XVII Nutritional and Complimentary Medicine (Chapters 67 & 69) Flashcards by Amy Wells

2 Classifications of Vitamins

Fat Soluble Vitamins

Water Soluble Vitamins

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What are the Fat Soluble Vitamins (4)

A
D
E
K

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Water Soluble Vitamins (2)

B family

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Which type of vitamin (fat soluble or water soluble) is stored in massive amounts and has a risk for toxicity?

Fat Soluble

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Which type of vitamin (fat soluble or water-soluble) undergo minimal storage in the body and must be frequently ingested to replenish supply?

Water soluble

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Indications for use of multivitamin supplementation (3)?

Malabsorption disorders
Those who have had weight loss surgery
Restrictive Diets (vegans)

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Which vitamins have solid evidence for benefit of use (3)?

B12 (all people over 50)
Folic Acid (all women of childbearing age)
Vitamin D plus Calcium (postmenopausal women and those at risk for fracture)

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What are substances present in food that can significantly decrease cellular and tissue injury caused by highly reactive forms of oxygen and nitrogen (free radicals)?

Antioxidants

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Risks of specific antioxidants (4)?

B-Carotene in high doses associated with increased lung cancer in those who smoke

Vitamin E in high doses associated with increased prostate cancer and stroke

High doses, in general, can cause nutritional deficiency and other harms

Significant drug interactions

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Indication for Vitamin A?

Prevention or correction of vitamin A deficiency

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Dietary sources of Vitamin A (4)?

Dairy
Meat
Fish Oil
Fish

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Results of Vitamin A Deficiency(3)?

Night vision blindness (first indicator)
Xerophthalmia (dry and thick conjunctiva)
keratomalacia (degeneration of cornea w/keratiniztion of corneal epithelium)

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Vitamin A Toxicity causes what (3)?

Birth Defects (HIGHLY teratogenic)

Liver damage

Bone Related disorders (infants/children bulging in the skull where bone has not formed, increase risk of hip fracture)

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Vitamin E indication for use?

Delay progression of age-related macular degeneration

Protecting blood cells from hemolysis (benefit to premature infants w/hemolytic anemia associated with Vitamin E deficiency).

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Vitamin E dietary sources(5)?

Vegetable Oils
Nuts
Wheat germ
Whole grains 
Mustard greens

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People at risk for Vitamin E Deficiency(2)?

Those with inborn deficiency of a-TTP

Those with fat malabsorption syndromes & can’t absorb fat-soluble vitamins

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Signs of Vitamin E Deficiency (4)?

Ataxia
Sensory neuropathy
Areflesia
Muscle hypertrophy

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Vitamin E Deficiency causes what(4)?

Increase risk for Hemorrhagic Stroke (inhibition of platelet aggregation)

Increase risk for cancer or poor cancer outcome

Blunted benefit of exercise on insulin sensitivity

Increased death, especially in older people

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Vitamin K Indications for use(2)?

Synthesis of prothrombin and clotting factors needed for blood coagulation

Recommended for ALL newborns immediately after birth r/t Vitamin K synthesized by intestinal bacteria (underdeveloped intestines for several days)

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Vitamin K main sources?

Dietary (unspecified)

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Vitamin K Deficiency causes what?

Bleeding tendencies

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Typical causes of Vitamin K Deficiency?

Obstructive jaundice
Malabsorption syndromes
Ulcerative colitis

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Vitamin K Toxicity causes what?

Hyperbilirubinemia
Hemolytic anemia
Jaundice in newborns

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What is another name for Vitamin A?

Retinol

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What is another name for Vitamin B?

Riboflavin

Vitamin B indications for use

Prevention and correction of Riboflavin deficiency

Dietary Sources of Vitamin B?

``` Milk Yogurt Cheese Bread Fortified Cereals ```

Signs of Vitamin B Toxicity

None---devoid of any in humans

Vitamin B1 (Thiamine) Indications for use?

Treatment and prevention of thiamine deficiency

Vitamin B1 dietary sources(6)?

``` Whole-grain products Bread Cereal Tuna Salmon Anchovies ```

Vitamin B1 Deficiency occurs in what patient population?

Chronic Alcohol Consumers

Vitamin B6 (Pyridoxine) Indications for use?

Prevention and treatment of all states of vitamin B6 Deficiency

Dietary sources for Vitamin B6?

``` Cereal Meat Fish Poultry Organ meats ```

Causes of Vitamin B6 Deficiency?

``` Poor diet (often r/t alcoholism) Isoniazid therapy for TB ```

Signs and Symptoms of Vitamin B6 Toxicity?

EXTREMELY LARGE DOSES: | Neurological injury to include ataxia and numbness of the feet and hands

Vitamin B12 (Cyanocobalamin)Indications for use?

