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153 Cards in this Set
- Front
- Back
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Aspirin (ASA)
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acetylsalicylic acid (Bayer)
MOA: inhibition of peripheral COX 1 and 2 and therefore prostaglandin synthesis indications: mild to mod pain, inflammation, OA mild to mod fever (antipyretic) dosing: 650-1000mg q4-6 max: 4000mg/day |
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Safety concerns with aspirin
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gastrointestinal irritation: dyspepsia, epigastric pain, NV
potentiation of bleeding |
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ASA contraindications
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renal or hepatic dysfunction
history of any bleeding disorder gout warfarin alcohol pregnancy/lactation children |
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NSAIDs
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Ibuprofen(Advil, Motrin) and Naproxen(Aleve)
MOA: inhibition of peripheral COX and prostaglandin synthesis indication: mild-mod pain or fever, dysmenorrhea dosing: IBU 200-400mg q4-6h NAP 220mg q8-12 max: IBU 1200mg/day NAP 660mg/day |
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Safety concerns with NSAIDs
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dyspepsia, heartburn, anorexia, epigastric pain
GI effects kidney dysfunction aspirin intolerance cross-reactivity |
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NSAID contraindications
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high risk of cardiovascular event
alcohol warfarin antihypertensive 3rd trimester NAP < 12 Geriatrics |
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Acetaminophen (APAP)
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Tylenol
MOA: inhibits COX and prostaglandin synthesis in CNS (metabolized in liver) indications: analgesic and antipyretic (not anti-inflammatory) |
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APAP contraindications
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Warfarin
Alcohol use/liver disease |
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APAP safety concerns
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overdose/hepatotoxicity: potentially fatal
drowsiness, confusion, DNV, abdominal pain, liver failure |
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Tension Type Headache characteristics
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bilateral
diffuse, aching gradual onset mild-moderate may be caused by stress, anxiety, fatigue |
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Migraine Headache characteristics
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unilateral
throbbing, aura sudden onset moderate to severe women > men pre-menopausal more common triggers are specific to person, may include: stress, change in sleep, food, caffeine, alcohol, menses |
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Exclusions for self care of headache
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severe pain (worst pain of life)
> 10 days last trimester of pregnancy < 8 yrs old liver disease or > 2 drinks/day secondary headache migraine w/o formal diagnosis recent head trauma |
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first genereation antihistamines
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Brompheniramine, Chlorpheniramine, Dimenhydrinate, Diphenhydramine, Doxylamine
MOA: compete with histamine at histamine-1 receptors preventing histamine binding and subsequent mediator release cross blood brain barrier, anticholinergic effects indications: non-allergic rhinitis |
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second generation antihistamines
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loratadine, cetirizine
MOA: compete with histamine at histamine-1 receptor preventing histamine binding and subsequent mediator release do NOT cross blood brain barrier do NOT have anticholinergic effects non-drowsy |
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Level of sedation of 1st gen antihistamines
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Clemastine, Diphenhydramine, Doxylamine > Brompheniramine and Chlorpheniramine
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Precautions w/ antihistamines
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drowsiness
alcohol confusion and dementia in geriatrics paradoxical CNS in pediatrics anticholinergic effects lower respiratory tract disease (emphysema, chronic bronchitis) |
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contraindications with antihistamines
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acute asthma exacerbation, peptic ulcer, BPH, glaucoma,
MAOIs alcohol or CNS depressant |
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exclusions for self treatment of allergic rhinitis
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< 12 yrs old
pregnant or lactating symptoms of non-allergic rhinitis symptoms of otitis media, sinusititis, bronchititis or other infection symptoms of asthma, COPD, or lower respiratory disorder moderate to severe persistent symptoms or unresponsive to treatment severe or unacceptable side effects |
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pregnancy and lactation with allergic rhinitis
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pregnancy drug of choice is chlorpheniramine
lactation DOC- loratadine lactation- antihistamine contraindicated |
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Geriatrics with allergic rhinitis
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DOC: loratadine and intranasal cromolyn
first gen antihistamines have greater risk of anticholinergic effects and some experience paradoxical sedation |
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pediatrics with allergic rhinitis
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should not be given OTC cold products w/o physician supervision
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single vs. combination products for allergic rhinitis
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single products preferred
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allergic rhinitis
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systemic disease with prominent nasal symptoms
intermittent <4days/week or <4 weeks persistent >4days.week AND >4weeks mild- does not impair work or sleep moderate-severe: impairs work or sleep |
