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OTC Final
PHAR 169 Final
| Question | Answer |
|---|---|
| Megadoses of vitamins and which are toxic at high doses | CLAIMS NOT SUBSTANTIATED! Vit A, D, niacin, pyridoxine (B6), iron, fluoride |
| DRI | Daily Recommended Intake, replaces RDA. Reference value for daily nutrient intake. |
| Tolerable UL | Highest dose safe to consume in general public |
| 10 Requirements on Supplemental Facts Label | 1.Name &"supplement" 2.Net quantity 3.%DV 4.ServingSize 5.Servings/container 6.Directions 7.List all required nutrients present in sign amts 8.List dietary ingred where %DV not established 9.Name of mfr, place of business 10.Approved by FDA: Disclaimer |
| When is a supplement facts label MISBRANDED | Failure to follow the 10 requirements |
| Disclaimer on supplement facts label | "this statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent disease." |
| Dosing of fat soluble vitamins (ADEK) | 50-150% of DRI. Caution if >200% |
| Conditions causing deficiency of vitADEK | Celiac, CF, jaundice, cirrhosis, short-bowel syndrome |
| Meds causing malabsorption of vitADEK | Cholestyramine, orlistat, mineral oil |
| Class of compounds vit A is included in | Retinoids, carotenoids (beta-carotene) |
| Food sources of Vit A | Dark green leafy veggies; red, orange, or deep yellow veggies & fruits; meat, poultry, fish, dairy |
| Function of Vit A | Normal vision, immune system, reproduction |
| Deficiency of vit A | night blindness (xerophthalmia), dry & thickened skin |
| DRI of Vit A | Measured in RAE; adult average= 700-900 mcg/day |
| UL of Vit A | 3 mg/day |
| Safety issues of vit A | High intake may increase risk of bone fractures. Acute toxicity=DZ, N, HA, coma. >UL teratogenic. Increase lung cancer in male smokers, increase CV risk |
| Food sources of vit D | Fortified foods. Milk, milk products, fatty fish |
| Function of vit D | Hormone and vitamin. Proper bone formation, mineral homeostasis, muscle function, immune system |
| Deficiency of vitamin D | Rickets, bone fractures, osteopenia, ostemalacia |
| DRI of vitamin D | 600-800 IU/day (15-20 mcg/day) |
| UL of vitamin D | 0.1 mg/day |
| Safety issues of vitamin D | Hypercalcemia, kidney stones, soft tissue calcification, N/V, anorexia, weight loss, confusion, disorientation, cardiac arrhythmias, increase cancer risk |
| Vitamin D Drug interactions | corticosteroids, cholestyramine, orlistat, phenobarb, phenytoin |
| Food sources of vitamin E | Vegetable oils, margarine, green leafy vegetables, egg yolks, nuts |
| Function of vitamin E | (Tocopherols) Antioxidant, heme biosynthesis, steroid metabolism, collagen, immune system |
| Deficiency of vitamin E | neuropathy, muscle weakness |
| DRI of vitamin E | 15 mg (22.14 IU) |
| UL of vitamin E | ~1000 IU/day |
| Safety issues of vitamin E | High dose increase risk of bleeding. May increase risk of prostate cancer |
| DI of vitamin E | Increase bleeding risk with warfarin and antiplatelet drugs |
| Food sources of vitamin K | Dark green vegetables, other vegetables, dark berries, fish, liver, meat, eggs, cereals |
| Function of vitamin K | Promotes hepatic synthesis of clotting factors (II, VII, IX, X), bone health |
| Deficiency of vitamin K | Bruising, bleeding |
| DRI of vitamin K | 90-120 mcg/day |
| UL of vitamin K | Not established |
| Safety issues of vitamin K | Problems in dialysis patients, avoid high doses if pregnant or lactating. |
| DI of vitamin K | Counters effects of warfarin (increase risk of clots). CoQ-10 (promote clotting) |
| B3 | Niacin/nicotinic acid |
| Food sources of vitamin B3 | fish, poultry, meat, eggs, nuts, fortified breads and cereals |
| Function of vitamin B3 | Convert carbs into fuels, support healthy skin, hair, eyes, liver, nervous system, sex and stress hormones |
| Deficiency of vitamin B3 | Burning mouth, swollen bright-red tongue. Pellegra= cracked skin, diarrhea, dementia |
| DRI of vitamin B3 | ~14-16 mg/day |
| UL of vitamin B3 | 35 mg/day |
