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