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 sat_flash_1 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

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