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Natural Medicine Flashcards

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1
Q

Dietary Supplements:
1. Dietary supplements are regulated by ______________ which requires manufacturers to ensure the products are _______, but NOT _________ like prescription drugs.

  1. Adverse events from supplements can be reported to _____________. The National Institutes of Health (NIH) has a Dietary Supplements Label Database and information can also be found in ____________ and _____________.
A
  1. Dietary Supplement Health and Education Act (DSHEA); safe; effective
  2. FDA’s Safety Reporting Portal; general drug references; Natural Medicines Database
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2
Q

What claims can supplements NOT make on their label?

A

Labeling cannot claim to treat, cure, or mitigate a condition (ex. “melatonin treats insomnia” vs. “melatonin can aid with sleep”)

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3
Q

What are concerns associated with St. John’s Wort (SJW)?

A
  1. Several DDIs - induces CYP3A4, 2C19, 2C9, 1A2, and P-gp decreasing the levels of other drugs; avoid use with other medications especially OCs, transplant drugs, and warfarin
  2. Serotonergic - do NOT use with MAOIs including linezolid; concurrent use with other serotonergic drugs can be dangerous
  3. Photosensitivity - sun protection and avoidance; increased risk w/ other drugs that increase photosensitivty (ex. diuretics, retinoids, quinolones, sulfamethoxazole, tetracyclines, tacrolimus)
  4. May lower the seizure threshold - caution w/ other drugs known to lower threshold (ex. bupropion, quinolones, tramadol, PCN, carbapenems)
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4
Q

Supplements with increased risk of bleeding

A

-The “5 G’s”: garlic, ginkgo, ginger, ginseng, glucosamine

-Fish oils (at higher doses)

-Vitamin E

-Dong quai

-Willow bark (a salicylate) - do NOT use with anticoagulants

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5
Q

Supplements with increased risk of hepatotoxicity

A

black cohosh, kava, chaparral, comfrey, green tea “extracts” may be a concern

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6
Q

Supplements with increased risk of cardiotoxicity

A

-Ephedra: removed from market and was replaced by bitter orange –> both stimulants that can increase BP and HR (there have been reports of MI, stroke, and arrhythmias)

-DMAA (dimethylamylamine): amphetamine derivative often used in body-building or performance-enhancement products –> can increase BP and HR

-Licorice: contains glycyrrhizin that when taken in excess can lower potassium and increase BP –> artifically flavored licorice products do NOT contain glycyrrhizin

-Yohimbe: can raise BP and HR and increase risk for seizures

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7
Q

Pros and Cons of Caffeine
-What is caffeine found in?

A

Caffeine found in: black tea, green tea, cocoa (including chocolate), yerba mate, guarana, kombucha (fermented tea)

Pros:
-Increases alertness
-Can help with weight management
-Can treat headaches
-Green tea, in reasonable amounts, can lower LDL and triglycerides

Cons: when taken in usual doses, typically NOT harmful
-In excessive doses, can raise BP and HR

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8
Q

List typical supplements you may see used for: Anxiety

A

Valerian, passionflower, kava, St. John’s Wort, chamomile, 5-hydroxytryptophan (5-HTP)

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9
Q

List typical supplements you may see used for: Depression

A

St. John’s Wort, SAMe (S-adenosyl-L-methionine), 5-HTP, valerian

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10
Q

List typical supplements you may see used for: Cold sores (aphthous ulcers/canker sores)

A

L-lysine

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11
Q

List typical supplements you may see used for: Colds and flus

A

Echinacea, zinc, vitamin C (ascorbic acid), eucalyptus oil (for nasal congestion/allergies), probiotics (Bifildobacterium animalis, Lactobacillus acidophilus)

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12
Q

List typical supplements you may see used for: Dementia/memory

A

Ginkgo, vitamin E (alpha-tocopherol), vitamin D, acetyl-L-caitine, vinpocetine (for memory, neuroprotection, weight loss)

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13
Q

List typical supplements you may see used for: Diabetes

A

Alpha lipoic acid (for diabetic neuropathy, memory, neuroprotection), chromium, cassia cinnamon, magnesium, American ginseng, Panax ginseng

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14
Q

List typical supplements you may see used for: Dyslipidemia

A

Red yeast rice (contains a natural form of lovastatin), omega-3 fatty acids (“fish oils”), garlic (controversal benefit: small decrease in TG and LDL), plant sterol (beta-sitosterol), fiber (barley, psyllium, oat bran), artichoke extract

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15
Q

List typical supplements you may see used for: Hypertension

A

Omega-3 fatty acids, garlic (controversal benefit: small decrease in BP), fibery (barley, psyllium, oat bran), potassium

