NAPLEX: Dietary Supplements, Natural, and Complementary Medicine

Dietary supplements are regulated by the ___

Dietary Supplement Health and Education Act of 1994

Under the DSHEA, manufacturers must prove that their products are ___

Safe

What are the four areas of particular safety concern with natural medicines?

1. Interactions

2. Bleeding risk

3. Cardiotoxicity

4. Hepatotoxicity

St. John's wort induces ____, ___ and ___

CYP enzymes 3A4 and 2C19 and P-gp

St. John's wort causes ___ and lowers ____

Photosensitivity; seizure threshold

What are the 5 Gs that increase bleeding risk?

Garlic, ginger, ginkgo, ginseng, glucosamine

What are the two big natural products that cause hepatotoxicity?

Black cohosh and kava (do NOT recommend kava)

What natural product has a stimulant effect that can cause cardiotoxicity?

Bitter orange

Four supplements to treat anxiety

Valerian, passionflower, SAMe, and kava

Supplement to treat ADHD

Fish oil

Supplement to treat cold sores

L-lysine

Two supplements to treat dementia/increase memory

Ginkgo, vitamin E

Three supplements for colds and flu

Echinacea, zinc, vitamin C

Three supplements for depression

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

Three supplements for diabetes

Chromium, alpha lipoic acid, cinnamon

Six supplements for dyslipidemia

Red yeast rice, garlic, niacin, fish oil, plant sterols/stanols, and fiber

Two supplements for dyspepsia

Calcium and magnesium

Three supplements for energy/weight loss

Bitter orange, caffeine, guarana

Supplement for heart health

COQ10

Four supplements for hypertension

Fish oil, L-arginine, COQ10, garlic

Supplement for IBD

Fiber

Two supplements to avoid with IBD

Cascara, senna

Three supplements for insomnia

Melatonin, lemon balm, passionflower

Supplement for liver disease

Milk thistle

Supplement for menopause

Black cohosh

Five supplements for migraines/headaches

Feverfew, butterbur, magnesium, COQ10, guarana

Two supplements for motion sickness

Ginger,, peppermint

Three supplements for osteoarthritis

Glucosamine, chondroitin, SAMe

Three supplements for osteoporosis

Calcium, vitamin D, soy

Two supplements for prostate health

Saw palmetto, pygeum

Two supplements for skin conditions

Aloe vera, tea tree oil

Lack of this vitamin can cause Wernicke's encephalopathy, which is characterized by mental confusion, ataxia, tremor, and vision changes

thiamine (vitamin B1)

Wernicke's encephalopathy can lead to this syndrome, which causes permanent neurological damage

Korsakoff syndrome

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

Women of childbearing age should obtain ___ mcg/day of folic acid

400mcg/day

Pregnant women should obtain at least ___ mcg/day of folic acid. This should start at least __ month(s) before pregnancy to prevent neural tube defects.

600mcg/day; one month

Exclusively breastfed infants need _____IU of vitamin D daily

400IU of vitamin D

0-4 months need _____ iron

no

4-6 months need ____ iron only if they are eating ____

1mg/kg/day; breast milk

Acetazolamide can deplete __ and __

Ca and K

Antiepileptic drugs can deplete __

Ca

Amphotericin B can deplete __ and __

Magnesium and potassium

Isoniazid can deplete __

Vitamin B6

Loop diuretics can deplete __

Potassium

Methotrexate can deplete __

Folate

Orlistat can deplete __ and __

Beta carotene and fat-soluble vitamins

PPIs can deplete __ and __ when taken for over 2 years

Magnesium and vitamin B12

Sulfamethoxazole can deplete __

Folate

Those with alcoholism should take __ and __

Vitamin B1 and folate

Those with microcytic anemia should take __

Iron

Those with macrocytic anemia should take __ and __

Vitamin B12, folate

Those who are pregnant should take these three supplements

Folate, calcium, vitamin D

People with osteopenia/osteoporosis and osteomalacia (rickets) should take __ and __

Calcium and vitamin D

Those with CKD should take __

Vitamin D

Those with scurvy should take __

Vitamin C

Define homeopathy

Belief that giving very small amounts of a substance in its undiluted form causes similar symptoms of the illness and will protect the patient or cure them of the illness

What are the four fat soluble vitamins?

A, D, E, K