contains fat
  • drug interactions: anticoagulants, amiodarone, levothyroxine, and vitamins

Clinical pearls:

  • take a MVI qd 2hrs before or after dose
  • due to risk of liver injury, inform pt signs/sx
24
Q

Diabetes tx options

A

chromium

vanadium

25
Q

Chromium MOA

A

Might reduce oxidative stress
Low levels are associated with impaired glucose & insulin
Chromium 0 has no activity
Chromium III found in food and supplements
Chromium VI used in welding industries & carcinogenic

Several salt forms: picolinate, nicotinate, polynicotinate, and chloride

  • Chromium picolinate form most often used in studies
  • caution in renal deficiency
  • mixed data and effectiveness
  • no reliable method to dx efficacy
26
Q

Chromium adverse reactions and dosage

A

HA, insomnia, irritability, mood changes & sleep disturbance
Vomiting, diarrhea, and hemorrhage

Dosage: 200-1000 mcq divided doses
-0.4-2.5% absorbed and rapidly excreted in urine

27
Q

interactions w/ chromium

A

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

28
Q

MOA Vanadium

A

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

29
Q

Efficacy of vanadium and adverse rxns

A

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

Adverse reactions:
GI upset, kidney toxicity, fatigue, lethargy & tongue discoloration

30
Q

Vanadium interactions/pearls

A

Dosage: 50 mg bid of the sulfate form

Interactions:
Herbs: garlic, ginger, ginkgo & ginseng
Drugs: anticoagulants and antiplatelets
Disease: diabetes and renal dysfunction

Clinical pearls:
Average diet contains 6-18 mcq qd
Only 5% is absorbed

31
Q

Garlic indications, MOA

A

indications: HTN, hyperlipidemia

MOA:
Allicin is the active ingredient
Inhibits hepatic cholesterol synthesis
Activates production of endothelium-derived relaxation factor to relax smooth muscle and vasodilation

32
Q

Garlic adverse rxns

A

Halitosis, body odor, heartburn, GI upset

33
Q

Garlic drug interactions

A

Anticoagulant
Antiplatelet
CYP3A4
CYP2E1

Herb interactions:
Ginger, ginkgo and vitamin E

34
Q

Standardized % allicin and clinical pearls (garlic)

A

Standardized to 0.65 - 1.3 % allicin

Clinical pearls:
When using fresh product needs to sit for 10 minutes chopped up prior to use for best results
Generally recognized as safe (GRAS)
Discontinue 2 - 3 weeks prior to surgery
Products marketed as odorless, may not contain allicin

35
Q

Coenzyme Q-10 indications, MOA

A

Indications:
Congestive heart failure
Preventing statin-induced myopathy

Mechanism of action:
Has antioxidant properties to stop damage and give energy to cells
Cofactor in metabolic pathways

36
Q

Co Q10 efficacy, adverse rxns, drug interactions

A

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

Adverse rxns:
GI upset, heartburn, and appetite loss

Drug interactions: anticoaguants

Lab interactions: increase T4/T8 ratio in normal pts

Disease interactions: may lower blood pressure, cigarette smoking may deplete body stores

37
Q

Clinical Pears CoQ10

A

Some meds can lower CoQ10 levels: statins, beta blockers, and diuretics
-take it with a fatty meal

My DEMS 4 (23 decks)

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