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170 Cards in this Set
- Front
- Back
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What is Vitamin B12
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It is a water-soluble co-enzyme with the name cyanocobalamin
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What is the function of Vitamin B12
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bone marrow, CNS, macronutrient and folate metabolism, GI tract cell division,
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What are sources of Vitamin B12
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meat, poultry, fortified cereals
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What are deficiencies of Vitamin B12
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megaloblastic anemia, neurologic damage (tingling of hands and feet), GI lesions
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What is the toxicity of Vitamin B12
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none likely
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What is the therapeutic use of Vitamin B12
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pernicious anemia
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What are the ADR's of Vitamin B12
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well tolerated
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What are the interactions of Vitamin B12
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metformin, colchicine, vitamin C, proton-pump inhibitors, H2 antagonists: decrease B12 absorption
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Who needs to take vitamin B12 supplements
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vegans, gastric bypass patients, patients >50
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What is DRI
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dietary reference intake. indicates daily intake necessary
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What is RDA
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recommended dietary allowance (replaced by DRI)
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What is RDI
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reference daily intakes (reflect increase knowledge of nutrients and role in previous disease)
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What is EAR
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intake level at 50% of healthy population. gender and age dependent
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What is AI
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adequate intake (if not enough info for EAR)
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What is UL
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tolerable upper intake level (max daily limit of a nutrient that is unlikely to pose adverse health risks for most people)
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What is DV
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daily value (ages 4 and up) based on DRI values.
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What is vitamin A
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fat-soluble, antioxidant (retinol, retinal, retinoic acid)
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Where is vitamin A stored
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in the liver
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What is the function of vitamin A
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vision, epithelial difference, embryonic development
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What are the sources of vitamin A
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liver, kidney, egg yolk, butter, beta cerotene- mostly found in green leafy vegetables
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What are deficiencies of vitamin A
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Xeropthalmia, night blindness
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What is the toxicity of vitamin A
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can occur when > 33,000 - 660,000 iu
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What are 3 forms of vitamin A
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retinols, beta carotene, carotenoids
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What are 2 major roles of vitamin A in the eyes
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preventing Xerophthalmia (corneal and conjuctival) and phototransduction
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What are ADR's for vitamin A
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hepatoxicity, teratogenicity, headache, N/V, diplopia
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What are drug interactions of vitamin A
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warfarin: increase anticoagulation
cholestyramin, orlistat, mineral oil: decrease vitamin A absorption |
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What is the UL of vitamin A
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3mg
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What is the RDI/RDA of vitamin A
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800 to 1000 mcg of retinol
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What should you avoid of taking vitamin A
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smoking- increases risk of lung cancer
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What is vitamin B1
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water- soluble, co-enzyme (thiamine)
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What is the function of vitamin B1
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carbohydrate metabolism myocardial/nerve cell function
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What are sources of vitamin B1
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beef, legumes, whole grains
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What are deficiencies of vitamin B1
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wet or dry beriberi
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What is the toxicity of vitamin B1
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unlikely when ingested orally because the excess is quickly cleared by kidney.
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what is the therapeutic use of vitamin B1
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metabolic disorders, alcoholism, and benefit with cardiac disease for people taking diuretics
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what are ADR's for vitamin B1
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well tolerated
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What are interactions of vitamin B1
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none significant
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What is the RDI/RDA
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1 to 1&1/2 mg
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What is the initial treatment with vitamin B1
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50 to 100 mg IV or IM daily for 3 days then po
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What is vitamin B2
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water soluble, co-enzyme (riboflavin)
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What is the function of vitamin B2
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vision, mucous membranes, skin, nails, hair
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What is the deficiency of vitamin B2
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vision changes, eye irritation
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What is the toxicity of vitamin B2
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not likely
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What is the RDI/RDA
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1.1 to 1.3 mg
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What is the therapeutic use of vitamin B2
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migraine prevention? reverses lactic acidosis caused b zidovidene and stavudine.
