dietary supplements, natural and complementary medicine

Who regulates dietary supplements?

Dietary Supplement Health and Education Act (DSHEA)

Adverse events from supplements can be reported to who?

FDA's Safety Reporting Portal

Information on natural medicines can be found in general drug references and the...

Natural Medicines Database

What are manufactures not allowed to do regarding their labeling for dietary supplements.

They cannot make claims that their products treat or cure a condition

Products that make claims on the structure or function of the body, such as, "Antioxidants maintain cell integrity" must state what in a disclaimer?

The FDA has not evaluated this claim

Who establishes the standards for dietary supplements?

United States Pharmacopeia

Which enzymes does St. John's Wort induce?

CYP450 3A4, 2C19, 2C9 and 1A2 enzymes

Which protein does St. John's Wort induce?

p-glycoprotein (P-gp),

St. John's Wort is labeled as _____, which is dangerous when combined with other serotonergic drugs such as SSRIs and SNRIs.

Serotonergic

St. John's Wort should not be used with what?

MAO inhibitors, linezolid

What counseling tips should you give with St. John's Wort?

Use sun protection since it can cause photosensitivity

What are the 5 G's?

Garlic, Ginger, Ginkgo, Ginseng, Glucosamine

Which supplements can increase bleeding risk? (List 9)

Garlic, Ginger, Ginkgo, Ginseng, Glucosamine, Fish oils, Vitamin E, Dong qual, Willow bark

Which supplements can increase the risk of liver toxicity? (List 2)

Black cohosh, Kava

Which supplements can increase the risk of cardiac toxicity? (List 2)

Bitter orange, Yohimbe

What supplements are often taken for anxiety? (List 4)

Valerian

Passionflower

Kava

St. John's Wort

What supplement is often taken for cold sores?

L-lysine

What supplements are often taken for energy/weight loss? (List 3)

Bitter orange, Caffeine, Guarana, Green tea powder

What supplements are often taken for colds and flu? (List 3)

Echinacea

Zinc

Vitamin C

What supplements are often taken for erectile dysfunction? (List 3)

Ginseng, L-arginine, Yohimbe

What supplements are often taken for dementia/memory? (List 2)

Ginkgo, Vitamin E

What supplements are often taken for heart failure or general heart health? (List 3)

Coenzyme Q10, Hawthorn, Omega-3 fatty acids

What supplements are often taken for depression? (List 3)

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

What supplements are often taken for hypertension? (List 2)

Omega-3 fatty acids, Garlic

What supplements are often taken for gastrointestinal health? (List 4)

Fiber, Chamomile, Probiotics, Ginger

What supplements are often taken for diabetes? (List 3)

Alpha lipoic acid, Chromium, Cassia cinnamon

What supplements are often taken for dyslipidemia? (List 2)

Red yeast rice, Omega-3 fatty acids

What supplements are often taken for inflammation? (List 3)

Omega-3 fatty acids, Flax seeds/oil, Tumeric

How should melatonin be taken to prevent/treat jet lag pre-flight?

0.5-2mg

How should melatonin be taken to prevet/treat jet lag post-flight?

5mg

What supplements are often taken for osteoarthritis? (List 4)

Glucosamine, Chondroitin, SAMe

Tumeric

What supplement is often taken for liver disease?

Milk thistle

What supplements are often taken for osteoporosis? (List 3)

Calcium, Vitamin D, Soy

What supplements are often taken for menopause? (List 5)

Black cohosh, Dong quai, Evening primrose oil, Soy, red clover,

What supplements are often taken for prostate health? (List 2)

Saw palmetto, Lycopene

What supplements are often taken for migraine and migraine prophylaxis (List 4)

Feverfew, Butterbur, Magnesium, Riboflavin

What supplement is often taken for skin conditions?

Tea tree oil

What supplements are often taken for motion sickness? (List 2)

Ginger, Peppermint

What supplement is often taken for UTI?

Cranberry

What's a note or safety risk for 5-HTP?

Serotonergic

What's a note or safety risk for Beta-carotene?

Increased cardiovascular mortality

What's a note or safety risk for bitter orange (synephrine component)?

It's a stimulant

What's a note or safety risk for Black cohosh?

Hepatoxic

What's a note or safety risk for Caffeine?

