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Pure Food and Drug Act of 1906
Established standards of strength, quality, and purity
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Federal Food Drug and Cosmetic (FD&C) Act of 1938
Established drug safety
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FD&C Amendment of 1951
Established the two classes of medications: prescription and OTC
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FD&C Amendment in 1962
Required drugs to be safe and effective
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Federal Trade Commission
Regulates supplement advertising
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Fish Oil Uses
- Hypertriglyceridemia (cardiovascular protective - stronger evidence for secondary prevention)
- Inflammatory conditions
- Hypertension
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Fish Oil Safety Concerns
- Bleeding (>3g/day)
- Vitamin E deficiency
- Vitamin A+D overdose
- Prostrate cancer
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Niacin Uses
- Cardiovascular (Increases HDL, lowers LDL and TGs)
- 1000-3000mg daily
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Niacin safety concerns
- Flushing (pretreat with aspirin, slow dose titration, take w/ meal, use ER form, take before bed)
- Hepatotoxicity (d/c if LFT >3x ULN)
- Myopathy
- Hypothyroidism
- hyperuricemia
- Hyperglycemia
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Red Yeast Rice Uses
- Lower Lipid Concentrations
- Is illegal in US; contains Monocolin K (lovastatin)
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Garlic Uses
- Hyperlipidemia (weak data; small benefit)
- Hypertension
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Garlic concerns
- Bleeding (may raise INH by 65%)
- Contraindication with birth control
- Heartburn
- Body odor
- GI problems
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CoQ10 Uses
- Cardiovascular benefits (angina, cardiomyopathy, infarction, CHF - only NYHA class I + II benefited)
- Parkinson's
- Migraine prevention
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CoQ10 safety concerns
- Well tolerated
- Rash
- GI complaints
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Drugs that deplete CQ10 (should use CoQ10 when taking these)
- Statins!!!
- Sulfonylureas
- beta blockers
- TCAs
- diuretics
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Glucosamine Sulfate Uses
- Arthritis (synthesis of articular cartilage)
- May be as effective as NSAIDs, but NSAIDs work faster (may take 4-8 wks to see benefits from glucosamine)
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Glucosamine safety concerns
GI problems
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Chondroitin Sulfate uses
- Osetoarthritis (formation of joint matrix)
- Osteoporosis
- Hyperlipidemia
- Ischemic Heart Disease
- ALL HAVE MIXED EFFICACY RESULTS (always recommend use with glucosamine for OA)
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Chondroitin Safety Concerns
- Bleeding (esp. w/ warfarin)
- GI problems
- DOES NOT INCREASE GLUCOSE
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Methyl Sulphonyl Methane Use
Arthritis (inhibits degenerative changes in joints)
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Ginkgo Uses
- Main action on CNS
- Improved sex function (blood flow relaxant)
- Memory (some improvement initially, but long term not sustained)
- PVD
- Raynaud's
- Veritgo
- Sexual dysfunction
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Ginkgo safety concerns
- Bleeding
- Seizures
- Allergic Reactions
- GI problems
- Inhibits CYP 450 enzymes
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St. John's Wort Uses
Mild depression (NOT major depression)
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St. John's Wort safety concerns
- Vivid dreams
- Dry mouth
- photodermatitis
- dizziness, irritability
- GI problems
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St. John's Wort Drug Interactions
- Is a CYP 3A4 inducer (cyclosporine, contraceptives, digoxin, HIV meds)
- Anything that affects serotonin
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Melatonin Uses
- Insomnia
- Sleep enhancement
- Jet Lag
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Melatonin safety concerns
- Drowsiness
- Dizziness
- Hormonal effects
- Seizure (rare)
- Headache
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Echinacea Uses
- Upper respiratory tract infections (must take at onset, then continue for 7 days)
- More likely to stimulate immune system (does not kill bacteria)
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Echinacea Interactions
- Immunosuppressants
- Increases caffeine concentrations
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Ginger Uses
- Chemo-induced N/V
- Motion Sickness
- PONV
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Ginger Safety
- Bleeding
- Heartburn
- GI problems
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Biblerry Uses
Ocular conditions
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Milk Thistle Uses
- Liver health
- Mushroom poisoning in other countries
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Soy Isoflavones (Genistein + Daidzein) Uses
- Has SERM effects
- Premenopausal women - anti-estrogen effect
- Postmenopausal women - weak estrogenic effect
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Soy Isoflavones for Menopause
- Hot flashes - mixed results
- Vaginal dryness - likely ineffective
