Tox: nutritional supplements

Question 1

Do manufacturers need to demonstrate safety, efficacy or quality of their products?

Answer 1

No (at least in the US)

Question 2

Function of vitamins ADEK

Answer 2

Vit A: maintains growth and differentiation of epithelial cells.
Vit D: regulates calcium homeostasis
Vit E: functions as antioxidant (may be pre-oxidant/antagonize vit K)
Vit K: required for development of clotting factors

Question 3

Sources of vitamin A

Answer 3

Liver, fish, cheese, whole milk

Question 4

Symptoms of vitamin A deficeincy

Answer 4

Dry skin/hair, broken fingernails, inc risk of resp infections, diarrhea, nephrolithiasis.

Question 5

Symptoms of vitamin A toxicity

Answer 5

HA, papilledema, photophobia, seizures, psychosis, n/v, abdo pain, liver injury, desquamation.
hypercarotenemia causes yellow-orange skin discoloration.
Blindness may be complication of both overdose and deficiency.

Question 6

Sources of vitamin D

Answer 6

Cod liver oil, fatty fish, dairy products

Question 7

Symptoms of vitamin D deficiency

Answer 7

rickets

Question 8

Vitamin D toxicity causes….

Answer 8

Hypercalcemia, hyperphosphatemia

Question 9

Sources of vitamin E

Answer 9

nuts, wheat germ, whole grain, vegetable/seed oils.

Question 10

Symptoms of vitamin E deficiency

Answer 10

peripheral neuropathy, spinocellular syndrome

Question 11

Symptoms of vitamin E toxicity

Answer 11

N/v/d, abdominal cramps, coagulopathy

Question 12

Examples of agents used as athletic performance enhancers

Answer 12

anabolic steroids, peptide hormones/growth factors, hormone agonists/metabolic modulators, stimulants

Question 13

Examples of peptide hormones/growth factors used as performance enhancers

Answer 13

Creatine: resynthesized ATP for use as short term energy burst during exercise.
Human growth hormone, insulin-like growth factor: stimulate protein synthesis.

Question 14

Potential systemic complications of anabolic steroids

Answer 14

1) Onc: increased cancer risk
2) Cardiac: MI, VTE, sudden cardiac death
3) Derm: Acne, ?striae, gynecomastia
4) Endo: gynecomastia in men, menstrual irregularities, breast atrophy in women
5) Hepatic: peliosis hepatis (blood-filled sinuses in liver)
6) Infectious: immunosuppression
7) MSK: tendon and ligament rupture. Can cause AVN and osteoporosis with prolonged use.
8) Neuropsych: mood lability, aggression, psychosis, insomnia

Question 15

Potential complications from peptide hormones/growth factors

Answer 15

1) Human GH/IGF –> myalgias, arthralgias, carpal tunnel syndrome, edema
2) Creatine: water retention, diarrhea.

Question 16

Ma huang: uses, toxic component, symptoms

Answer 16

Aka ephedra.
Used to treatment asthma, nasal congestion, for weight loss.
Active components: ephedrine, pseudoephedrine.
AE: HA, dizziness, seizures, sympathomimmetic efects.

Question 17

Gingko balboa: uses, toxic component, symptoms

Answer 17

Used for asthma, chillblains, as digestive aid, for ‘cerebral dysfunction.’
Active components: Ginkgolides, bilobalide.
AE: GI upset, HA, skin reaction. Can have antiplatelet effect.

Question 18

Ginseng: uses, tox component, AE

Answer 18

Uses: increase metabolism, regulate BP, glucose. Aphrodisiac. Used for resp illnesses and as anti-inflammatory agent.
Active comp: Ginsenosides (panax, ginseng).
AE: Stimulant effect, HTN, hypoglycemia

Question 19

What is saw palmetto used for? SE?

Answer 19

To tx BPH.
Is a 5-a-reductase inhibitor.
AE: diarrhea.

Question 20

St john’s wort: uses, SE

Answer 20

Uses: anxiety, depression, gastritis, insomnia, promote healing.

SE: MAOI properties, +drug-drug interactions (is a CYP3A4 inducer).