Nutritional and Herbal Supplements Flashcards

(41 cards)

1
Q

why do I need to be aware of studies on supplements?

A
many performed outside US
-flaws (not RDBPCT)
-limitations (small)
-unable to interpret results
-different population
not regulated by any governing body
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2
Q

St. John’s Wort

-mechanism

A

inhibits metabolism and reuptake of serotonin, dopamine, and epinephrine

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3
Q

St. John’s Wort

  • purpose
  • study results
A

depression
no more effective than placebo for mild to moderate depression (similar to Rx agents) with fewer side effects
not effective for major depression

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4
Q

St. John’s Wort

  • recommendations
  • side effects
A

more rigorous studies needed - they always say this
associated with allergic reactions and photosensitization
relatively inexpensive
patient should not self-treat depression

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5
Q

Echinacea

  • MOA
  • function
A

enhances phagocytosis, stimulates certain cytokines

anti-inflammatory actions

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6
Q

Echinacea

-study results

A

may be beneficial for early treatment of URTI (upper resp tract infection), though larger, properly designed trials show no beneefit over placebo

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7
Q

Echinacea recommendations

  • may be effective for…
  • side effects
  • long-term use?
A

may be effective in reducing a cold’s severity and duration if taken early
probably safe for short term use
allergies and GI pain are commonly reported
long-term use should possibly be avoid due to immunosuppression, though evidence for this is scarce

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8
Q

Ginkgo Biloba

-MOA

A

free radical scavengers (antioxidant)
inhibits platelet activating factor
increases GABA

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9
Q

Ginkgo Biloba

-study results

A

potentially increases memory and attention

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10
Q

Ginkgo Biloba

-side effects

A

drug interactions max exist

may increase risk of bleeding

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11
Q

Saw Palmetto

-MOA

A

inhibit 5-alpha-reductase
blocks testosterone and dihydrotestosterone uptake by the prostate
anti-inflammatory activity

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12
Q

Saw Palmetto

-study results

A

improved urologic symptoms and flow when compared to finasteride with fewer side effects

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13
Q

Saw Palmetto

  • recommendations
  • safety
  • drug interactions
A

may decrease BPH symptoms
probably safe
limited (known) drug interactions

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14
Q

garlic

-MOA

A

potentially inhibits cholesterol synthesis

also has effects on plasma protein and cell membrane remodeling

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15
Q

garlic

-study results

A

mixed results on lipid-lowering ability
potentially has modest ability to lower LDL
possible antihypertensive effect
antiplatelet, antithrombotic and fibrinolytic activity seen

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16
Q

garlic

-recommendations

A

well tolerate with few side effects
drug interactions exist, must use carefully
must use high doses to see any effect

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17
Q

ginger

-function

A

potentially affects GI motility

some evidence for use as an antiemetic

18
Q

ginger

-study results

A
hyperemesis gravidarum (severe morning sickness)
results are mixed for treating motion sickness and nausea associated with surgery or chemotherapy
19
Q

ginger

-drug interactions

A

drug interactions may exist, must use carefully

20
Q

ginseng

  • MOA
  • function
A

proposed: central cholinergic and dopamingeric effects and stimulation if the HPA axis
claims to increase energy and improve mental abilities

21
Q

ginseng

-study results

A

multiple studies have shown no effects on exercise performance, mood, memory or concentration

22
Q

herbal agents used for pain relief

A
arnica montana
black cohosh
chamomile
Boswellia Serrata
evening primrose oil
kava
peppermint
piscidia-Jamaican Dogwood
SAM-e
St. Johns Wort
Willow Bark
Wintergreen Oil
23
Q

arnica montana

-how is it used

A

used externally for muscle pain increased by movement

24
Q

black cohosh

  • don’t confuse with…
  • used for…
A

don’t confuse with blue cohosh

generally used to treat Sx of menopause, though high quality trials show no effect

25
chamomile - purpose - evidence
used for stomach and GI pain, cramps, rheumatism, neuralgia, inflammation, ulcers no robust evidence
26
boswellia serrata - aka - purpose - evicence
frankincense believe to disrupt the enzymes which cuase inflammatory pain robust evidence of efficacy is lacking
27
evening primrose oil - evidence - purpose
no robust evidence | proposed anti-inflammatory actions --> arthritis, joint and back pain
28
kava - linked to... - function - may be useful for...
linked to liver damage/failure mild CNS depressant may be useful in the Tx of anxiety
29
chondroprotective agents | -how do they work?
increase proteoglycan synthesis decrease collagenolytic activity increase in hyaluronic acid production inhibit lysosomal enzyme release
30
oral bioavailability of - glucosamine - chondroitin
``` glucosaming -26% -87% absorbed from GI tract (first-pass metabolism accounts for the difference) chondroitin -12% ```
31
glucosamine and chondroitin | -MOA
exact machanism not known
32
glucosamine and chondroitin | -in vitro anti-inflammatory activity
proposed to prevent breakdown of synovial sturctures
33
glucosamine and chondroitin - exogenous glucosamine has been shown to... - -unclear if...
distribute to joints (knees) and increase the synthesis of hyaluronic acid -unclear if this occurs at synovial concentrations that can be achieved through supplements (5 uM vs. 500 uM)
34
glucosamine and chondroitin | -trial results
no benefit vs. placebo in short-term studies long-term (2 years) trials show no benefit over placebo small sample size in a lot of studies
35
glucosamine drug interactions
ACE inhibitors K sparing diuretics diabetic medications
36
chondroitin drug interactions
none reported
37
glucosamine adverse effects and cautions/contras
``` heartburn moderate constipation diarrhea avoid in/with -pregnancy -shellfish allergy -diabetics/glucose intolerance -CHF/renal impairment ```
38
chondroitin adverse effects and cautions/contras
``` moderate constipation diarrhea nausea/epigastric pain hypersensitivity avoid in pregnancy ```
39
supplement concerns
``` not FDA regulated allergic reactions can still occur -can be serious such as anaphylactic shock toxities -direct -unlisted poisonous ingredients -excessive pharmacologic activity adulteration/contamination misidentification/mislabeling ```
40
patients should never...
use herbal products in lieu of seeking medical treatment -use of herbals may delay Tx patients should never stop taking their proven conventional therapies to use an unstudied, unproved regimen
41
use extreme caution around _____ when taking herbal agents
surgery