Botanicals and Supplements

Question 1

What are the 3 claims that can be made regarding dietary supplements?

Answer 1

1) Nutrient claim - addresses a deficiency 2) Health claim - reduce risk of disease or health condition (need FDA pre-approval) 3) Structure-Function claim - May affect/maintain body structures/functions

Question 2

Are there risks for excessive intake of vitamins?

Answer 2

Yes. U-shaped curve: risk at very low and high levels

Question 3

Which Vitamins are not recommended for any supplementation (other than deficiency)?

Answer 3

A, C, E

Question 4

Toxicity associated with vitamin A

Answer 4

First trimester birth defects

CVD/Osteoporosis

Lung cancers in smokers

Question 5

Reasons for Vitamin D supplementation

Answer 5

Older adults/institutionalized

limited exposure to sunlight

Dark skinned individuals

GI disorders

Question 6

Toxicity associated with Vitamin D

Answer 6

Hypercalcemia

Vascular tissue calcification

Damage to heart, blood vessels and kidneys

Nausea, vomiting, weight loss

Question 7

Toxicity associated with Vitamin E

Answer 7

Increase in all cause mortality

Increased blEEding with anticoagulants

Question 8

Reasons for Vitamin K supplementation

Answer 8

All newborns get IM vitamin K to prevent hemorrhagic disease of the newborn

Question 9

Toxicity associated with Vitamin C

Answer 9

GI issues

Kidney stones

Question 10

Reasons for Vitamin B1 (Thiamine) supplementation

Answer 10

Chronic alcoholics

Wernicke-Korsakoff Syndrome (Emergent!)

Question 11

Reasons for Vitamin B12 supplementation

Answer 11

Elderly (decreased absorption)

Vegans and vegetarians

Alcoholics

Pernicious anemia

GI malabsorption disorders

Question 12

Reasons for Folate supplementation

Answer 12

Women of childbearing age to prevent neural tube defects

Question 13

Reason for melatonin supplementation

Answer 13

Insomnia/Jet lag, changing sleep patterns

Question 14

Reason for Fish oil supplementation

Answer 14

Decreased CVD, BP, HR, CHD death, sudden cardiac death

Question 15

Reason for Co-enzyme Q10 supplementation

Answer 15

For rare genetic deficiency in CoQ10 biosynthetic enzymes

Improves heart health, migraines

Question 16

Why should doctors discuss dietary supplement usage with patients

Answer 16

They are pharmacologically active

They can be toxic

Discussion may uncover unspoken medical concerns

May be interactions with drugs

Question 17

What is commonly used herbal medication is a CYP inducer?

Answer 17

St. Johns Wort induces CYP450 enzymes and reduces levels of several drugs including:

• protease inhibitors
• oral contraceptives
• cyclosporin

Question 18

Use of aloe vera supplementation

Answer 18

Wound healing

Laxative

Osteoarthritis

Question 19

Use of bitter orange supplementation and associated adverse effects

Answer 19

Uses: Nausea, Constipation, Weight loss

Adverse effects: increased HR, BP; Stroke/MI with caffeine Interacts with MAOI, inhibits gut 3A4

Question 20

Use of black cohosh

Answer 20

Menopausal symptoms

Question 21

Use of cranberry

Answer 21

UTIs

Question 22

Use of Echinacea

Answer 22

Colds/Flu Immune booster

Question 23

Use of Ephedra and associated adverse effects

Answer 23

Used for: colds, fever, flu and weight loss

Adverse effects: increased risk for CVD/stroke death *Additive with stimulants*

Question 24

Use of feverfew

Answer 24

Fevers, headaches, migraines

Question 25

Use of garlic

Answer 25

High cholesterol High BP

Question 26

Use of ginger

Answer 26

GI upset, nausea CVD/inflammation Rheumatoid arthritis

Question 27

Use of ginkgo

Answer 27

Memory loss Sexual dysfunction Headache Fatigue Tinnitus (Mawp...... Mawp.... Mawp)

Question 28

Use of Ginseng

Answer 28

Increased mental/physical performance Immune booster Erectile dysfunction Lower blood glucose

Question 29

Use of Hawthorn

Answer 29

Heart disease CHF/High BP Angina Interacts with digoxin/nitrates and BP meds

Question 30

Use of Horse chestnut and associated adverse effects

Answer 30

Uses: Chronic venous insufficiency, varicose veins, and hemorrhoids Adverse effects: Raw seed contains poisonous toxin that may exacerbate kidney disease

Question 31

Use of Kava and associated adverse effects

Answer 31

Uses: insomnia, anxiety, depression, ADHD Adverse effects: liver damage, muscle spasms

Question 32

Use of milk thistle

Answer 32

Liver protection, jaundice/cirrhosis, high cholesterol, diabetes

Question 33

Use of Saw malmetto

Answer 33

BPH

Question 34

Use of St. Johns wort and associated adverse effects

Answer 34

Uses: depression, anxiety, sleep disorders, heart palpitations, wound healing, chronic fatigue, migraine Adverse effects: Photosensitization, serotonin syndrome, CYP inducer decreases concentration of many drugs

Question 35

Use of valerian

Answer 35

Sleep disorders, anxiety, depression

Question 36

Use of yohimbe and associated adverse effects

Answer 36

Sexual dysfunction, erectile dysfunction, athletic performance, weight loss Adverse effect: increase BP, HR, anxiety, insomnia, kidney failure

Question 37

Thunder god vine was demonstrated to be efficacious for treating what disease?

Answer 37

Rhematoid arthritis Non-inferiority to methotrexate