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complications with allergic rhinitis
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acute: sinusitis, otitis media
chronic: nasal polyps, sleep apnea, hyposmia |
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Decongestants for allergic rhinitis
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Nasal Cromolyn (Nasalcrom)
MOA: stabilizes mast cells, preventing release of mediators indications: prevention and treatment of allergic rhinitis dosing: 1 spray each nostril 3-6x/day must be > 5 yrs old usually only for geriatrics |
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common cold
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limited to upper respiratory tract
most common cause is rhinovirus symptoms include: sore throat, nasal congestion, post nasal drip, cough, headache/malaise/low grade fever |
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rhinovirus
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most common cause of common cold
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t/f
antibiotics can be given to treat the common cold |
false, anitbiotics are ineffective against viral infections
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oral (systemic) decongestants
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pseudoephedrine, phenylephrine
MOA: stimulate alpha-adrenergic receptors which causes vasoconstriciton and decreases congestion indication: sinus and nasal congestion, cough due to post nasal drip |
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pseudoephedrine
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Sudafed
oral decongestant dosing: 60mg q4-6h max: 240mg/day works longer and faster than phenylephrine |
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phenylephrine
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Sudafed PE
oral decongestant dosing: 10mg q4h max: 60mg/day |
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precautions for oral decongestants
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HTN
coronary heart disease ischemic heart disease diabetes mellitus elevated intraocular pressure (glaucoma) hyperthyroidism Benign Prostatic Hyperplasia (BPH) |
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topical (non-systemic) decongestants
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Oxymetazoline (Afrin), xylometazoline, phenylephrine
indications: nasal congestion only works quickly do not use for more than 3-5 days usually given when pt has pre-existing condition w/ only nasal congestion |
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precautions for topical decongestants
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rebound congestion (rhinitis medicamentosa)
nasal polyps |
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rebound congestion
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rhinitis medicamentosa
prolonged vasoconstriction from topical decongestatns causes vasodilation enhanced due to benzalkonium chloride preservative |
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duration of topical decongestants
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oxymetazoline is the longest acting and therefore preferred over others because of reduced risk of RM, less doses given
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drug interactions with decongestants
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MAOIs
tricyclic antidepressants (TCAs) methyldopa (BP med) |
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antihistamines for common cold
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first gen antihistamines can be given for the common cold
helps with runny nose and cough due to PND combination with decongestant helps reduce congestion, reduce fluid build up and dry up pt |
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systemic analgesics for common cold
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APAP preferred unless contraindicated
treat throat pain, aches and low grade fever |
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Antitussive
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dextromethorphan, diphenhydramine(low dose)
cough suppressant indication: dry, non-productive cough Delsym |
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Protussive
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guaifenesin
expectorant indication: productive cough helps loosen mucus so pt can cough it up Mucinex |
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when to refer for common cold
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symptoms have not improve in 7 days
symptoms worsen recurring cough after treatment |
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exclusions for self treatment of common cold
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fever >101.5°F (38.6°C)
chest pain shortness of breath underlying chronic cardiopulmonary diseases (asthma, COPD, CHF) AIDS or chronic immunosuppressant therapy frail patients of advanced age < 6 yrs old hypersensitivity to recommended OTC therapy pregnancy lactation |
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cough
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elicited by stimulation of sensory receptors in the larynx and trachea
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classification of cough
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acute: < 3 weeks
subacute: 3-8 weeks chronic: > 8 weeks productive: wet, exples secretions (mucous) non-productive: dry, hacking cough |
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treatment for different types of cough
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non-productive: use suppressant
productive: use expectorant to thin mucus post nasal drip: only first gen antihistamine (can add expectorant with phlegm) |
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exclusions for self treatment of cough
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thick yellow or green phlegm
fever > 101.5°F > 7 days inintended weight loss nighttime sweats hemoptysis foreign Aspiration side effects suggesting underlying disease states (COPD, asthma, emphysema) drug-associated cough developing of additional symptoms |
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fever
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not medical condition
defined as body temp higher than normal core temp of 100°F (37.8°C) regulated response by the hypothalamus in response to a pyrogen |
