Dietary Supplements

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giddyupp
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47522
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Dietary Supplements
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2011-01-13 12:20:24
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Dietary Supplements PHPR522
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Dietary Supplements
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  1. What did the Dietary Supplement Health and Education Act of 1994 do?
    • provided a definition of dietary supplement: a product intended to supplement the diet through ingestion of a pill, capsule, tablet, or liquid that is not considered a food or a drug.
    • required "....not evaluated by the FDA. lllnot intended to diagnose, treat, cure, or prevent...." to be on the label
    • only requires removal of a product when it's hazardous
    • created the office of dietary supplements
    • limited claims to structure/function, no claims of efficacy
  2. What OTC claims are allowed as structure/function claims?
    • antacid
    • antigas
    • laxative
    • stool softener
    • stimulant
    • nighttime sleep-aid
  3. What are the advantages of dietary supplements?
    • patient autonomy
    • patient use
    • cheaper than prescription meds
    • faster to market
  4. What are the disadvantages of dietary supplements?
    • may be ineffective
    • may not be safe
    • amount of active ingredient not regulated
    • fear of legal liability
    • lack of reputable manufacturers
    • absence of FDA approval
    • difficulty identifying product content
    • too many to work with
  5. Which dietary supplements have been deemed unsafe?
    • Borage
    • Calamus
    • Coltsfoot
    • Comfrey
    • Life root
    • Sassafras
    • Butterbur
    • Chaparral
    • Germander
    • Pennyroyal oil
    • Heliotrope
    • Comfrey
    • Kava
    • Licorice
    • Ma Huang
    • Pokeroot
    • Willow bark
    • Jin Bu Huan
    • Stephania
    • Magnolia
    • Lobelia
    • L-tryptophan
    • Phenylalanine
    • Yohimbe
    • Aconite
    • Bitter Orange
    • Colloidal Silver
    • Coltsfoot
    • Country Mallow
    • Greater Celadine
  6. What did the June 2007 Good Manufacturing Practices ruling do?
    • required identity, purity, strength, and composition
    • plants must be designed and contructed in a way that facilitates maintenance
    • plants must be clean
    • plants must use proper manufacturing operations
    • quality control procedures must be in place
    • final product, incoming, and in-process materials must be tested
    • consumer complaints must be handled
    • records must be maintained
  7. What are the limitation trends in dietary supplement studies?
    • several ingredients studied
    • lack of standardization
    • adulterated or misbranded
    • foreign language only
    • small sample size
    • poorly defined inclusion/exclusion
    • short study durations (usually 1-2 wks)
  8. What is black cohosh used for?
    • premenstrual symptoms
    • painful menstruation
    • hot flashes
  9. What are the CI/precautions for black cohosh?
    • pregnancy
    • no more than 6 mo use
    • liver disease
  10. What are the drug interactions for black cohosh?
    • cisplatin (decreased)
    • 2D6 drugs
  11. What is cranberry used for?
    recurrent urinary tract infections
  12. What are the CI/precautions for cranberry?
    • BPH
    • urinary obstruction
    • nephrolithiasis
    • allergies/asthma (high salicylic acid content)
    • GERD/ulcers
    • d/c 2wks prior to surgery
  13. What are the drug interactions of cranberry?
    • B12 absorption (increased - but not really an issue)
    • warfarin (increased INR through 2C9 interactions AND salicylic acid aspirin effects)
    • 2C9 drugs (warfarin and phenytoin)
  14. What are the SE associated with cranberry?
    • NVD
    • nephrolithiasis (salycilic acid content)
  15. What are the SE associated with black cohosh?
    • intestinal problems
    • wt gain
    • nausea
    • liver toxicity (monitor LFTs)