| Safety issues of vitamin B3 | "Niacin flush" with higher doses. Hepatotoxicity (SR, higher doses). Avoid if liver or kidney disease, CV conditions, DM, gallbladder dx, gout |
| Vitamin B6 | Pyridoxine |
| Food source of vitamin B6 | Fruit |
| Function of vitamin B6 | fetal and brain development, immune function, used for N/V of pregnancy |
| Deficiency of vitamin B6 | itchy rashes, anemia, swollen tongue, depression, confusion |
| DRI of vitamin B6 | 1.7-1.9 mg/day |
| UL of vitamin B6 | 100 mg/day |
| Safety issues of vitamin B6 | High dose and long duration = nerve damage, skin reactions |
| Vitamin C | Ascorbic acid |
| Food sources of vitamin C | citrus fruits, other fruits/vegetables, fortified foods |
| Function of vitamin C | Antioxidant, collagen for wound healing, immune system, increase iron absorption from plants |
| Deficiency of vitamin C | Scurvy |
| DRI of vitamin C | 75-90 mg/day |
| UL of vitamin C | 2000 mg/day |
| Safety issues of vitamin C | N/V/D, stomach cramps |
| Food sources of folate | SPINACH, ASPARAGUS, BRUSSEL SPROUTS, vegetables, fruits, nuts, dairy, fortified cereals and grains |
| Function of folate | Co-enzyme for homocysteine->methionine, RBC function |
| Deficiency of folate | Megaloblastic anemia, fetal risk NEURAL TUBE DEFECTS |
| DRI of folate | ~400mcg/day (pregnant women need 600 mcg/day) |
| UL of folate | 1 mg/day |
| Safety issues of folate | Excess use may increase risk of cancers |
| Food sources of vitamin B12 | NOT IN PLANTS!! fish, meat, poultry, eggs, dairy, breakfast cereals |
| Function of vitamin B12 | Prevents megaloblastic anemia |
| Deficiency of vitamin B12 | Fatigue, weakness, constipation, nerve problems, anemia, CNS |
| DRI of vitamin B12 | 2.4 mcg/day |
| UL of vitamin B12 | Not established |
| Safety issues of vitamin B12 | Avoid high folate doses or masks B12 deficiency |
| 3 Main categories of anemia | 1. Decreased production of RBC's 2. Increased destruction of RBCs (hemolytic anemia) 3. Blood loss (ex GI bleed) |
| 2 main causes of iron deficiency anemia | Inadequate absorption of dietary iron, excess blood loss |
| General symptoms of anemia (NONSPECIFIC) | Fatigue, lethargy, DZ, SOB, HA, edema, tachycardia |
| FDA permitted claims | health claim, nutrient content claim, structure/function claim (CAN'T MENTION SPECIFIC DISEASE) |
| Weight loss supplements to avoid | HCG, green coffee beans, green tea, acai berry, raspberry ketone |
| Avoid using supplements in: | pregnant/lactating, young children, multiple chronic illness/high "med burden", immune suppressed, organ failure, increased bleeding risk with "G" supplements especially |
| "G" supplements to especially avoid in patients on warfarin or antiplatelet drugs | Garlic, ginseng, ginkgo, grapeseed |
| Common use of alpha-lipoic acid | diabetic peripheral neuropathy |
| proposed mechanism for alpha-lipoic acid | cofactor for enzymes needed for glucose metabolism |
| Side effects of alpha-lipoid acid | HA, N, allergic rash, hypoglycemia |
| CI of alpha-lipoic acid | thyroid disease |
| Common use of asian ginseng | decrease fatigue, increase concentration, prevent cancer |
| proposed mechanism of asian ginseng | suppress and stimulate CNS, corticosteroid activity, hypoglycemic activity |
| SE of asian ginseng | insomnia, HA, BP changes, anorexia, rash, menstrual abnormalities |
| CI of asian ginseng | Renal failure, acute infection, pregnancy and lactation |
| Precautions of asian ginseng | CV disease, HTN, DM |
| Interactions of asian ginseng | Anticoags, antiplatelets, other herbs, stimulants, antipsychotics |
| common uses of coenzyme Q10 (ubiquinone) | CV conditions |
| proposed mechanisms of coenzyme Q10 (ubiquinone) | cofactor for energy production and antioxidant, vasodilator, inotropic effects |
| SE of coenzyme Q10 (ubiquinone) | GI, HA, irritability, DZ |
| Interactions of coenzyme Q10 (ubiquinone) | Similar to vitK--counteracts effect of warfarin, statin reduce levels |
| Common uses of echinacea purpurea | prevent URIs and prevent/treat common cold |
| Proposed mechanism of echinacea purpurea | stimulates immune system |
| SE of echinacea purpurea | GI discomfort, tingling sensation of tongue, HA |