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hyperthermia
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malfunctioning of normal thermoregulatory process of hypothalamus
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hyperpyrexia
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body temp > 106°F typically results in mental and physical consequences
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pyrogen
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substance that causes fever
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antipyretics
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analgesics
usually IBU and APAP recent studies show IBU more effective but both recommended equally |
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IBU pediatric dosing
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5 mg/kg if < 102.5ºF
10 mg/kg if > 102.5ºF q6-8h max dose 40 mg/kg/day |
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APAP pediatric dosing
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10-15 mg/kg q4-6h
max of 5 doses/day suppositories available (FeverAll) infant drops= 80mg/0.8mL, 1 dropperful |
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exclusions for self treatment of fever
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> 6 months with rectal temp of ≥104ºF (40ºC)
< 6 months with rectal temp of ≥101ºF (38.3ºC) symptoms of infection risk for hyperthermia impaired oxygen utilization (COPD, HF) impaired immune function (cancer, HIV) Iipaired CNS function CNS damage (head trauma, stroke) history of febrile seizures or seizure disorder |
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max length of treatment for fever
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> 3 days of OTC treatment without improvement
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diarrhea
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abnormal increase in stool frequency or liquidity compared to normal
may be caused by infection, drug-induced, disease-induced, food intolerance/allergy |
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types of diarrhea
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osmotic
secretory exudative motor |
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non-pharmacological treatment for diarrhea
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oral rehydration therapy
dietary management (avoiding foods that cause diarrhea) preventative measures (washing hands, avoiding bacteria, etc) |
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Oral rehydration therapy
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Pedialyte, Enfalyte
MOA: promote intestinal sodium and water absorption recommended for mild to moderate dehydration usually contain sodium, potassium, chloride, and carbs (dextrose or fructose) |
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oral rehydration therapy dosing
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6 months - 5 yrs: 50-100mL/kg over 3-4 hrs then 10 mL/kg per event or < 10 kg: 60-120 mL per event > 10kg: 120-240 mL per event
max duration: 48 hrs > 5yrs: 2-4L over 3-4 hrs + replace for events, may use sports drink if > 6 yrs old |
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Loperamide
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Imodium A-D
MOA: synthetic opioid DOC for diarrhea if > 6 yrs old ADRs: dizziness, constipation, dry mouth, abdominal pain adult dosing: 4 mg onset, 2 mg after subsequent loose stool, max 8 mg/day pediatric dosing: 2 mg at onset, 1 mg each additional stool, max 6 mg/day |
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Bismuth Subsalicylate
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Pepto-Bismol, Kaopectate
MOA: anitmicrobial, antisecretory indication: traveler's diarrhea, nausea with indigestion, heartburn, gas caused by food/drink, ulcer treatment ADRs: darkening or tongue or stool, mild tinnitus dosing: 524 mg q30-60min max: 8 doses/day must be 16 yrs old |
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Lactase Enzyme
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Lactaid
MOA: enzyme replacement indication: prevent osmotic diarrhea due to lactose intolerance dosing: recommended with first bite of dairy |
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Probiotics
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Lactobacillus, Saccharomyces boulardii, L. acidophilus
MOA: friendly organisms replace/decrease bacteria and viruses in gut indications: antibiotic induced diarrhea ADRs: gas, bloating, GI upset NOT FDA APPROVED |
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exclusions for self treatment of diarrhea
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< 6 months of age
severe dehydration persistent high fever (>102.2˚ F) blood, mucus or pus in stool protracted vomiting pregnancy risk for significant complications DM, severe CVD or renal disease multiple chronic medical conditions immunosuppressed inability of caregiver to administer ORT suboptimal response to ORT |
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max time for self treatment of diarrhea
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72 hours then refer
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antihistamines for nausea/vomiting
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meclizine, diphenhydramine, cyclizine, dimenhydrinate, doxylamine
MOA: depress labyrinth excitability indication: motion sickness ADRs: drowsiness dosing: 30-60 mins prior to trip |
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antacids/anti-GERD for n/v
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antacids, H2RAs, PPIs
MOA: neutralize gastric acid, increase pH indication: N/V associated w/ food |
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phosphorated carbohydrate solution
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Emetrol
MOA:hyperosmolar solution acts directly on the GI tract wall to decrease gastric emptying time indication: N/V due to GI flu, food/drink indiscretions ADRs: hyperglycemia in diabetes dosing: 15-30 mL q15min max 1 hr or 5 doses/day |
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exclusions for self treatment for N/V in adults
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urine in ketones (diabetes)
severe suspected food poisoning severe abdominal pain w/ fever and/or diarrhea severe right upper quadrant pain, worsened by fatty foods signs of jaundice or meningitis recent head injury PHM, BPH, COPD or asthma pregnancy cancer treatment drug-induced chronic disease-induced (Gastroparesis, GERD) |