- Osteoporosis - likely ineffective
- Cardiovascular - likely ineffective
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Soy Isoflavones safety concerns
- Premenopausal - longer periods
- Hormone sensitive malignancies
- Endometriosis
- Migraine
- Blood clot risk
- Allergy risk
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So Isoflavones Interactions
- Antibiotics
- Estrogens + SERMS
- Antiestrogens
- MAO-Is
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Red Clover Uses
- Likely no better than placebo for menopausal symptoms
- Ineffective for CV, cancer, osteoporosis
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Red Clover Safety Concerns
- Rash
- Myalgia
- Nausea
- Vaginal Spotting
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Red Clover Drug Interactions
- Anticoagulants, NSAIDs
- Estrogen or anti-estrogen agents
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Black Cohosh Uses
- MOA: unknown - does not bind to estrogen receptors; may be partial agonist at serotonin receptors
- May reduce hot flashes + mood symptoms
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Black Cohosh Safety Concerns
- Seizure
- Hepatotoxicity
- Use caution with ASA allergy
- GI problems
- Rash
- Headaches
- Cramping
- Breast tenderness
- Weight gain
- Spotting
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Black Cohosh Drug Interactions
- SERMs/ estrogen therapy
- Hepatotoxic drugs
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Cranberry Uses
Prevention of UTIs (interfere with bacteria's ability to adhere to urinary tract wall)
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Cranberry safety concerns
- ASA allergies
- Kidney stones
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Fenugreek Uses
Increased breast milk production
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Fenugreek safety concerns
- GI problems
- allergic reactions
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Saw Palmetto Uses
- BPH - likely ineffective
- MOA: may inhibit 5-alpha reductase
- DOES NOT REDUCE PROSTATE SIZE
- May inhibit COX and lioxygenase
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Saw Palmetto Concerns
- GI problems
- Cholestatic hepatitis
- Antiplatelet effects questionable
- NO EFFECT ON PROSTATE SPECIFIC ANTIGEN (PSA) (used for testing prostate cancer)
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Horny Goat Weed Uses
Increased fertility
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Horny Goat Weed safety concerns
- CV disease
- Nosebleeds
- bipolar disorder
- Immune function disorders
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Tribus Terrestris Uses
- Performace enhancer
- Increases testosterone
- Increased LH
- Increased DHEA
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Yohimbe Uses
- Not appropriate for Self-care
- Causes fatal seizures, renal failure, and CV effects
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Bitter Orange (synephrine) uses
- Weight loss (CNS stimulant)
- Synergistic effect when combined with caffeine
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Caffeine Sources
- Guarana
- Green Tea extract
- Yerba Mate
- Kola Nut, Cocoa Nut
- Guta Cola
- Coffee extracts
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CNS stimulants (synephrine/caffeine) adverse effects
- CV effects (tachycardia, hypertension...)
- Ringing in ears
- Hypokalemia
- Hyperthermia
- Tolerance + withdrawal possible
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Caffeine drug interctions
- Fluconazole & Verapamil decrease clearance
- Cimetidine decreases clearance
- Contraceptives decrease clearance
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Hydroxycitric acid uses
Weight loss ( may inhibit lipogenesis) - mixed results
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Hydroxycitric acid safety
- Serious liver injury/ hepatotoxicity (FDA issued a 2009 recall)
- Seizure
- Rhabdomyolysis (muscle breakdown)
- Renal failure
- Serotonin increase
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Chromium Uses
- Glucose metabolism
- May only have an effect in those with a chromium deficiency
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Conjugate Linoleic Acid uses
- NOT likely to decrease BMI
- May be beneficial for overall body composition (fat loss, muscle gain)
- NOT beneficial in young, healthy people who do resistance training
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Conjugated Linoleic Acid safety concerns
- Burp Back
- Diarrhea/ loose stools
- Nausea
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Chitosan Uses
Fiber source to block fat absorption (marketed as a "fat trapper") - likely ineffective for weight loss
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Chitosan Safety Concerns
- Steatorrhea
- Decreased absorption of vitamin A, D, E & K
- Avoid with shellfish allergies
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Psyllium, glucomannan, methylcellulose, pectin Uses
- Bulk forming laxatives for weight loss - possibly effective
- Increased satiety
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Whey Protein Uses
- Increase muscle protein synthesis
- Decrease muscle protein breakdown
- Take within 30 minutes of workout
- Contraindicated in: milk allergy + renal insufficiency
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Creatine Uses
- Improvements in weight lifting perfromance
- DOES NOT IMPROVE AEROBIC EXERCISE/ENDURANCE
- DOES NOT CAUSE WEIGHT LOSS