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16
Q

List typical supplements you may see used for: Heart failure, heart health (general)

A

Coenzyme Q10 (ubiquinone - used as adjunctive w/ HF meds), hawthorn, omega-3 fatty acids

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17
Q

List typical supplements you may see used for: Energy/weight loss

A

Bitter organ (synephrine component), caffeine, guarana (contains caffeine), green tea power (contains caffeine), garcinia cambogia

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18
Q

List typical supplements you may see used for: Dyspepsia

A

Calcium, magnesium, peppermint, chamomile

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19
Q

List typical supplements you may see used for: Erectile dysfunction

A

ginseng, L-arginine, yohimbe

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20
Q

List typical supplements you may see used for: GI health

A

fiber (barley, psyllium, oat bran - for diarrhea/constipation), chamomile, probiotics (Lactobacillius, Saccharomyces boulardii, Bifidobacterium infantis), ginger (for nausea), peppermint, horehound (for GI health, constipation), wheatgrass (for GI health, detoxification)

Know: fiber, chamomile, probiotics, ginger

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21
Q

List typical supplements you may see used for: Inflammation

A

Omega-3 fatty acids, flax seeds/oil (converted to DHA and EPA), tumeric

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22
Q

List typical supplements you may see used for: Insomnia/sleep

A

Melatonin (for sleep when taken Qhs and to help prevent jet lag: 0.5-2mg taken pre-fligh and higher doses such as 5mg post-flight) , valerian, chamomile, lemon balm, passionflower, 5-HTP, L-tryptophan

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23
Q

List typical supplements you may see used for: Liver disease

A

Milk thistle

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24
Q

List typical supplements you may see used for: Menopause

A

Black cohosh, dong quai, evening primrose oil (provides essential fatty acids gamma-lineoloic acid or GLA)