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exclusions for self treatment of N/V in children
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severe dehydration
stiff neck < 6 months or < 8 kg decreased urination lethargic vomiting after feeding repeat projectile vomiting vomiting > 8 hrs red, black or green vomit w/ diarrhea, fever, distented abdomen, or severe headache recent head injury suspected poisoning severe, acute abdominal pain |
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max self treatment time for vomiting
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48 hours then refer
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natural defense mechanism of the esophagus
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barriers to limit reflux (LES)
clearance via peristalsis saliva contains sodium bicarb which buffers the esophagus |
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natural defense mechanism of the stomach
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epithelial cells
mucosal blood flow prostaglandins |
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heartburn
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pyrosis
burning that arises from the substernal area (lower chest) and moves upward toward the throat or neck |
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4 types of heartburn
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postprandial: 2 hrs after eating
nocturnal: occurs during sleep and often awakes the individual simple: mild, infrequent, episodic and often associated with diet or lifestyle frequent: occurs 2 or more days/week |
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dyspepsia
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consistent or recurrent discomfort located primarily in the upper abdomen (epigastrum) characterized by bloating, belching, postprandial fullness, nausea and early satiety
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2 types of dyspepsia
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acute, infrequent: associated with food, alcohol, smoking or stress
chronic: associated with PUD, GERD, H. pylori, lack of identifiable cause |
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peptic ulcer disorder (PUD)
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gastric or duodenal ulcer caused mostly by H. pylori and/or NSAIDs
gnawing or burning epigastric pain, occurring during day and frequently at night; maybe accompanied by heartburn and dyspepsia |
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gastro-esophageal reflux disorder (GERD)
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reflux of gastric contents into the esophagus, causing symptoms and/or esophageal damage that interfere with quality of life
typical symptoms: heartburn, dyspepsia, regurgitation |
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GERD symptoms
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alarm symptoms: dysphagia (difficult swallowing), odynophagia (painful swallowing), chest pain, upper GI bleeding, unexplained weight loss, continuous N/V/D
atypical symptoms: noncardiac chest pain, hoarseness, cough, asthma, laryngitis, dental erosions (due to the acid), sleep apnea |
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antacids
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Gaviscon, TUMS, Rolaids, Mylanta, Maalox
MOA: direct neutralizaiton of acid, inhibits the conversion of pepsinogen into pepsin, may also increase LES pressure indications: mild, infrequent heartburn, sour stomach and acid indigestion |
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4 types of antacids and duration of relief
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aluminum hydroxide, calcium carbonate, sodium bicarbonate, and magnesium oxide
Al-hydroxide and Ca-carb longer than Na-bicarb and MgOH |
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antacid dosing
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begin with 40-80 mEq acid neutralizing capacity prn, then titrate to after meals and at bedtime
max: 600mEq/day do not take for more than 2 weeks |
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sodium bicarbonate antacids
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Alka-Seltzer
indication: short term relief of overeating or indigestion only completely absorbs into systemic circuit avoid in pt w/ CRF, CHF, HTN, cirrhosis, edema, sodium restricted diet may cause milk-alkali syndrome if taken w/ calcium |
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calcium-based antacids
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Rolaids, TUMS (calcium carbonate)
slow dissolution, but potent and prolonged neutralization ADRs: hypercalcemia, milk-alkali syndrome, constipation, benign acid rebound (after meals) only 500-600 mg can be absorped at one time |
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aluminum-based antacids
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Mylanta, Maalox (aluminum hydroxide/magnesium hydroxide/simethicone)
slowest dissolution, lowest ANC caution: CRF side effects: constipation, intestinal obstruction, hypophosphatemia |
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magnesium-based antacids
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Mylanta (Ca carbonate/ magnesium hydroxide), Dulcolax Milk of Magnesia (Magnesium hydroxide)
caution: CRF common side effects: diarrhea (dose related) severe side effects: cardiac arrhythmias, respiratory depression, hypotension, N/V, muscle paralysis decrease side effects by combining with aluminum products |
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alginic acid
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Gaviscon
mixed w/ antacid prepartions MOA: forms a barrier that floats on the top of the stomach, so when reflux occurs sodium alginate rather than acid is refluxed (does not neutralize acid) indications: GERD but not PUD |
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Bismuth Subsalicylate
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Maalox, Pepto, Kaopectate
MOA: possibly coat mucosal lining indications: nausea, heartburn, indigestion, upset stomach, diarrhea dosing: 2 tabs or tblsp after meals and at bedtime for no more than 14 days side effects: darkened stool, tongue avoid with CRF, aspirin allergy, pregnancy, children |
