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ANTI-viral Dx > Dietary Supplements > Flashcards

Dietary Supplements Flashcards

(52 cards)

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1
Q

How common is the use of dietary and herbal medications in the US?

A
  • 50% >20 used dietary supplemets, alternative stuff
    • 33% take TOGETHER with prescription meds
  • 30 billion spent
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2
Q

What is a dietary supplement?

A
  • supplements diet
  • contains (concentrate, metabolite, constituent, extract):
    • vitamins
    • herbs or other botanicals
    • amino acids
    • COMBO
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3
Q

Dietary Supplement Health and Education (DSHE) Act 1994

A
  • 1994 Act of Congress
    • restricted FDA’s ability to regulate the industry…as long as manufacturers made NO CLAIMS a/b their products:
      • treating
      • preventing
      • curing dz
  • supplements=food supplements NOT drugs
  • places burden on FDA to prove that supplement is unsafe/ineffective
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4
Q

Regulation and Role of FDA…Wild Wild West

A
  • makers NOT required to prove EFFICACY and SAFETY of a product prior to marketing
    • just need adequate evidence…which they dont have to give to the FDA
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5
Q

Safety?

A
  • ingredient sold pre-Oct 15 1994 is considered to be safe based upon their prior use by humans
  • post 10/15/94 safety testing is not reliably enforced
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6
Q

What are the three types of claims that the DSHE act allows regarding dietary supplements and herbal medications?

A
  1. Nutrient claim
  2. health claim
  3. structure-function claim
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7
Q

DSHE-allowed: Nutrient Claim (1/3)

A
  • relative amt of a nutrient or dietary ingredient in a product
  • limite to nutrients that have FDA-established DC:
    • vitamins, minerals, dietary fiber, AA
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8
Q

DSHE-allowed: Health Claim (2/3)

A
  • VERY restrictive
  • ability of dietary supplement ingredient to reduce r/o dz or health condition
  • must be:
    • pre-approved by FDA
      • Ex: vit/folate/mineral/fish oils
    • based on significant scientific agreement
    • evidence-based w/ strong evidence (RCT)
      • Ex: folate-NTD; Ca/Vit D-osteoporosis
      • Ex text: “adequate ca as pt of a healthy diet MAY help REDUCE the r/o osteroporosis”
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9
Q

DSHE-allowed: Structure-Function Claim (3/3)

A
  • most dietary supplements and herbals
  • how the dietary supplement may affect or maintain nml body structure/fxn:
    • CANNOT imply that supplement will affect a dz or condition
    • claim does NOT need FDA approval, BUT claim must be provided within 30 days of marketing
  • Ex good: antioxidants help maintain cell integrity
  • Ex good: Echinea supports the bodys immune system
  • Ex bad: antioxidants prevent the onset of ca
  • Ex bad: Echinea is useful in preventing colds
  • ***product label must contain the following statement: “this product has not been evaluated by the FDa. This product is no tintended to diagnose, treat, cure or prevent any diseases”
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10
Q

DSHE modification in 2007

A
  • companies must now inform the FDA of any serious SE
  • Manufacturers responsible for Good Manufacturing Practices (GMP)
    • ensure QUALITY of manufacturing PROCESS
    • supplements shouldn’t contain contaminants or impurities
    • supplements should be accurately labeled
    • lies, fairytales, and fallicies
  • >70% supplements are mislabeled
  • 50% dx recalls due to dietary supplements
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11
Q

Why are dietary supplements basically useless in the genpop (3)?

A
  • body only needs LOW LEVELS
  • typically in HEALTHY DIET
  • supplements dont replace fresh fruit/veggies (balanced diet)
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12
Q

Who may benefit from vitamin and mineral supplements?

A
  • pregnant/nursing
  • vegetarians/vegan
  • crash dieters/chronic low-cal diet (bariatric sx)
  • elderly (disabled or chronically ill)
  • malabsorption problems (diarrhea, celic dz)
  • food allergies (lactose intolerant)
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13
Q

Excessive intake of vitamins and minerals can be toxic

A
  • U-shaped curve for micronutrients and health
  • risk assoc w/ BOTH insufficient and xs intake
    • Vit D/Ca insufficiency=INC r/o osteoporosis
    • Vit D/Ca overconsumption=INC r/o CVD & overall mortality
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14
Q

Vit A <nah></nah>

A
  • Deficiency: uncommon
  • Supplementation (other than deficiency): not recommended
  • Toxicity (PC CHAT):
    • painful joints
    • coma
    • chronic: INC ICP
    • hyper-vitaminosis A
    • acute: nausea/vision
    • Teratogenic
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15
Q