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What are the ADR's of vitamin B2
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well tolerated, bright yellow-orange urine
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What are the interactions of vitamin B2
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none significant
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What is the UL of vitamin B2
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none set
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What is vitamin B3
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water soluble, co-enzyme (niacin)
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what is the function of vitamin B3
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energy metabolism (lipid)
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what are the sources of vitamin B3
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meat, fish, poultry, enriched grains, tryptophan
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what is the deficiency of vitamin B3
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pellagra (rare, mostly in alcoholics)
dermatitis, diarrhea, dementia |
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What is the therapeutic use of vitamin B3
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dyslipidemia ( increase HDL and decrease LDL, TG, and total number)
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What are the ADR's of vitamin B3
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flushing due to peripheral vasodilation (reduced by taking ASP 81mg right before taking) , N/V, diarrhea, itching, headache, hepatotoxicity
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What are the interactions of vitamin B3
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diabetic meds (increase of glucose...), probenecid, isoniazid
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What is vitamin B6
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water soluble, co-enzyme (pyridoxime)
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What is the function of vitamin B6
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heme production, homocystein metabolism, cofactor for 100+ enzymes
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What are the sources of vitamin B6
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meats, cereals, legumes, eggs
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what is the deficiency of vitamin B6
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dermatologic, oral lesions, convulsions, peripheral neuritis, sideroblastic anemia
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what is the toxicity of vitamin B6
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with long term doses > 250mg per day
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what is the therapeutic use of vitamin B6
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hyperhomocystenemia in cardiac, PMS, carpal tunnel, migranes, depression
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What are the ADR's of vitamin B6
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neuropathy
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What is the UL of vitamin B6
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none
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What are the interactions of vitamin B6
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levodopa: decreased effect
isoniazid: B6 antagonism- supplement during therapy Phenytoin, PB: levels decreased |
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what are the top 8 dietary supplements
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echinacea, ginsing, ginko bilboa, probiotics, glucosamine/chondritin, st john's wort, fish oil
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what is the main reason people use CAM
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combined with conventional medicine it would help
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what is the primary evidence that supports dietary drug interactions
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anecdotal evidence and case reports
(no clinical trials, no pharmacokinetic studies- st john's wort is the exception to the rule) |
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what drug interacts with many dietary supplements
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warfarin (usually increases bleeding risk if starts with G)
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what are the pro's and con's of dietary supplement resources information from facts and comparisons
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Pro's: monographs well referenced for
pharmacology and efficacy, pt info Con's: limited info on safety and interactions |
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what are the pro's and con's of dietary supplement resources information from PDR for herbal medicines
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Pro's:index sections, monographs site clinical trials and case reports for efficacy and safety and interactions
Con's: missing non-herbal supplements |
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what are the pro's and con's of dietary supplement resources information from clinical pharmacology
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Pro's: monographs, citing primary literature, pt ed printout
Con's: cost, no rating system of safety/efficacy, cumbersome |
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what are the pro's and con's of dietary supplement resources information from the natural standard
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most thorough of all of them. efficacy "grades" provided, evidence based monographs, online database
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what does the efficacy rating, likey safe, mean
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government rating deem safe as long as used properly
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what does the efficacy rating, possibly safe, mean
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might be safe if used properly
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what does the efficacy rating, possibly unsafe, mean
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evidence suggests that it is not safe even when used properly
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what does the efficacy rating, likely effective, mean
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reputable references agree and there is good scientific evidence
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what does the efficacy rating, possibly effective, mean
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reputable refernces agree that there is good scientific evidence
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what does the efficacy rating, possibly ineffective mean
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reputable referrences agree that there is some negative scientific evidence.
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what types of echinacea are species of medical interest
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echinacea angustifolia, pallida, purpurea
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what are proposed uses for echinacea
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prevention of the common cold and upper respiratory infections, vaginal candiditis, herpes simplex virus
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what is the rating for echinacea in regards to treatment of the common cold
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possibly effective: evidence supports a possible reduction of symptoms. start at onset and continue for 7 to 10 days. most studies done with purpurea.
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is echinacea good for prevention of the common cold
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current evidence does not support
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what is the rating for echinacea in regards to vaginal candiditis
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possibly effective. reduces symptoms with used with topical antifungal cream
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what is the rating for echinacea in regards to herpes simplex virus
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possible ineffective
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what are the ADR's for echinacea
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well tolerated
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what are the echinacea warnings
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avoid use in people with allergy to asteraceae/compositae plant family
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what are drug interactions with echinacea
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P450 3A4?
all interactions are theoretical |
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what is fish oil
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long-chain, polyunsaturated fats called omega-3 fatty acids, EPA, and DHA
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what are the uses for fish oil
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hypertriglyceridemia, prevention of cardiovascular disease, stroke
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efficacy rating of fish oil for hypertriglyceridemia
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effective. reduces levels of VLDL and TG transport, lowers TG when used 3 to 4g a day
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efficacy rating of fish oil for cardiovascular disease
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likely effective. AHA recommends 2 servings of fatty fish per week or 1g daily if history of CHD
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what are the ADR's of fish oil
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fishy burps, heartburn, bad breath
increase LDL, vitamin A & D toxicity, mercury toxicity |
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what are the warnings with fish oil
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using fish oil for the treatment of hypertriglyceridemia without the consent of the physician
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drug interactions with fish oil
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anticoagulants- theoretically for bleeding.