-Soy, red clover, Panax ginseng: contain mild phyto-(plant) estrogens

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25
List typical supplements you may see used for: Migraine prophylaxis
*Feverfew, butterbur, magnesium, riboflavin (vitamin B2)*, conenzyme Q10, guarana (for caffeine) or other caffeine sources
26
List typical supplements you may see used for: Motion sickness
*Ginger, peppermint*
27
List typical supplements you may see used for: Osteoarthritis
*Glucosamine* (best evidence w/ sulfate salts), *chondroitin, SAMe* (S-adenosyl-L-methionine), tumeric (to reduce inflammation and pain)
28
List typical supplements you may see used for: Osteoporosis
*Calcium, vitamin D, soy*, ipriflavone
29
List typical supplements you may see used for: Prostate health
*Saw palmetto, lycopene*, pygeum, pumpkin seed (contains beta-sitosterol)
30
List typical supplements you may see used for: Skin conditions
*Tea tree oil* (for acne, dandruff, fungal infections), aloe vera (for lichen planus, psoriasis, HSV, burns), topical vitamin D (for psoriasis, seborrheic keratosis), vitamin A & D ointment (for diaper rash)
31
List typical supplements you may see used for: UTI
*Cranberry*, yogurt, probiotics (Bifidobaceria, Lactobacillus)
32
Safety concern for: 5-HTP
*serotonergic* - increased risk with other serotonergic drugs
33
Safety concern for: Beta-carotene
increased risk of lung cancer (in smokers or asbestos exposure), *increased CV mortality*
34
Safety concern for: Bitter orange (synephrine component)
*Stimulant* that can increase BP, HR, and arrhythmia risk
35
Safety concern for: Black cohosh
*May be hepatotoxic;* do NOT use with medications for HF (ACEIs, ARBs, beta-blockers, amiodarone)
36
Safety concern for: Chamomile
Allergic rxns (uncommon) due to possible allergenic cross-reactivity (avoid in pt w/ allergy to asters, echinacea, chrysanthemums, and ragweed)
37
Safety concern for: Chondroitin
Bleed risk at higher doses, increased INR w/ warfarin
38
Safety concern for: Echinacea
Controversal safety w/ autoimmune disorders; due to allerginic cross-reactivity, pts w/ allergics to artichoke, asters, chamomile, chrysantheumums, and ragweed should avoid
39
Safety concern for: Feverfew
Mouth ulceration (inflammation of oral cavity/tongue), increasd bleeding with (w/ concurrent use of anticoagulants, antiplateltes, salicylates)
40
Safety concern for: Fiber (barley, psyllium, oat bran)
GI effects (bloating, cramping, flatulence
41
Safety concern for: Hawthorn
*Positive inotrope, avoid concurrent use w/ digoxin* (additive effect), decreasesd BP (caution for additive effects with other BP lowering drugs)
42
Safety concern for: L-arginine
Converts into nitric oxide, decrasing BP and potentially causing dizziness (caution with toher drugs that lower BP, avoid concurrent use w/ nitrates)
43
Safety concern for: Melatonin
When used chronically for sleep, endogenous melatonin can be decreased, resulting in dependency for sleep
44
Safety concern for: Passionflower
QT prolongatoin (avoid with other QT-prolonging drugs)
45
Safety concern for: Potassium
*Levels should be measured in lab and dosed accordingly (NOT with OTC supplements)*
46
Safety concern for: Probiotics
Seperate from PO ABXs, *safety concerns with use of live bacteria in immunocompromised states*
47
Safety concern for: Red yeast rice
CYP450 inhibitors (ex. amiodarone) will increase red yeast rice; red yeast rice can decreased coenzyme Q10 levels which may incresed myopathy risk *(do NOT use with statins)*
48
Safety concern for: SAMe (S-adenosylmethionine)
*Serotonergic* (increased risk w/ other serotonergic drugs), can incresed bleeding risk, do NOT use in bipolar disorder due to increased risk of manic behavior
49
Safety concern for: Soy, red clover, Panax ginseng
Contain mild phyto-(plant) estrogens; soy might increase breast cancer risk in postmenopausal women NOT producing estradiol
50
Safety concern for: Valerian
*Sedation*, CNS depression (risk w/ concurrent CNS depressants)
51
Safety concern for: Vitamin C
*Nephrolithiasis at high doses*, false-negative stool occult blood 48-72 hours after ascorbic acid ingestion
52
Safety concern for: Yohimbe
increased BP, HR, and seizure risk
53
Safety concern for: Zinc
nasal product can cause loss of smell
54
Name for: Vitamin A
Retinol
55
Name for: Vitamin B1
Thiamine
56
Name for: Vitamin B2
Riboflavin
57
Name for: Vitamin B3
Niacin
58
Name for: Vitamin B6
Pyridoxine
59
Name for: Vitamin B9
Folic acid
60
Name for: Vitamin B12
Cobalamin
61
Name for: Vitamin C
Ascorbic acid
62
Name for: Vitamin D2
Ergocalciferol
63
Name for: Vitamin D3
Cholecalciferol
64
Name for: Vitamin E
Alpha-tocopherol
65
Supplementation: 1. True or False: Vitamin E is recommended for prevention of CVD or cancer. 2. Thiamine (vitamin B1) deficiency is common in __________ and can cause what? 3. What are some supplements containing only iron? What are some vitamin supplements with iron?
1. *False - lack of benefit* 2.* Alcohol use disorder (or malabsorptive states) --> can lead to Wernicke's encephlopathy (s/sx: mental confusion, ataxia, tremor, vision changes; as symptoms of Wernicke's fade, Kaorsakoff syndrome can develop which is permanent neurologica damage)* 3. -Iron-only supplements: Fer-In-Sol (iron supplement drops), Feosol (tablets and caplets) -Vitamin supplements w/ iron: *Poly-Vi-Sol (for if vitamin D and iron needed),* others: multivitamins
66
What are drugs that can cause nutrient depletion, and which nutrient do they deplete?
1. Amphotericin B - magnesium, potassium 2. Anticonvulsants - calcium 3. Isoniazid - vitamin B6 4. Loop diuretics - potassium 5. Metformin - vitamin B12 6. Methotrexate - folate 7. Orlistat - beta-carotene, fat-soluble vitamins (ADEK) 8. PPIs - magnesium, vitamin B12 (>2 years of TX for B12)
67
What are conditions where supplementation is actually recommended, and what should be supplemented?
1. Alcohol use disorder - *vitamin B1*, folate *2. Chronic kidney disease - vitamin D *3. Goiter - iodine (iodized salt) *4. Macrocytic anemia - vitamin B12 and/or folate *5. Microcytic anemia - ferrous sulfate *6. Pregnancy - folate, calcium, vitamin D, pyridoxine (for nausea) *7. Osteopenia/osteoporosis - calcium, vitamin D 8. Bariatric surgery - varies (pt specific) 9. Crohn's disease (possibly ulcerative colitis) - pt specific (depends on the levels); can require iron, zinc, folate, calcium, vitamin D, B vitamins
68
What is homeopathy?
Based on the "law of similars" or the concept that "like is cured by like" --> very small amounts of active substance are given to stimulate the body to react against similar symptoms produced by that same substance when given at a higher dose Ex. homeopathic medicine made from coffee bean relieves sleepiness w/ agitatoin and racing thoughts

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