    • autoimmune hepatitis
    • dizziness, HA, stiffness, and trembling limbs at high doses
    • no increase in endometrial hyperplasia
  16. What is echinacea used for?
    strengthens resistance to upper respiratory tract infections
  17. What are the CI/precautions for echinacea?
    • TB
    • leukosis
    • collagenosis
    • MS
    • AIDS
    • HIV
    • autoimmune diseases (theoretical)
    • allergies to ragweed
    • 8 wk maximum use
    • asthma (exacerbated one attack)
  18. What are the DIs associated with echinacea?
    • immunosuppressants
    • 1A2 drugs
    • 3A4 drugs
  19. What are the SE associated with echinacea?
    • N,V
    • allergic rxns (anaphylaxis, angioedema, urticaria)
    • acute asthma
    • leukopenia
    • decreased male fertility
  20. What is feverfew used for?
    prophylaxis of migraines
  21. What are the CI/precautions of feverfew?
    • pregnancy, lactation
    • children
  22. What are the DI of feverfew?
    • anticoagulants
    • 1A2, 2C9, 2C19, 3A4 drugs
  23. What are the SE of feverfew?
    • mucosal and gastric irritation
    • "post-feverfew syndrome" (anxiety, HA, insomnia, muscle and joint stiffness)
  24. What is fish oil supposedly useful for?
    • HTN
    • hyperlipidemia
    • bipolar
    • psychosis
    • depression
    • anticoagulant
    • coronary heart disease
    • stroke
  25. What are the CI/precautions for fish oil?
    • seafood allergy
    • bipolar
    • bleeding
    • cardiac disease
    • depression
    • DM
    • HTN
    • immunodeficiency
  26. What are the DI of fish oil?
    • anticoagulants/antiplatelets/thrombolytics
    • antihypertensives
    • xenical, Alli, Orlistat
  27. What are the SE of fish oil?
    • bleeding
    • bruising
    • nosebleeds
    • hypervitaminosis A and D
    • rash
    • dyspepsia
    • burping
    • NVD
    • halitosis
    • taste perversion
  28. What is flaxseed supposedly good for?
    • constipation
    • diarrhea
    • diabetes
    • menopause
    • HTN
    • hyperlipidemia
    • CAD
  29. What are the DI of flaxseed?
    • anticoagulants
    • antidiabetic agents
    • estrogens
    • decreased absorption of oral drugs
  30. What are the SE of flaxseed?
    • bloating
    • flatulence
    • abdominal pain
    • diarrhea
    • constipation
    • dyspepsia
    • nausea
  31. What is garlic used for?
    • hyperlipoproteinemia
    • arteriosclerosis
  32. What are the CI/precautions for garlic?
    • diabetes (increases insulin)
    • pregnancy/lactation
    • children
    • peptic ulcers
    • GERD
    • d/c 2 wks prior to surgery
  33. What are the DI of garlic?
    • anticoagulants
    • protease inhibitors (decreased)
    • NNRTI (decreased)
    • 2D6, 2C9, 2C19, 2E1, 3A4 drugs
    • increases Amp B activity against cryptococcus neoformans
    • diabetic agents
    • doxorubicin, APAP, methotrexate, fluorouracil toxicity protected against
  34. What are the SE of garlic?
    • GI discomfort
    • sweating
    • dizziness/lightheadedness
    • allergic rxns (anaphylaxis and urticaria)
    • bleeding
    • menorragia
  35. What is horse chestnut seed used for?
    • venous conditions
    • eczema
    • leg pains
    • hemorrhoids
    • phlebitis
    • menstruation
  36. What are the CI of horse chestnut seed?
    • nephropathy
    • liver injury
    • children
    • pregnancy/lactation
    • diabetes
    • GI irritation
    • latex allergy
  37. What are the DI of horse chestnut seed?
    • anticoagulants/antiplatelets (theoretical)
    • antidiabetic drugs
    • Li (theoretical)