Treat deficiency due to all causes | Prevent deficiency in patients with increased Vitamin B12 requirements

Dietary Sources of Vitamin B12(6)?

``` Meat Fish Poultry Eggs Milk Animal products ```

What results from Vitamin B12(2)?

Megaloblastic anemia | Macrocytic anemia

Vitamin B9 (Folic Acid) Indications for use(2)?

Prevent neural tube deficiency in developing fetus | Treatment of Megaloblastic anemia

Dietary sources of Vitamin B9(6)?

``` Beef Liver Spinach Black Eyed Peas Asparagus Green leafy Veggies ```

Results of Vitamin B9 Deficiency?

During pregnancy can impair the development of the central nervous system resulting in neural tube defects

Results of Vitamin B9 Toxicity(2)?

Possible acceleration of pre-cancerous lesions | Increase in prostate cancer in older men

St. John's Wort drug interactions?

Induce CYP34A (accelerates metabolism of many drugs, decreasing therapeutic effect)

Which supplements suppress aggregation when taken with anticoagulants (3)?

Ginko Biloba Feverfew Garlic

Adverse effect of Ma Huang (Ephedra)

Rases BP | Stimulates CNS

Black Cohosh Indications for use?

Menopause Hot flashes Vaginal Dryness **DO NOT USE if hot flashes are related to Tamoxifen or other SERMs

When should you NOT use Black Cohosh for hot flashes?

DO NOT USE if hot flashes are related to Tamoxifen or other SERMs

Adverse Effects of Black Cohosh?

Liver Inflammation (leading to liver failure)

Black Cohosh Durg Interactions(2)?

Hypertensives (potentiate hypotensive effects) | Insulin and other diabetic drugs (potentiate hypoglycemic effects)

Coenzyme Q-10 Indications for use(2)?

Heart Failure | Muscle injury caused by statins

Adverse Reactions of Coenzyme Q-10?

GI Upset

Coenzyme Q-10 Contraindications?

Pregnancy | Breastfeeding

Drug interactions with Coenzyme Q-10?

Warfarin

Cranberry Juice Indications for use?

Prevention of UTI | Decreases urine odor in patients with incontinence

What age group is Cranberry Juice effective for preventing recurrent UTI?

Older women | Women in teens and 20's

Adverse Reactions of Cranberry Juice(2)?

``` Dose Dependent (more than 1L/day) Increases risk for GI upset and kidney stone formation ```

Cranberry Juice Drug Interactions?

Warfarin

Indications for use of oral Echinacea(3)?

Stimulates immune function Suppresses inflammation Treats viral infections

Indications for use of topical Echinacea(4)?

Treatment of burns Eczema Psoriasis HSV

What supplement has shown some effectiveness in preventing the common cold?

Echinacea

Adverse Effects of Echinacea?

Allergic response (ragweed family)

Contraindications of Echinacea?

Autoimmune Diseases such as LE, RA, TB, and HIV

Echinacea Drug Interactions?

Immunosuppressant drugs and drug therapies for TB, CA, and HIV (oppose effects)

Flaxseed Indications for use?

Constipation Dyslipidemia Provides a vegetarian source of Omega-3s

How does flaxseed relieve constipation?

It works as a bulk-forming laxative

Adverse Effects of Flaxseed?

GI Issues

Flaxseed Drug Interactions?

Can decrease absorption of conventional | medications (take 1-2 hours after meds)

Garlic Indications for Use(2)?

Reduce triglycerides and LDL

Garlic has shown effectiveness in treating/preventing what 3 disease processes?

Hypertension (lowers BP) Decreases rate of atherosclerosis development May have a role in cancer prevention

Garlic Drug interactions?

SIGNIFICANT anti-platelet effects, especially when combined with ASA, warfarin, and heparin Can reduce levels of cyclosporine (immunosuppressant and saquinavir (HIV med)

Indication for use of Ginkgo Biloba?

Improve memory (effectiveness unknown)

Adverse effects of Ginkgo Biloba (seeds)?

can cause seizure and death

Ginkgo Biloba drug interactions?

Suppresses Coagulation | Promotion of seizures

Glucosamine and Chondroitin Indication for use?

Treatment of osteoarthritis--but American College of RA advised providers NOT to use for OA

Adverse effects of Glucosamine and Chondroitin?

Gi Upset

Glucosamine and Chondroitin have cross sensitivity with what food allergy?

shellfish (produced from the exoskeleton of shrimp)

Glucosamine and Chondroitin drug interactions?

ASA, warfarin, Heparin (risk for increased bleeding)

St. John's Wort Indications for use?

Mild to moderate depression

St. John's Wort effectiveness?

Superior to placebo, equal to TCA

St. John's Wort Adverse Effects?

Allergic reactions (esp in those allergic to ragweed, daisies)

St. John's Wort Drug Interactions?

CYP Inducer (accelerates metabolism of several drugs, decreasing therapeutic effect) ``` Accelerates Elimination of: Digoxin CCB Steroid hormones Protease inhibitors Certain anticancer drugs ``` ``` Causes Serotonin Syndrome when combined with: MAOI SSRI TCA Duloxetine Effexor ```