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Histamine-2 receptor antagonist (H2RA)
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Pepcid (famotidine), Zantac (ranitidine), Tagamet (cimetidine), Axid AR (nizatidine)
MOA: decrease gastric acid secretion by inhibiting histamine from binding to parietal cells indications: mild to moderate, infrequent, episodic heartburn and for prevention of heartburn associated with acid indigestion and sour stomach not approved for < 12 yrs old |
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H2RA dosing
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Pepcid AC (famotidine) 10-20 mg daily
Tagamet (cimetidine) 200-400 mg daily Zantac (ranitidine) 75-150 mg daily Axid AR (nizatidine) 75-150 mg daily take 30 min to 1 hr prior to event or meal max: twice a day, 2 weeks |
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side effects of H2RA
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headache
N/V C/D drowsiness ranitidine: darkened tongue/stool cimetidine: hair loss, impotence or gynecomastia in men |
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H2RA drug interactions
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cimetidine major: warfarin, theophylline, phenytoin
cimetidine minor: TCAs, benzodiazepines, beta-blockers, ca-channel blockers ranitidine: warfarin, phenytoin Nizatidine/famotidine: negligible, chose if pt on a lot of meds |
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proton pump inhibitors (PPIs)
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Prilosec OTC (omeprazole), Zegerid 24H (lansoprazole)
MOA: direct acid secretion suppression via proton pump inhibition indications: frequent heartbrun, NOT GERD, PUD dosing: 1 tab po before meals for 14 days onset: 2-3 hours but complete relief may take 1-4 days > 18 yrs old |
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PPI side effects and drug interactions
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side effects: diarrhea, constipation, abdominal pain, headache
drug interactions: warfarin, cyclosporines, benzodiazepines, phenytoin |
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geriatrics with heartburn
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refer unless side effects are related to overeating, spicy foods, or occasional reflux
DOC: H2RA (not cimetidine) or PPI stay away from Na-bicarb likely to have side effects with antacids |
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pediatrics with heartburn
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refer if < 12 yrs old
antacids commonly used but safety not established avoid BSS and H2RAs |
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pregnancy with heartburn
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DOC: antacids (other than Na-bicarb)
calcium preferred 1300mg/day do not exceed 2500mg/day refer before giving H2RAs or PPIs |
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lactation with pregnancy
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magnesium hydroxide, aluminum hydroxide, ranitidine, famotidine are preferred
insufficient evidence with PPIs, do not recommend |
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exclusions for self treatment of heartburn
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frequent heartburn > 3 months
H2RA or PPI not effective after 2 weeks worsening symptoms nocturnal heartburn difficulty or painful swallowing of solid foods vomiting blood chronic hoarseness, wheezing, coughing, or choking unexplained weight loss continuous D/N/V chest pain w/ sweating, paid radiating to shoulder, arm, neck or jaw, and shortness of breath children < 12 yrs old |
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causes of intestinal gas
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chronic disease: lactose intolerance, IBS
indigestible carbs fatty foods carbonated beverages/sweeteners antibiotics or other drug sources meds |
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simethicone
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Gas-X, Maalox, Mylicon drops, Gelusil
MOA: acts on the stomach and intestine to reduce surface tension of gas bubbles embedded in the mucus of the GI tract indications: anti-flatulence dosing: 1 tab prn pc or hs max: 500mg/day usually for gas associated with foods or unknown reason not systemically absorbed so no drug interactions may be given to children and infants |
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activated charcoal
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not approved or indicated for relief and treatment of intestinal gas
may promote relief DO NOT RECOMMEND |
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alpha-Galactosidase replacement
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Beano, Gaz Away
MOA: hydrolyzes carbs before they can be metabolized by bacteria in colon indications: anti-flatulence relate to foods with oligosaccharides (high fiber) dosing: with first bite of food caution may raise BG in diabetics |
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lactase replacement products
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Lactaid, Dairy Ease
MOA: lactase enzyme break down lactose to glucose and galactose, which are absorbed indications: lactose intolerance dosing: start with lowest dose and titrate to relief |
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probiotics
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align capsules, activia yogurt
indication: intestinal gas and bloating adequate trial of 14 days serious problems in pt with pancreatitis |
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exclusions for self treatment of intestinal gas
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symptoms persist for several months or are more than occasional
severe unbearable symptoms sudden change in location of abdominal pain significant increase in severity or frequency of symptoms or an onset of symptoms for individuals > 40 yrs old accompanied by sudden change in bowel movements w/ diarrhea, constipation, GI bleeding, fatigue, unintentional weight loss, or frequent nocturnal symptoms |
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dietary supplement
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any oral product (other than tobacco) intended to supplement the diet that contains: vitamins, minerals, herbals, botanicals, amino acids, enzymes, glands, metabolites, a dietary supplement to increase the total diet intake...