Vit D <nd></nd>

A
  • Deficiency:
    • overt-rare: rickets.osteomalacia
    • some SUBclinical deficieny (po folk)
  • Supplementation (other than deficiency): <biologi>
    </biologi><ul>
    <li>blk</li>
    <li>institutionalized</li>
    <li>obese</li>
    <li>limited sunlight</li>
    <li>old</li>
    <li>Gi d/o</li>
    </ul></biologi>
  • Toxicity <hv>:
    </hv><ul>
    <li>damage: heart, blood vessels, kidney</li>
    <li>N/V/weight loss</li>
    <li>HYPERcalcemia</li>
    <li>vascular tissue calcification</li>
    </ul></hv>
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16
Q

Vit E

A
  • Deficiency: uncommon
  • Supplementation (other than deficiency): not recommended
  • Toxicity:
    • INC all causes of mortality
    • INC bleeding with anticoagulants
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17
Q

Vit K <babies></babies>

A
  • Deficiency: common in NBN (VKDB)
  • Supplementation (other than deficiency):
    • NBN given IM Vit K @ birth to prevent hemorrhagic dz of the NBN
  • Toxicity: rare
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18
Q

Vit C

A
  • Deficiency: uncommon
  • Supplementation (other than deficiency): not recommended
  • Toxicity: GI issues + kidney stones
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19
Q

Vit B1

A
  • Deficiency: poor countries Beriberi
  • Supplementation (other than deficiency):
    • chronic alcholics: WKS (psychotic encephalopathy)
      • vision changes/ataxia/memory loss
  • Toxicity:
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20
Q

Vit B12 <gvape></gvape>

A
  • Deficiency: common: 2-15%
  • Supplementation (other than deficiency):
    • elderly (poor absorption)
    • vegan/veggies
    • alcoholics
    • pernicious anemia
    • GI malabsorption d/o
  • Toxicity:
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21
Q

Folate

Study These Flashcards
A
  • Deficiency: uncommon
  • Supplementation (other than deficiency): childbearing women, prevent NTD
  • Toxicity:
22
Q

Melatonin

Study These Flashcards
A
  • Purported Use:
    • insomnia/jet lag: +/-
    • sleep patterns: +/-
    • cognitive impairment: NO
  • Clinical Evidence
  • Toxicity: dont combine w/ anti-seizure meds or warfarin
23
Q

Glucosamine/Chondroitin

Study These Flashcards
A
  • Purported Use: osteoarthritis
  • Clinical Evidence: NOOOOO
  • Toxicity
24
Q