| CI of echinacea purpurea | HIV/AIDS, MS, TB, autoimmune disorder |
| Precautions of echinacea purpurea | allergic reactions especially asthma, allergies to daisy familiy |
| DI of echinacea purpurea | induces cyp3A4 |
| Common use of fish oil | lower TGIs, RA, psoriasis |
| proposed mechanism of fish oil | omega-3 FA (DHA and EPA) |
| SE of fish oil | GI, fish burp |
| CI of fish oil | Active bleeding |
| Precautions of fish oil | Potential increase risk of bleeding if on antiplatelet meds |
| Interactions of fish oil | antiplatelet meds |
| Common uses of garlic | lower cholesterol, treat bacterial and fungal infections |
| proposed mechanisms of garlic | inhibit platelet aggregation, antimicrobial, free radical scavener |
| SE of garlic | bad breath, Gi, dermatitis, allergic rxn |
| Ci of garlic | active bleeding |
| DI of garlic | anticoags, antiplatelets, squinavir decrease levels |
| Common uses of ginger | antiemetic, digestive aid |
| proposed mechanisms of ginger | stimulates gastric secretions and peristalsis |
| SE of ginger | heartburn, dermatitis |
| Precautions of ginger | increase risk of hypoglycemia |
| Di of ginger | increase risk of bleeding on anticoags and antiplatelets |
| Common uses of ginkgo biloba | enhance memory, vascular dementia |
| proposed mechanism of ginkgo biloba | increased bf, antioxidant, inhibits platelet aggregation |
| SE of ginkgo biloba | GI, spontaneous bleeding |
| CI of ginkgo biloba | active bleeding, surgery within next week |
| DI of ginkgo biloba | antiplatelets, anticoags, other antiplatlet herbs |
| Common uses of glucosamine | DJD of knee, arthritic pain |
| proposed mechanisms of glucosamine | precursor to glycosaminoglycans in cartilage |
| SE of glucosamine | mild Gi |
| CI of glucosamine | shellfish allergy, active bleeding |
| DI of glucosamine | antithrombics, antihyperglycemics |
| Common uses of green tea | decrease CV disease and cancer, performance enhancer |
| proposed mechanisms of green tea | caffeine as stimulant, antioxidants |
| SE of green tea | GI, CNS and CV stimulation |
| Precaution green tea | conditions affected by caffeine |
| DI of green tea | Coumadin? (brewing destroys most of vitamin K) |
| Common uses of kava | anxiety, stress |
| proposed mechanisms of kava | GABA receptor binding, DA antagonist |
| SE of kava | similar to alcohol |
| CI of kava | pre-existing hepatic disease, alcoholism |
| Precautions of kava | stem and root can lead to hepatotoxicity |
| DI of kava | L-dopa: decrease effectiveness. CNS depressants-additive sedative effects |
| common uses of melatonin | sleep disorders, jet lag |
| proposed mechanism of melatonin | mimic endogenous release of melatonin from pineal gladn |
| SE of melatonin | HA, confusion |
| CI of melatonin | depression |
| Precaution of melatonin | Long term use NOT recommended |
| DI of melatonin | other CNS depressants-additive |
| Common use of probiotics | antibiotic induced diarrhea, GI disorders, atopic dermatitis, allergies |
| proposed mechanism of probiotics | contain active bacteria, rebalance gut flora |
| SE of probiotics | Bloating, flatulence, diarrhea |
| CI of probiotics | avoid if immune-compromised |
| DI of probiotics | may decrease antibiotic absorption, separate by several hours |
| Common uses of saw palmetto | symptoms of BPH |
| proposed mechanisms of saw palmetto | inhibits 5alpha-reductase and DHT binding to androgen receptors |
| SE of saw palmetto | GI, HA, urine retention, dysuria, impotence |
| Precautions of saw palmetto | discuss with provider to R/O prostate cancer before using |
| Common uses of St. John's wort | mild to moderate depression, anxiety |
| Proposed mechanisms of St. John's wort | inhibit monoamine reuptake, decrease IL-6 |
| SE of St. John's wort | Mild Gi, fatigue, insomnia, dry mouth, photosensitivity |
| CI of St. John's wort | Severe depression, HIV/AIDs |
| DI of St. John's wort | Induces CYP3A4 and reduces effect of: warfarin |
Created by:
steponmegrace
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