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t/f
the FDA can regulate effectivenes of dietary supplements |
false no one can
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t/f
FDA regulates marketing of dietary supplements |
false FTC
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t/f
dietary supplements do not have to prove effectivenss but just that they are not harmful. |
true
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misbranding
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improper labeling
claims to diagnose, treat, cure, or prevent disease enforced by FDA |
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potency
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amount of the drug needed to produce intended effect
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contamination
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also called adulteration
supplement contains wrong ingredients or unlabeled ingredients |
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hepatotoxic dietary supplements
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borage
kava kava |
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cardiotoxic dietary supplements
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bitter orange
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anticoagulation/antiplatelete dietary supplements
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feverfew
fish oil > 3g/day garlic ginkgo ginseng vitamin E |
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ragweed allergy dietary supplements
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echinacea
feverfew |
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other names for caffeine
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black tea
cocoa coffee green tea guarana kola nut yerba mate |
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black cohosh
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indications: menopausal symptoms
dosing: 20mg bid onset in ~4weeks safe up to 6 months side effects: GI, headache, dizziness not helpful for urogenital symptoms avoid if risk/history or hormone-sensitive cancer unsafe in pregnancy/lactation |
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fish oil
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fatty fish (salmon, mackerel, herring)
Omega-3 fatty acids indications: lower triglycerides side effects: GI (fishy burps, heartburn, loose stools)-taper up slowly > 3g/day may thin blood, reduce immune response Caution: not cod liver oil |
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ginkgo biloba
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indication: memory improvement, intermittent claudication
dosing: 120-240mg/day bid or tid, 12 weeks side effects: GI distress, headache, rare bleeding drug interactions: anticoagulant/antiplatelet not for diabetes, epilepsy or hemophilia |
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glucosamie/chondroitin
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indication: OA treatment not prevention
dosing: 1500mg glucosamine + 1200mg chondroitin onset: 6 weeks efficacy about the same as IBU but slower onset avoid in shellfish allergy |
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psyllium
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laxative
indication: lower cholesterol (LDL) dosing: 10-12g/day lowers LDL 5-10% safe for long term use minimize side effects by slowoly titrating up take with lots of water |
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st. john's wort
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indication: mild depression
dosing: 300mg tid side effects: sleep changes, GI upset MANY drug interactions- lowers levels of Rx drugs in body use sunscreen |
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cranberries
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used to prevent UTIs
side effects: diarrhea, kidney stones at >1L/day increase potential for bleeding w/ warfarin |
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echinacea
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used to stimulate immune system
start asap when symptoms occur use for 7-10 days to max of 8 weeks doesnt prevent may decrease severity/duration side effects: mild GI distress contraindications: ragweed allergy, allergic rhinitis, HIV/autoimmune disorders |
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ginger
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used for nausea
1-2g/day powder form efficacy: pregnancy related N/V not helpful for motion sickness side effects: heartburn theoretically may interact with warfarin |
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ginseng
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many different types
900 mg po tid aided erectile dysfunction hypoglycemic effects unsafe for > 3 months caution in diabetes and cardiac conditions |
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melatonin
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used in insomnia
3mg (0.5-5mg) po qhs for jet lag take at target bedtime and continue for 2-5 days mixed results for effectiveness side effects: sadness, headache, N/V, paradoxical excitement caution in pregnancy, epilepsy, and kids interactions: procardia XL less effective, excessive sedation w/ fluvoxamine, increased bleeding with warfarin/aspirin |
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SAMe
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s-adenosyl-methionine
used for OA, depression, more 400-1600 mg/day OA: same as IBU but longer onset depression: same as TCAs side effects: mild GI theoretically interact with antidepressants theoretically could worsen Parkinson's disease |
