what are the top 2 reasons why people take supplements?
weight loss & heart probz
what is the DSHEA act (1994)?
established GMP standards for the supplement industry; however it was 2007 when FDA issued final ruling
what is the dietary supplement and non-prescription drug consumer protection act (2006)?
says that manufacturers, packers, or distributors must report serious adverse events to FDA
who is responsible for making sure a supplement is safe before marketing?
manufacturer
who is responsible for making sure supplement is safe after it reaches the market?
FDA
what does the word standardized mean regarding supplements?
nothing, doesn’t indicate product quality
Just because a supplement is natural doesn’t make it __________
safe
what kind of claim can supplements make?
- firms can make statements about classic nutrient deficiency dzs-as long as the statements disclose prevalence of dz in USA (folic acid fixes neural tube defects) 2. makers can: describe supplement’s effect on structure or function or well being 3. product label: “not been evaluated by FDA…”
regarding surgical pts what are some herbs that can cause prolonged bleeding?
- garlic 2. ginkgo biloba 3. panax ginseng Note: stop supplements 2 wks before surgery
what kind of toxicity is assoc. with ephedra?
cardiotoxicity (arrhythmias, sudden cardiac death)
what is ephedra used for?
weight loss
name 1 herbs that have hepatotoxicity
- kava-kava
what is the intended use of kava-kava?
sleeping aid, anti-anxiety
what is the intended use of licorice?
peptic ulcer, flavoring agent
what is the toxicity assoc. w/ licorice?
pseudo-hyperaldosteronism
what is the metabolite of licorice that promotes salt and water retention by the kidney?
glycyrhizzin
describe some herbals affecting coagulation status?
- natural coumarin (celery, red clover, anise)
- natural salicylates (meadowsweet, poplar, willowbark)
- antiplatelet action (garlic, ginkgo biloba)
- hypocoagulability (capiscum) note: interaction w/ coag. cascade or w/ warfarin
which herbs inhibit CYP3A4 (2)?
bitter orange
echinacea (intestinal CYP3A4)
which herbs inhibit CYP1A2 (2)?
Echinacea
ginkgo biloba
Which herbs induce CYP3A4 (2) ?
St. john’s wort
Echinacea
which herbs inhibit CYP2D6 (2)?
Ginseng
Ginkgo Biloba
what are the 3 CYPs that St. John’s wort messes with?
Induces CYP1A2
Induces CYP3A4
Induces CYP2C9
Name the 2 herbs that antagonize immunosuppressants like azathioprine, corticosteroids, cyclosorine, and tacrolimus?
Echinacea & Ginseng
what is cranberry juice used for?
most effective in women with recurrent UTIs, females, kids
what are some of the adverse effects of vitamin A supplements?
N/V, headache, dizziness, blurred vision, clumsiness, birth defects, liver probs, risk of osteoporosis note: exacerbated by high amounts of alcohol, hepatic dysfunction, high cholesterol
what are the adverse effects of vitamin D supplements?
N/V, poor appetite, constipation, weakness, weight loss, confusion, heart arrhythmia, CaPO4 deposits in soft tissues
which 2 fat soluble vitamins can antagonize warfarin?
Vitamin E or K
do antioxidants work in preventing alzheimer’s dz?
No, The majority of antioxidants have limited success
what are benefits of using omega-3 fatty acids fish oil, alpha-linoleic acid?
increased HDL & LDL decreased risk of 2nd MI + death from any cause -additive effects may be seen b/c of CV drugs:
—decreased risk of developing CV dz
—protection from cyclosporine tox.
—improvement in RA pts Also has decreased risk of dementia
what are the benefits to using coenzyme Q10 (ubiquinone)?
Potent antioxidant: healthy muscle
HTN: lowers BP
IHD: increased HDL, better excercise tolerance
coenzyme Q10 is structurally related to what anticoagulant?
warfarin
melatonin levels are altered by what kinds of drugs?
NSAIDs
antidepressants
beta-adrenoceptor agonists & antag.
scopolamine
sodium valproate
melatonin is metabolized by CYP1A2 and may intereact with what drug to cause decreased BP?
nifedipine
what are the main adverse effects of melatonin?
decreased male/female fertility + decreased milk prod.
what are the benefits of using beta-sitosterols?
decreased BPH symptoms and improved urine flow w/o shrinking prostate
what are the benefits of using CoQ?
decreased BP where diet is deficient
what are the benefits of using garlic?
decreased cholesterol
what are the benefits of using ginseng?
decreased LDL
decreased BG
boost immune system & antimicrobials & enhance response to flu vaccine
what are the shown benefits of melatonin?
decreases jet lag
what are some of the natural supplements for mental health?
- folic acid (combine w/ anti-depressant)
- ginkgo biloba (slows decline, use as additive w/ AChE inhibitors)
- SAMe (as effective as older TCAs; boost effect of SSRIs)
- valerian: (useful for sleep/anxiety in ADHD kids)
- omega-3 FA: (boost effect of antidepressants; may trigger mania in bipolar disorder; use w/ mood stabilizer)
- st. john’s wort (works w/ mod. depression)
- Melatonin (improves sleep quality in schizophrenics, major depression & seasonal affective disorder)
what are the sources and role of selenium?
brazil nuts; antioxidants preventing free radical damage
what are the clinical effects of selenium ?
Cancer: some benefit in prostate, CRC, lung
HIV: selenium deficiency assoc. w/ reduced immune function
what is the best place to get info on supplements?
national center for complementary and alternative medicine