Aloe Vera Indication (3)
Wound Healing
Laxative - some clinical evidence
Osteoarthritis
Aloe Vera SE
Stomach Cramps (PO)
Bitter Orange Indication (3)
Nausea
Constipation
Wt. Loss
Bitter Orange SE (3)
INC HR
INC BP
[Stroke / MI (especially with caffeine)]
[Bitter Orange] DDI (2)
* Inhibits Intestinal CYP3A4
*[Interacts with MAOI since it contains tyramine metabolites]
Black Cohosh Indication
“Use Black Cohosh to help a painful Black Coochie”
Menopausal Sx
Black Cohosh SE
Worsens Breast CA (estrogenic)
Is there Clinical Evidence for Black Cohosh?
+/-
[Cranberry Juice] Indication
UTI
Is there Clinical Evidence for [Cranberry Juice]?
+/-
Echinacea DDI
Inhibits 3A4
Echinacea SE
Ech(i)nacea… (i) for immune booster
Exacerbates Autoimmune Dz
Echinacea Indication (2)
Ech(i)nacea… (i) for immune booster
Cold vs. Flu (immune Booster)
Ephedra Indication (4)
- Colds
- Fever
- Flu
- Wt. Loss
Ephedra DDI
Has Additive Effects with stimulants
Ephedra SE
INC risk for CVD / stroke / death
Is there Clinical Evidence for Feverfew?
+/-
Feverfew Indication (2)
Feverfew reduces Fever with only a few HA left afterwards
- Fever
- [HA / Migraine]
Feverfew DDI (3)
Inhibits CYP
1A2
2C9
2C19
Feverfew SE
Withdrawal Syndrome with chronic use = Rebound HA & Joint Pain
Feverfew Contraindication
Pregnancy (causes early contractions)
Garlic Indication (2)
- Hypercholesterolemia
- HTN
+/- Clinical Evidence
Garlic DDI (5)
Anticoagulants + [DEC SINO]
- Anticoagulants
- DEC Isoniazid
- DEC Saquinavir
- DEC NNRTI
- DEC OCP
Garlic SE
Bleeding Risk
Ginger Indication
GI upset (Morning Sickness / Nausea)
+/- Clinical Evidence
Ginger DDI
Anticoagulants
Ginger SE
Bleeding Risk
Ginkgo Indication (5)
- Memory Loss
- HA
- Fatigue
- Tinnitus
- Sexual Dysfunction
Ginkgo DDI
Anticoagulants
Ginkgo SE (3)
Bleeding Risk
Pregnancy Safety concerns
Seizures (uncooked Ginkgo)
Ginseng Indication (3)
HEP drank Gin to Sing
- Performance Enhancer (Mental / Physical / Immune)
- Erectile Dysfunction
- Hyperglycemia
+/- Clinical Evidence
Ginseng DDI (2)
- INC Effects of Insulin/Sulfonylurea
- Blocks Anticoagulants
Ginseng SE (2)
Babies and Preggos Hate to hear HepSing!
Birth Defects
Pregnancy Safety Concern
Ginseng Contraindication
Pregnancy (estrogenic)
Hawthorn Indication (3)
- Heart Dz CHF - clinical evidence
- HTN
- Heart Pain (Angina)
Hawthorn DDI (3)
- Digoxin
- Nitrates
- BP meds
Is there Clinical Evidence for Hawthorn?
YES, ONLY FOR MILD CHF
[Horse Chestnut] SE (2)
[Raw seed = poisonous Esculin toxin]
Exacerbates Renal Dz
[Horse Chestnut] Indication (3)
- [Chronic Venous Insufficiency]
- Varicose Veins
- Hemorrhoids
[Horse Chestnut] DDI
Anticoagulants
Is there Clinical Evidence for [Horse Chestnut]?
YES
Kava Indication (4)
“Her name was Kava AAID”
- Insomnia
- Anxiety
- Depression
- ADHD
Is there Clinical Evidence for Kava?
YES
Kava DDI (2)
- Additive with sedatives
- INC APAP toxicity
Kava SE (2)
Liver Damage (SERIOUS)
Muscle Spasm
[Milk Thistle] Indication (3)
- Liver Protection (Jaundice/Cirrhosis)
- Hypercholesterolemia
- DM
[Milk Thistle] DDI
Inhibits UGT
[Saw Palmetto] Indication
BPH
Is there Clinical Evidence for [Saw Palmetto]?
+/-
[Saw Palmetto] DDI (4)
- Inhibits*
- UGT
- 3A4
- 2D6
- 2C9
[St. John’s Wort] Indication (6)
St. John Prays tht Demons May Wane
- Depression/Anxiety
- Sleep DO/Chronic Fatigue
- Palpitations
- Wound Healing
- Migraine
Is there Clinical Evidence for [St. John’s Wort]?
YES
[St. John’s Wort] DDI (5)
- Antidepressants
- INC Expression of 3A4/SC19 –> DEC HOCS
- DEC OCP
- DEC Cyclosporin
- DEC Statin
- DEC HIV PTI
[St. John’s Wort] SE (4)
PMS & T
- Photosensitization
- Serotonin Syndrome (with SSRI/MAOI/TCA)
- Mania (in Bipolar/Depressed/Psychotic)
- Teratogenic
Valerian Indication (3)
“Grab Valerie if ur SAD”
- Sleep DO
- Anxiety
- Depression
Is there Clinical Evidence for Valerian?