  38. What are the SE of horse chestnut seed?
    • GI irritation
    • pruritis
    • giddiness
    • HA
    • toxic nephropathy
    • bleeding/bruising
  39. What is ginkgo used for?
    • cerebral circulatory disturbances
    • peripheral arterial circulatory disturbances
  40. What are the CI of gingko?
    • epilepsy
    • bleeding disorders
    • diabetes
    • infertility
  41. What are the DI of ginkgo?
    • antiplatelets
    • NSAIDS
    • warfarin
    • aminoglycosides
    • thiazide (increases BP)
    • trazadone
    • seizure threshold lowering drugs
    • anticonvulsants
    • antidiabetic drugs
    • 1A2, 2C19, 2C9, 2D6, 3A4
  42. What are the SE of ginkgo?
    • GI disturbances
    • HA
    • dizziness
    • allergic skin rxns
    • bleeding
    • seizures and unconsciousness
    • death
  43. What is the best ginseng available?
    asian ginseng (also chinese, korean, oriental by name)
  44. What is ginseng used for?
    • adaptogen - for increasing resistance to environmental stress
    • lassitude and debility
    • lack of energy
    • inability to concentrate
    • convalescence
  45. What are the CI for ginseng?
    • HTN
    • emotional and psychological imbalances
    • HA
    • palpitations
    • insomnia
    • inflammation
    • infection
    • pregnancy/lactation
    • children
    • Hx of bleeding
    • d/c 2 wks prior to surgery
    • diabetes
    • schizophrenia
  46. What are the DI of ginseng?
    • hormonal tx
    • antihypertensives
    • cardiac meds
    • asthma meds
    • 2D6
    • immunosuppressants
  47. What are the SE of ginseng?
    • diffuse mammary nodularity
    • vaginal bleeding
    • gynecomastia
    • HTN
    • hypglycemia
    • nervousness/excitation
    • insomnia
    • inability to concentrate
    • palpitations
    • diarrhea
  48. What is milk thistle used for ?
    • chronic inflammatory liver conditions
    • cirrhosis
  49. What are the CI of milk thistle?
    • pregnancy
    • allergy to ragweed, chryanthemums
    • hormone sensitive cancers
  50. What are the DI of milk thistle?
    2C9 and 3A4
  51. What are the SE of milk thistle?
    • nausea
    • diarrhea
    • dyspepsia
    • flatulence
    • allergic rxns
    • rash
  52. What is saw palmetto used for?
    BPH
  53. What are the CI of saw palmetto?
    • pregnancy
    • children
    • d/c 2 wks before surgery
  54. What are the DI of saw palmetto?
    • anticoagulants
    • contraceptive drugs
    • HRT
  55. What are the SE of saw palmetto?
    • intraoperative hemorrhage
    • HA
    • stomach upset
    • acute hepatitis and pancreatitis
  56. What is St. John's wort used for?
    • anxiety
    • depression
  57. What are the CI of St. John's wort?
    • fair-skinned
    • pregnancy/lactation
    • psychiatric conditions
    • alzheimer's
    • hypothyroidism
    • anesthesia
    • d/c 2 wks before surgery
    • infertility
  58. What are the DI of St. John's wort?
    • antidepressants
    • anti-retrovirals
    • clopidogrel (increased efficacy)
    • 1A2, 2C9, 2C19, 3A4
  59. What are the SE of St. John's wort?
    • photodermatitis/phototoxicity
    • nausea
    • constipation
    • GI distress
    • allergic rxns
    • tiredness
    • restlessness
    • sleep disturbances
    • mania or hypomania
    • elevated TSH
    • elevated BP
    • male/female infertility
  60. What is coenzyme Q supposedly used for?
    • CHF
    • HTN
    • stable angina
    • ventricular arrhythmias
    • cancer
    • heart surgery
    • periodontal disease
  61. What are the CI for coenzyme Q?
    • biliary obstruction
    • DM
    • hepatic insufficiency
    • renal insufficiency
    • HTN
    • hypotension
  62. What are the DI of coenzyme Q?
    • statins may lower Coenzyme Q levels
    • oral hypoglycemic agents
    • doxorubicin toxicity increased
    • antihypertensive agents
    • warfarin (coenzyme Q is related to vitK K)
  63. What are the SE of coenzyme Q?
    • rash
    • GI disturbances
    • elevations in LFT

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