UWORLD Chapter 79: Dietary Supplements, Natural & Complementary Medicine

What is complementary medicine?

simultaneous use of both traditional and alternative medicine

What is alternative medicine?

treatment used instead of conventional medical treatment

What does the Dietary Supplement Health and Education Act mandate?

that the FDA regulate dietary supplements as a special type of food, rather than a drug

What does the United States Pharmacopeia do?

Establishes standards for dietary supplements

Where can adverse events from supplements be reported?

FDA's Safety Reporting Portal

Where can information on natural medicines be found?

General drug references

Natural Medicines Database

What can manufacturers of supplements not do?

Make claims that a product treats or cures a disease since it isn't FDA evaluated

What are supplements that increase bleeding risk?

Five "G"s - garlic, ginger, ginseng, ginkgo, glucosamine

Fish oils

Vitamin E

Dong quai

Willow Bark (salicylate)

What drugs should not be used with st. john's wort due to serotonin syndrome risk?

MAO inhibitors and SSRI and SNRIs

What are the main side effects of St. John's wort?

Photosensitivity (sun protection recommended), lower seizure threshold

What are supplements that have risk of hepatotoxicity?

Black cohosh and Kava

What supplements have risk of cardiotoxicity?

Ephedra, Bitter orange, Synephrine

Yohimbe used for erectile dysfunction

Caffeine can raise blood pressure and increase HR

What are supplements used for anxiety?

Valerian, passionflower, Kava, St. John's wort

What are supplements used for cold sores?

L-lysine

What are supplements used for cold and flu?

Echinacea, Zinc, Vitamin C

What are supplements used for dementia and memory?

Ginkgo and Vitamin E

What are supplements used for depression?

St. John's Wort, SAMe, 5-HTP

What are supplements used for diabetes?

Alpha lipoic acid, chromium, Cassia Cinnamon

What are supplements used for dyslipidemia?

Red yeast rice (natural form of lovastatin), omega 3 fatty acids

What are supplements used for Dyspepsia?

Calcium and magnesium

What are supplements used for energy/weight loss?

bitter orange (synephrine), caffeine, Guarana, green tea powder

What are supplements used for erectile dysfunction?

Ginseng, L-arginine, Yohimbe

What are supplements used for heart failure?

CoQ10, Hawthorn, Omega 3 fatty acids

What are supplements used for HTN?

omega 3 fatty acids, garlic

What are supplements used for gastrointestinal health?

Fiber, probiotics, ginger

What are supplements used for inflammation?

omega 3 fatty acids and flax seeds/oil

What are supplements used for insomnia/sleep?

melatonin QHS (0.5-2 mg taken preflight, 5 mg post flight)

Valerian

Kava

Chamomile

What are supplements used for liver disease?

Milk thistle

What are supplements used for menopause?

Black cohosh, evening primrose oil, soy, red clover

What are supplements used for migraine prophylaxis?

feverfew, butterbur, magnesium, riboflavin

What are supplements used for motion sickness?

Ginger

What are supplements used for osteoarthritis?

glucosamine and chondroitin, SAMe and tumeric

What are supplements used for osteoporosis?

calcium, vitamin D, soy

What are supplements used for prostate health?

saw palmetto and lycopene

What are supplements used for skin conditions?

tea tree oil

What are supplements used for UTI?

Cranberry

What are safety concerns with 5-HTP?

It is serotonergic

What are safety concerns with beta carotene?

increased cardiovascular mortality

What are safety concerns with bitter orange?

It's a stimulant

What are safety concerns with black cohosh?

may be hepatotoxic

What are safety concerns with caffeine?

Dose-related increase in BP and HR

What are safety concerns with chondroitin and dong quai?

increased bleeding risk

What are safety concerns with hawthorn?

positive inotrope, avoid with digoxin

What are safety concerns with kava?

hepatotoxicity

What are safety concerns with omega 3 fatty acids?

increased bleeding risk with higher doses

What are safety concerns with probiotics?

Separate from antibiotics, live bacteria in immunocompromised patients

What are safety concerns with red yeast rice?

Contains a natural form of lovastatin

Increased risk of myopathy, dont use with statins

What are safety concerns with valerian?

Sedation

CNS depressants

What are safety concerns with vitamin C?

Nephrolithiasis

What are safety concerns with vitamin E?

bleeding risk

What is needed for calcium absorption?

Vitamin D

What is the name of vitamin A?

Retinol

What is the name of vitamin B1?

Thiamine

What is the name of vitamin B2?

Riboflavin

What is the name of vitamin B3?

Niacin

What is the name of vitamin B6?

Pyridoxine

What is the name of vitamin B9?

folic acid

What is the name of vitamin B12?

Cobalamin

What is the name of vitamin C?

ascorbic acid

What is the name of vitamin D2?

ergocalciferol

What is the name of vitamin D3?

cholecalciferol

What is the name of vitamin E?

alpha-tocopherol

How much vitamin D do exclusively breastfed infants need a day?

400 IU

What is 600 DFE equivalent to as folic acid?

360 mcg

When is thiamine given? Why?

Alcohol use disorder to avoid Wernicke's encephalopathy (mental confusion, ataxia, tremor, and vision changes) which can lead to korsakoff syndrome

How much iron is recommended for breast fed babies 4-6 months of age?

1 mg/kg/day until consuming iron rich foods

What is a baby iron supplement?

Poly-Vi-Sol

What nutrients are depleted with amphotericin B?

magnesium and potassium

What nutrients are depleted with antiseizure medications?

calcium

What nutrients are depleted with isoniazid?

B6

What nutrients are depleted with loop diuretics?

potassium

What nutrients are depleted with metformin?

vitamin B12

What nutrients are depleted with methotrexate?

folate

What nutrients are depleted with orlistat?

vitamin ADEK, beta carotene

What nutrients are depleted with PPIs?

magnesium, vitamin B12

What is a recommended supplement in CKD?

vitamin D

What is a recommended supplement with goiters?

iodine

What is a recommended supplement with macrocytic anemia?

vitamin B12 and/or folate

What is a recommended supplement with microcytic anemia?

ferrous sulfate

What is a recommended supplement in pregnancy?

folate, calcium, vitamin D, pyridoxine

What is a recommended supplement in osteoporosis?

calcium and vitamin D