**FISH OILS**

Study These Flashcards
A
  • Purported Use:
    • DECCCC:
      • CVD
      • CHD death
      • sudden Cardiac death
      • BP/HR
  • Clinical Evidence: YASSSSS
  • Toxicity
25
Co-enzyme Q10
* Purported Use :
  • heart conditions
  • CHF/angina
  • high BP/diabetes
  • migraine
 * Clinical Evidence: +/- * only for rare genetic deficiency in CoQ10 biosynthetic enzymes * Toxicity
26
Multivitamins
* each constituent: 100%-150% RDA * benefit those with: * poor nutrition * low cal diet * v/v+age\>50-Vit B12 * PM women-Vit D & Ca
27
Historical use of Herbal medications
* 3000BC sumerian clay tablets * 2700 BC Han dynasty * 1900 BC turmeric (anti-inflamm/anti-microbial) India * 1500 BC saw palmetto, garlic, junier: Egypt * 500 BC St Johns Wort: Hippocrates
28
Modern Use of Herbal Meds
* health promotion, dz prevention (\*chronic dz: RA, memory, fatigue, energy, immune system) * shit outcomes with conventional for serious illness * limited availability of conventional * SE/risks of conventional * thoughts natural "safer"/superior
29
Physicians attitude to dietary supplements and herbal meds
* 50% physicians never ask pts about herbal med use * 70% think public havemisplace faith in herbal meds
30
Pt attitudes to dietary supplements and herbal meds
* MAJORITY of pts DO NOT TELL their doc: * no reason for doc to know * doc never asked * embarassed * think safe/effective
31
Reasons physicians should discuss dietary supplement usage with their patients
* herbs are pharmalogically active * certain dietary supplements have well-established toxic effects: * heptatotoxiity: comfrey/kava * nephrotoxic: aristolochic acid (chinese herbs) * CV (+ death): ephedra/bitter orange * uncover unspoken medical concerns * **\*\*\*Potential for serious herb-drug interactions:** * **St. JW induces CYP450 enzymes=DEC levels of certain drugs** * **=clinical failure of HIV PI, OCP, cyclosporin (transplant rejection)**
32
Quality and Efficacy of Herbal Meds
* diff pharm with diff plant parts * closely related may have diff ingredients/contaminants * harvest/storage/processing techniques may be diff * many cases of mislabeling * **recent study using fingerprinting:** * **2/44 herbal supplements had 100% authentic, rest were contaminated, had filler, mislabeled**
33
Problems with Herbal Standardization, Purity, Efficacy
* diff prep=diff activity * contamination: **lead, mercury, arsenic** * few high quality clinical trials
34
Aloe Vera
* Common Use :
  • laxative (some)
  • OA
  • wound healing
 * CTE: * SE: stomach cramps * DDI:
35
\*\*BITTER ORANGE\*\* | (Pseudophedrine and ephedrine same)
* Common Use: * N * constipation * weight loss * CTE: * SE: * INC HR/BP * stroke/MI (espec w/ caffeine) * DDI: MAOI (contains tyramine metabolites); inhibits gut 3A4
36
Black cohosh
* Common Use: menopausal s/s * CTE:+/- * SE: estrogenic-may worse breast ca * DDI:
37
Cranberry
* Common Use: UTI * CTE: +/-
38
Echinacea
* Common Use: colds/flu; immune booster * SE: exacerbate a/i/d * DDI: inhib 3A4
39
\*\*EPHEDRA (banned in US)\*\*
* Common Use: * cold/fever/flu * \*\*weight loss * SE: INC reisk CVD/stroke/death * DDI: additive effects with stimulants
40
*Fever-few*
* Common Use: fever/HA/MA * CTE:+/- * SE: * withdrawal syndrome w/ chronic use: rebound HA/jt pain * Ci in pregnancy (early contractions) * DDI: inhib 1A2, 2C9, 2C19
41
Garlic
* Common Use: high cholesterol, high BP * CTE:=+/- * SE:INC bleeding risk * DDI: * ANTIcoagulants * DEC: * Saquinavir * Isoniazid * NNRTI * OCP
42
Ginger
* Common Use: upset tum, N, morning sickness * CTE: +/- N * SE: INC bleeding risk * DDI: anticoagulants
43
Ginkgo
* Common Use: * memory loss * sex dysfunction * HA/fatigue * tinnitus * CTE: +/- * SE: * INC bleeding risk * unsafe preg * uncooked: seizure toxin * DDI: ANTI coags
44
Ginseng
* Common Use: * INC mental/physical performance * immune booster * erectile dysfunction * lower BG * CTE:+/- * SE: * Teratogenic * contraindic in Breast ca * estrogenic * birth defects * DDI: * INC effects of insulin/sulfonylureas * ANTagonize ANTicoags
45
\*\*HAWTHORN\*\*
* Common Use: * heart dz * CHF/high BO * angina * CTE: yes for mild HF * DDI: * digoxin/nitrates * BP meds
46
\*\*HORSE CHESTNUT\*\*
* Common Use: * chornic venous insufficiency * varicose veins * hemorrhoids * CTE: YES * SE: * raw seeds: poisonous ESCULIN toxin * may exacerbate kidney dz * DDI: ANTIcoags
47
\*\*KAVA\*\*
* Common Use: * insomnia/anxiety * depression * ADHD * CTE: YES * SE: * liver damage * muscle spasms * DDI: * additive effects with sedatives * INC acetominophen toxicity
48
Milk Thistle
* Common Use: * liver protection; jaundic/cirrhosis * high cholesterol * diabetes * DDI: inhibits UGT
49
Saw Palmetto
* Common Use: BPH * CTE:+/- * DDI: inhibits UGT, 3A4, 2D6, 2C9
50
\*\*\*SJW\*\*\*
* Common Use: * Wound healing * heart palpitations * anxiety/depression * sleep d/o; chronic fatigue * MA * CTE: YES * SE: * photosensitization * SEROTONIN SYNDROME (w/ SSRI, MAOI, TCA) * induce mania in bipolar * depressed/psychotic * teratogenic * DDI: * Anti-depressants (serotonin syndrome) * INC expression 3A4/SC19 * DEC: * Statins/HIV PI * OCP * Cyclosporin
51
\*\*\*VALERIAN\*\*\*
* Common Use (SAD): * sleep d/o * anxiety * depression * CTE: +/- * SE: drowsiness * DDI: additive effets on other sedatives (BZ/barbs/Kava)
52
Yohimbe (congo and maui)
* Common Use: * sexual dysfxn * erectile dysfxn * athletic performance * weight loss * CTE: +/- * SE: * INC: BP/HR/anxiety * insomnia * kidney failure * DDI: INC SE MAOIs

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