Nutraceuticals

Question 1

Which is more common: supplements or vitamins?

Answer 1

supplement use is much more common than vitamin. Women are more likely to take than men

Question 2

What is most common reason for taking a supplement?

Answer 2

weight loss and heart problems equal. Followed by digestion, pain and allergies

Question 3

What is DSHEA?

Answer 3

established standards for supplement industry. Pretty lax rules of self-regulation. If adverse effects occur, must report to FDA

Question 4

What kind of ADE do kava-kava and comfrey have?

Answer 4

serious liver damage

Question 5

Are supplments regulated by FDA?

Answer 5

only if there is an adverse effect. Otherwise no.

Question 6

Are supplements required to be standardized in US?

Answer 6

no. no legal or regulatory definition exists in US. Even if label says standardized, doesnt mean it’s quality

Question 7

Do nutritional support statments on packages need FDA approval? Do health claims?

Answer 7

no.

Health claims do however need approval.

Question 8

What is the general rule for surgery and supplements?

Answer 8

stop them 2 weeks ahead of surgeries

Question 9

Are most people willing to disclose supplement use?

Answer 9

Yes. 92% are but ONLY if asked

Question 10

What is ephedra for and what is its possible toxicity?

Answer 10

for weight loss.

Cardiovascular toxicity

Question 11

What is kava-kava for and what is its possible toxicity?

Answer 11

sleeping aid/antianxiety.

hepatotoxicity

Question 12

Which herbals are natural salicylates?

Answer 12

WILLOWBARK

Question 13

What is licorice for and what is its possible toxicity?

Answer 13

peptic ulcer, flavoring agent.

Psuedo-hyper aldosteronism

Question 14

How does licorice cause pseudo-hyperaldosteronism?

Answer 14

it is metabolized to glycrhizzin, which promotes salt and water retention by kidney. Occurs despite normal aldosterone levels.

Question 15

Which herbals have antiplatelet function?

Answer 15

garlic, ginkgo biloba

Question 16

What can bitter orange do to CYP?

Answer 16

inhibit CYP3A4

Question 17

What can echinacea do to CYP?

Answer 17

Inhibit CYP1A2, inhibit ntestinal 3A4, and induce normal CYP3A4

Question 18

What can ginkgo biloba do to CYP?

Answer 18

INhbiit CYP1A2 and 2D6

Question 19

What can ginseng do to CYP?

Answer 19

inhibit CYP 2D6

Question 20

What can st. John’s wort do to CYPs?

Answer 20

induce CYP 1A2, 3A4, and 2C9

Question 21

Which common drugs rely on CYP1A2?

Answer 21

duloxetine, fluvoxamine, frovatriptan, mexiletine, olanzapine, ropinirole, tacrine, tizanidine, zileuton

Question 22

Which common drugs rely on CYP2D6?

Answer 22

amitriptyline, codeine, desipramine, dextromethorphan, metorolol, oxycodone, tamoxifen, timolol

Question 23

Which common drugs rely on CYP3A4?

Answer 23

verapamil, cyclosporine, protease inhibitors, midazolam, simvastatin, atorvastatin, tacrolimus, tamoxifem, triazolam

Question 24

Which common drugs rely on CYP2C9

Answer 24

ARBs, NSAIDs, oral hypoglycemics and warfarin

Question 25

What are the interactions of echinacea and Ginseng?

Answer 25

antagonize immunosuppressants like azathioprine, corticosteroids, cyclosporine and tacrolimus

Question 26

What are the interactions of pomegranate juice?

Answer 26

effective for treating prostatic cancer. increase in mean PSA doubling time (15 months to 54 months) Good thing. Inhbiits CYP3A4 and can cause rhabodmylysis with statins

Question 27

What can taking > 1 g of Vit C per day for many months cause?

Answer 27

oxalate crystal deposition causing tubulointerstitial nephritis, predominantly in distal tubules

Question 28

What can excessive vitamin A cause?

Answer 28

N/V, headache, dizziness, blurred vision, clumsiness, birth defects, liver problems, osteoporosis

Question 29

What can excessive vitamin D levels cause?

Answer 29

N/V, poor appetite, constipation, weight loss, constipation, weakness, weight loss, confusion, arrhythmia, Ca and P deposits in soft tissues

Question 30

What can excessive vitamin E or K do?

Answer 30

antagonize warfarin anticoagulant

Question 31

Is there evidence that multivitamins are helpful?

Answer 31

no

Question 32

Is there evidence that Coenzyme Q10 or melatonin can help prevent alzeimers by antioxidation?

Answer 32

no

Question 33

Is there evidence omega-3 fatty acids help?

Answer 33

yes. they decrease BP. Increase HDL and LDL (not good) and decrease risk of MI and dementia

Question 34

What does Coenzyme Q10 (ubiquinone) do?

Answer 34

potent antioxidant. Lowers both systolic and diastolic BP. Improves HDL and exercise tolerance. Prevents statin-induced myopathy. Can reduce warfarin activity though.

Question 35

What does melatonin do?

Answer 35

serotonin derivative produced in pineal gland. Useful for resetting jet-lag. Prescription form = ramelteon used for insomnia. metabolized by CYP 1A2. May interact with Nifedipine. Can cause psychosis and antagonise SSRIs. Decreases M/F fertility and breast milk production.

Question 36

What do beta-sitosterols do?

Answer 36

good evidence that they decrease BPH symptoms without shrinking prostate

Question 37

What does echinacia do?

Answer 37

no evidence for therapy

Question 38

Where is zinc found and what does it do?

Answer 38

beef, fish, spinach. Important cofactor for many enzymes, including SOD involved in protein and carb metabolism. Increases healing of gastric ulcers.

Question 39

What does garlic do?

Answer 39

evidence that it lowers cholesterol

Question 40

What does ginseng do?

Answer 40

MAY provide benefit for CV. Decreases LDL and blood sugar, boost immune system and antimicrobial agents. Enhances response to flu vaccine

Question 41

Which supplement is good for jet lag?

Answer 41

melatonin

Question 42

What natural supplement is good to combine with antidepressants?

Answer 42

folic acid OR omega3FA boosts effectivness but may trigger mania in bipolar

Question 43

What supplement can be given with AchE inhibitors like donepezil?

Answer 43

Ginkgo Biloba

Question 44

What supplement can be given as a sleep aid in children with ADHD?

Answer 44

valerian

Question 45

What supplment works for mild depression?

Answer 45

St. John's wort

Question 46

What mineral should be supplmented in HIV patients?

Answer 46

selenium

Question 47

What mineral should be supplemented in 3rd world childhood diarrhea?

Answer 47

zinc

Question 48

What mineral can interact with BBs, insulin or NSAIDs?

Answer 48

chromium can enhance them or these drugs can increase chromium's absorption

Question 49

Where is chromium obtained and what does it do?

Answer 49

broccoli. Enhances insulin, carb fat and protein metabolism

Question 50

Where is selenium found and what does it do?

Answer 50

brazil nuts. Important for antioxidant