Increases BP and HR

What's a note or safety risk for Dong quai?

Increased bleeding risk

What's a note or safety risk for the 5 G's?

Increased bleeding risk, d/c before surgery

What's a note or safety risk for Hawthorn?

Positive inotrope, avoid use with digoxin due to additive effect

What's a note or safety risk for Kava?

Hepatotoxic

What's a note or safety risk for Omega-3 fatty acids or"fish oils"?

Increased bleeding risk w/ high doses

What's a note or safety risk for SAMe?

Serotonergic

What's a note or safety risk for Valerian?

Sedation

What's a note or safety risk for Vitamin C (ascorbic acid)?

Sedation

What's a note or safety risk for Vitamin E (alpha-tocopherol)?

Bleeding risk

Vitamin A

Retinol

Vitamin B1

Thiamine

Vitamin B2

Riboflavin

Vitamin B3

Niacin

Vitamin B6

Pyridoxine

Vitamin B9

Folic Acid

Vitamin B12

Cobalamin

Vitamin C

Ascorbic Acid

Vitamin D2

Ergocalciferol

Vitamin D3

Cholecalciferol

Vitamin E

Alpha-tocopherol

What becomes impaired if there are low levels of vitamin D?

Calcium absorption

How many IU of vitamin D per day do exclusively breastfed infants need?

400 IU

For all prescription medications for low bone density, what should be recommended if dietary intake is inadequate?

calcium and vitamin D supplementation

Folate deficiencies can cause what?

Birth defects of the brain and spinal cord (neural tube defects).

What is the recommended folic acid intake for women of childbearing age

Folic Acid 600 mcg DFE

Folic Acid 600 mcg DFE is equal to much of actual folic acid daily?

360 mcg of folic acid daily

Is Vitamin E supplementation recommended for the prevention of cardiovascular disease or cancer?

No

During pregnancy, folate requirements increase to _____________ DFE/day.

600 mcg

Folate should be taken at least ____________ before pregnancy and continued for the first 2-3 months of pregnancy.

One month

Prescription prenatal vitamins usually contain _________ of folate

1,000 mcg (1 mg)

Vitamin B1 (thiamine) deficiency is commonly seen with which disorder?

Alcohol use disorder

Vitamin B1 (thiamine) deficiency can cause what?

Wernicke's encephalopathy

Wernicke's encephalopathy symptoms

Mental confusion, ataxia, tremor, vision changes

As Wernicke's encephalopathy symptoms start to fade, what starts to develop.

Korsakoff psychosis

Breastfed babies need __________ from _________________ and until consuming iron-rich foods

1mg/kg/day from 4-6 months old

Adolescent girls are at risk of what once menstruation begins?

Anemia

What is recommended for adolescent girls to prevent anemia once menstruation begins?

Consumption of an iron-rich diet

What vitamin supplement with iron is recommended if both vitamin D and iron are needed?

Poly-Vi-Sol

What nutrient can Amphotericin B deplete?

Magnesium, Potassium

What nutrient can Antiseizure medications deplete?

Calcium

What nutrient can Isoniazid deplete?

Vitamin B6

What nutrient can Loop Diuretics deplete?

Potassium

What nutrient can Metformin deplete?

Vitamin B6

What nutrient can Methotrexate deplete?

Folate

What nutrient can Orlistat deplete?

Beta-carotene andFat-soluble vitamins

What nutrient can Proton Pump Inhibitors deplete?

Magnesium

What supplement is recommended to use in Alcohol Use Disorder?

Vitamin B1

What supplement is recommended to use in Chronic Kidney Disease?

Vitamin D

What supplement is recommended to use for Goiter?

Iodine (Iodized salt)

What supplement is recommended to use in Macrocytic Anemia?

Vitamin B12 and/or folate

What supplement is recommended to use in Microcytic Anemia?

Ferrous sulfate

What supplement is recommended for use in pregnancy?

Folate, Calcium, Vitamin B6 and D

What supplement is recommended to use in Osteopenia/Osteoporosis?

Calcium and Vitamin D

Is Vitamin E supplementation recommended for the prevention of cardiovascular disease or cancer?

No

During pregnancy, folate requirements increase to 600 mcg DFE/day. Folate should be taken at least one month before pregnancy and continued for the first 2-3 months of pregnancy.