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saw palmetto
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used for BPH
160 mg bid, 1-2 months for full effect take w/ food similar to finasteride side effects: N/V/D, sexual dysfunction < beta-blockers |
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valerian
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used for insomnia
400-900mg .5-1 hour before bed full effect at 4 weeks no hangover effect side effects: headache, paradoxical excitement, rare cardiac disturbances case report: benzo-like W/D not in pregnancy additive sedation with hypnotics |
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vitamins
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nutrients containing carbon required by human in microamounts
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fat soluble vitamins
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vitamin ADEK
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vitamin A
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use: required for reproduction and embryonic development, bone, teeth formation
deficiency: rare, but causes blindness worldwide toxicity: birth defects, liver abnormalities, bone fractures |
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vitamin D
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hormone and vitamin
uses: stimulate bone reabsorption, needed for bone formation deficiency: rickets, osteomalacia, osteoporosis made in skin after sun exposure |
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vitamin E
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tocopherols
uses: antioxidant in cell membranes most adults do not get enough in diet contraindicated with vitamin K high dose may interact with warfarin |
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vitamin K
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uses: coagulation (clotting) cascade
deficiency: malaborption syndromes, liver disease |
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water soluble vitamins
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vitamin B and C
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vitamin C
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ascorbic acid
uses: immune system functions? require for nonheme iron aborption antioxidant activity, decrease risk of atherosclerosis deficiency: scurvy toxicity: osmotic diarrhea, nephrolithiasis, gout, iron toxicity |
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vitamin B1
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thiamine
coenzyme: catalyze key biochemical rxns intestinal aborption limited severe deficiency: beri-beri |
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vitamin B2
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riboflavin
redox metabolic process essential for cellular growth, maintenance of vision, skin, nails, and hair supplementation may turn urine bright yellow |
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vitamin B3
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niacin or nicotinic acid
lipid metabolism, tissue reproduction, glycogenolysis lower triglycerides and raise HDL used to treat hyperlipidemia and hypertriglyceridemia |
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vitamin B6
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pyridoxine
protein metabolism, rbc metabolism, and immune system function toxicity: severe sensory neuropathy, inhibit prolactin drug interactions: decrease phenytoin, phenobarbital, levodopa |
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vitamin B12
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colbalamin or cyanocobalamin
maintaining folate concentrations intrinsic factor needed in stomach for absorption deficiency unlikely w/ exception: strict vegetarian or decreased absorption from intrinsic factor deficiency may cause anemia, must understand the cause prior to treatment |
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folic acid
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essential during growth periods and pregnancy
deficiency during pregnancy causes increased risk of neural tube birth defects and spontaneous abortion CDC recommends all women of childbearing age take 400mcg supplement 1 mg during pregnancy |
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calcium
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bone health and cardiovascular/nerve conduction
may decrease PMS symptoms and risk of colorectal cancer avoid oyster-shell, dolomite, or bone meal b/c of possible arsenic big pills- choose chewables side effects: gas, bloating, constipation |
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calcium and osteoporosis
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calcium and vit D should be given with all OP meds
1000mg elemental calcium daily max intake 500-600mg at a time do not exceed 1800mg/day |
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percent calcium in carbonate, citrate and lactate
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calcium carbonate 40%
calcium citrate 21% calcium lactate 13% |
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iron
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responsible for oxygenating red blood cells and making hemoglobin
toxicity: alcohol, poisoning in children- FATAL deficiency: anemia salts absorb better absorption: enteric coating decreases absorption, increased absorption with vitamin C ADRs: constipation, darkened stool drug interaction: fluoroquinolones, tetracyclines, excessive zinc or vitamin E |
