Dietary supplements a special category under dietary medicines. True or false?
Dietary supplements a special category under food – NOT drugs.
The FDA is responsible for safety of dietary supplements. True or false?
The manufacturer is responsible for safety. The FDA is responsible for taking action if there is a problem.
What are considered dietary supplements? (5)
Botanicals: herbals or extracts
Glandular extracts from animals or synthetics
What types of pts typically use herbals and dietary supplements? (8)
Former or non-smokers
Educated beyond high school
Generally good health
Patients with: cancer, liver disease, HIV, asthma, rheumatologic disorders
What are the primary uses for aloe? (3)
cathartic (laxative properties)
burns, infections, wounds
What is the potential concern for those taking aloe?
Hypokalemia due to diarrhea.
What are two uses for echinacea?
What is the primary concern for those taking echinacea?
It inhibits CYP3A4, so there is an increased risk for drug toxicity for drug metabolized by this enzyme.
What drugs put pts taking echinacea at risk for drug toxicity? (3)
Calcium channel blockers
Protease inhibitors (antiviral drugs for HIV, AIDS, and Hep)
What are the uses for garlic? (5)
What are the potential concerns for those taking garlic? (2)
Inhibits platelete aggregation
Induces CYP 450 (decreasing the effectiveness of drugs)
What is the major drug interaction for a pt taking garlic?
Warfarin, increases INR which increases risk of bleeding.
What are the uses of ginkgo biloba? (6)
increased mental acuity
What are the signs of ginkgo biloba toxicity? (4)
What are the major drug interactions for those taking gingko? (2)
Warfarin--due to increased bleeding
What are the uses for ginseng? (4)
Improve strength and stamina
What are the potential concerns for those taking ginseng? (5)
What are the drug interactions for those taking ginseng? (3)
Insulin and sulfonylureas--increases hypoglycemia
MAOIs--increases manic-like episodes
What are the uses of saw palmetto? (3)
BPH (benign prostatic hyperplasia)
Chronic pelvic pain
What are the potential concerns for those taking saw palmetto? (2)
What drugs adversly interact with saw palmetto?
What are the uses of St. John's wort? (5)
Seasonal affective disorder (SAD)
What are the drug interactions of St. John's wort?
St. John's wort INDUCES CYP 450, 3A4, 2C9.
It alters the effectiveness of many drugs.
What are the drugs of concern for anesthesia for those taking St. John's wort? (3)
Calcium channel blockers
For pts taking St. John's wort, there have been case reports of of cardiovascular collapse after induction with fentanyl, propofol, d-tubocurarine followed by maintenance with nitrous oxide, oxygen, and isoflurane. True or false?
What are the uses of CoQ10? (7)
What are the potential concerns/drug interactions for pts taking CoQ10? (3)
Decrease effectiveness of warfarin
Statins--can cause a decrease in natural amounts in body
What are the uses of dong quai? (2)
Gyn issues like dysmenorrhea
What is the potential concern for pts taking dong quai?
Possible inhibition of platelet aggregation
What are the drug interactions for pts taking dong quai? (2)
Increase INR with warfarin
Possible risks with hormone meds because may have estrogen-like effects
What dietary supplements increase the risk of bleeding?
Most everything we studied affects bleeding and Jenny stated that things that start with "G".
In general, when should pts discontinue herbal medicins prior to surgery?
2-3 weeks prior
When should garlic, ginseng, and St. John's wort be discontinued prior to surgery?