+/-
Valerian DDI
Additive Effects on Sedatives (Benzo / Barbituates / Kava)
Valerian SE
Drowsiness
Yohimbe Indication (4)
WASE
Sexual Dysfunction
Erectile Dysfunction
Athletic Performance
Wt. Loss
Yohimbe DDI
INC SE of MAOIs
Yohimbe SE (4)
- INC BP
- INC HR
- INC Anxiety –> Insomnia
- Renal Failure
List the ingredients typically found in Dietary Supplements (4)
Vitamins
Minerals
Herb Botanicals
Amino Acids
What was the stipulation made by the 1994 Health Act that restricted FDA regulation on Dietary Supplement
Dietary Supplement Manufactureres can not make any claims stating their products treat, prevent, or cure
Supplements are not Drugs
What type of evidence does Dietary Supplements have to provide due to the 1994 Health act
NOT required to prove Efficacy and Safety of product, but only have to provide substantiated claims by adequate evidence (yet this evidence has no standard of proof)
FDA can only prove that supplements (after 1994) are unsafe/ineffective. anything before 1994 is automatically safe
List & Describe the 3 Claims [Dietary Supplements and Herbal Meds] are allowed to make
- Nutrient Claim = Certain amount of a nutrient in the product
- Health Claim (must be pre-approved by FDA first and evidence based w/ scientific agreement) = DS can DEC risk of obtaining a Dz or health condition
- [Structure-Function Claim] (MOST DS & HERBALS USE THIS CLAIM)= “Antioxidants help maintain cell integrity” or “Echinea supports the body’s immune system”. Can’t imply it’ll affect a Dz or condition
What is the Product Label that must be contained on all [Dietary Supplements & Herbals]
“This product has not been evaluated by FDA. This product is not intended to diagnose, treat, cure or prevent any dz”
Are [Dietary Supplement and Herbal] Manufacturers responsible for reporting SE?
YES! Serious SE must be reported to FDA AND [Good Manufacturing Practices] must be maintained
Descibe how Common Vitamin A Deficiency is
Uncommon
Describe Supplementation for Vitamin A Deficiency
Not Recommended
Vitamin A Toxicity causes what? (5)
AAAA, ur a PINTH!
- Tertogenic
- Hypervitaminosis A
- Nausea/Vision: Acute
- INC ICP: Chronic
- Painful Joints & Coma
Descibe how Common Vitamin D Deficiency is (2)
Overt Deficiency is rare = Osteomalacia/Rickets
Sublinical is common in some populations
Who should receive Vitamin D Supplementation (5)
- Older
- Institutionalized Adults
- Limited Sunlight pts (Dark skinned pts)
- Obese pts
- GI DO pts
Vitamin D Toxicity causes what? (4)
- Hypercalcemia
- Vascular Tissue Calcification
- [Damage to Heart / Blood vessel / Kidney]
- [NV, weight loss]
Descibe how Common Vitamin E Deficiency is
Uncommon
Describe Supplementation for Vitamin E Deficiency
Not Recommended
Vitamin E Toxicity causes what? (2)
Mortality
Bleeding (when with anticoagulants)
Descibe how Common Vitamin K Deficiency is
Rare although common in Newborns!
Who should receive Vitamin K Supplementation
All newborns are given [IM Vitamin K] to prevent [Hemorrhagic Dz of Newborn]
Vitamin K Toxicity causes what?
Rare
Don’t worry about it
Vitamin C Toxicity causes what? (2)
Too much C causes [Gee-I issues] & [Kid-Ney Stones]
GI Issues & Kidney stones
Descibe how Common Vitamin B1 Deficiency is
Rare in developed world but may –> BeriBeri
Who receives Vitamin B1 Supplementation? What’s the PGN?
Chronic Alcoholics: [Wernicke Korsakoff Syndrome]
20% Fatal if untreated
Descibe how Common Vitamin B12 Deficiency is
Kinda Common actually
Who should receive Vitamin B12 Supplementation (5)
12 Grassleaves to VAPE!
- Elderly (poor absorption)
- [Vegans / Vegetarians]
- Alcoholics
- GI Malabsorption DO
- Pernicious Anemia
Descibe how Common Folate Deficiency is
Uncommon
Who should receive Folate Supplementation
Women of childbearing age
(prevents Neural tube defects)
Melatonin Indications (2)
Are these Clinical evidenced?
- Cognitive Impairment: NO EVIDENCE
Melatonin Contraindications (2)
Anti-Epileptic
Warfarin
[Glucosamine Chondroitin] Indication
Is this Clinical evidenced?
Osteoarthritis: NO EVIDENCE
Fish Oil Indications (5)
Are these Clinical evidenced?
ALL IS EVIDENCED
DECREASES….
CVD
CHD death
Sudden CArdiac Death
HR
BP
[Co-Enzyme Q10] Indications (5)
Are these Clinical evidenced?
“CHAD Married the Q (fraternity) life”
- CHF
- Angina
- HTN
- DM
- Migraine
+/- evidence: only for rare genetics