- Should not cause dehydration or cramping, but hydrate well anyways
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Bulk Forming Laxatives
- Wheat Dextran
- Calcium polycarbophil
- Psyllium
- Methylcellulose
- MOA: Forms a colloidal mixture that softens and increases bulk of stool to increase peristalsis
- Onset: 12 hours - 3days
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Surfactant (emollient) laxatives
- Docusate sodium (Colace)
- MOA: lowers surface tension to allow water and lipids to penetrate the stool
- Does NOT increase motility
- Onset: 1-3 days
- May be used during pregnancy
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Lubricant laxatives
- Mineral oil
- Coats stool and allows for easy passage
- Does NOT increase motility
- Oral onset: 6-8 hours
- Rectal: 2-15 minutes
- Should not use routinely (can aspirate and cause lipid pneumonia)
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Osmotic Laxatives
- Lactulose (1-2 days)
- Sorbitol (<1 hr)
- PEG (12-72 hrs)
- Glycerin (<30 min)
- MOA: Cause fluid accumulation that softens the stool and distend colon to enhance peristalsis
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Stimulant Laxatives
- Senna (6-12 hours orally; 30-120 minutes rectally) - may cause pink or brown urine)
- Bisacodyl (Dulcolax) (6-8 hrs orally; 15-60min rectally)
- MOA: directly stimulates peristalsis
- Can develop dependence (use short term unless using with opioid)
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Saline Osmotic Laxatives
- Magnesium citrate
- Sodium Phosphate
- Magnesium hydroxide
- MOA: creates an osmotic gradient that pulls water into the intestine
- Onset: <1 hour
- May affect electrolyte levels
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Chloride channel activator
- Lubriprostone (Amitiza)
- MOA: increase fluid secretion
- Doesn't cause electrolyte imbalance
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Anorectal Local Anesthetics
- Pramoxine
- Benzocaine
- MOA: block transmission of nerve impulses
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Anorectal Vasoconstrictors
- Preparation H
- MOA: alpha adrenergic stimulation
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Anorectal Protectants
- Cocoa butter
- Mineral Oil
- Glycerin
- Petrolatum
- Zinc Oxide
- MOA: prevents irritation and water loss by forming a physical barrier
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Anorectal Astringents
- Witch Hazel
- Tucks medicated pads
- Zinc Oxide
- MOA: promotes tightening of skin cells which protects underlying tissues and dries up excess moisture
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Hepatitis B vaccine
- Recombivax HB
- Enginerix HB
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Hepatitis A + B vaccine
Twinrix
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Chronic Insomnia
Insomnia >3 weeks
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Transient Insomnia
Self-limiting, lasts less than 1 week
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Short-term insomnia
Insomnia that lasts 1-3 weeks
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Meds used for Insomnia
- Diphenhydramine 25-50mg
- Doxylamine 25mg
- Use off night dosing (3 on, 1 off)
- Only used if Transient or short term insomnia
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Melatonin
- 0.3-5mg nightly
- Used as sleep aid
- Jet lag
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Valerian
- 400-900mg 1/2 - 2 hours before bed to treat insomnia
- Avoid in pregnancy
- May have withdrawal symptoms
- Hepatotoxic
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Kava
Should never be recommended for due to liver toxicity
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Caffeine
- Used to treat drowsiness/fatigue
- Pregnancy: <200mg/day
- Breast feeding: 200-300mg/day
- >70yrs old: <300mg/day
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Dental Carries
- Caused by dental plaque
- Progression may lead to calculus or tartar
- Saliva and fluoride prevent this
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Gingivitis
- Mild periodontol disease
- Causes alveolar bone loss and ulceration
- Increased risk during hormone changes
- Treat with cetylpyridinium, triclosan, and stannous fluoride
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Halitosis
- Oral Malodor
- Caused by poor oral hygiene: dental caries, periodontal disease, oral infections, impacted food/debris
- Treat with tongue blade, zinc salts, and chlorine dioxide rinses
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Tooth Hypersensitivity
Treat with soft-bristle toothbrush with normal toothpaste that contains fluoride
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Canker Sores
- Caused by stress or local trauma
- Rule out vitamin deficiencies and HIV beforehand
- Treat with oral anesthetics
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Minor Oral Mucosa Treatment
- Sodium Bicarbonate solution
- Saline rinse
- Topical oral anesthetics
- Oral protectants
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Herpes Simplex
- Treat with Docosanol 10%
- Do not use longer than 10 days
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Xerostomia (dry mouth)
- Can cause tooth decay
- Treat with artificial saliva
- Avoid sodium
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Dentifrices
- Removes dental plaque and stains
- Reduces dental caries and gum disease
- lessens mouth odor
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