rated likely safe |
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otc vs rx fish oil
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Lovaza is 4 times more potent than otc
Lovaza is more costly |
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what is ginko biloba
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it is extracted from leaves of a tree
(some names: flavonoids, terpenoids) |
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what is the proposed use for ginko biloba
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conditions associated with cerebral vascular insufficiencies
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What is the efficacy of ginko biloba with dementia
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Possibly effective
fairly significant improvement of cognitive function |
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what is the efficacy of ginko biloba with memory improvement
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possibly effective
benefits to memory and cognitive function |
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what are the ADR's of ginko biloba
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mild: GI discomfort, constipation, dizziness, headache
high doses: diarrhea, restlessness, bleeding? |
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what are drug interactions of ginko biloba
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anticoagulants, antiplatelets, (inhibits platelet activation factor PAF). may inhibit CYP450 enzymes
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what is ginseng
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extract from plant roots- (american, asian (panax), siberian) *ginsenosides
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what is the proposed uses of ginseng
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panax ginseng- adaptogen (increases resistance to stress). improve immune function, general tonic to improve energy
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what is the efficacy of ginseng
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few beneficial effects vs placebo
probably not the energy pill that people expect possibly effective (cognitive) possibly ineffective (athletic perform..) |
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ADR's for ginseng
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rare but serious side effects, not be used long term
rated: possibly safe |
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interactions for ginseng
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anticoagulants, antiplatelets, antidiabetic, immunosuppressent, caution in DM, cardiac, insomnia
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what is glucosamine/chondritin
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not an herbal, glycoprotein derived from marine exoskeletons or synthetically.
HCL or SO4 (glucosamine) |
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what is the proposed use for glucosamine/chondritin
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use for pain associated with osteoarthritis
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what is the efficacy of glucosamine/chondritin with osteoarthritis
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most trials show improvement with pain associated with knee pain from osteoarthritis.
Natural standard give an A rating |
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what is GAIT
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glucosamine arthritis intervention trial
trial shows improvement in knee pain |
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ADR's of glucosamine/chondritin
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common or serious side effects
GI, HA, NV, drowsiness similar to placebo |
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what are the interactions with glucosamine/chondritin
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caution if shellfish allergy
anticoagulants, antidiabetics, rating: likely safe |
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important counseling facts of glucosamine/chondritin
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not used prn
need to use 4-6 wks sulfate salt recommended not for use of "mild" pain |
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what are probiotics
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live organisms in intestine
decrease disease causing bacteria and viruses from causing diarrhea lactobacillus, bifidobacteria, saccharomyces boulardii |
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what are the uses of probiotics
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antibiotic induced diarrhea, prevention of travelers diarrhea, irritable bowel, ulcerative colitis. prevent flu symptoms
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safety of probiotics
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well tolerated
antibiotics may decrease effectiveness |
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what is st john's wort
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extract from buds, leaves, and flowers of hypericum perforatum
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what is st john's wort used for
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depression (mild to moderate)
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efficacy of st john's wort with depression
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effective as low dose TCA's, possibly as effective as SSRI's
** self treatment of depression is not safe rating: likely effective |
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side effects of st john's wort
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GI, dry mouth, restlessness/insomnia more common
also, vivid dreams, agitation, mania, dizziness, skin rash |
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what are some herbal treatments for diabetes
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possibly safe/possibly effective (ginseng, chromium)
likely safe/not enough evidence (cinnamon) possibly unsafe/ineffective (selenium) |
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what are some herbal treatments for hyperlipidemia
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niacin, fish oil (LS- Eff)
plant stanols, blond psyllium(LS-L eff) red yeast rice (PS- L Eff) garlic (LS- P Ineff) |
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patient counceling points for herbals
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explain disclaimer
consult MD before, during, after review current RX meds/conditions choose a product by a reputable manufacturer |
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what is the common cold
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self limiting, can't be prevented or cured, affects people of all ages, highly contagious
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etiology of the common cold
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infecting agent: rhinovirus
mode of transmission: airborne risk factors: smoking, poor nutrition, stress, high population density, allergic rhinitis, nasal polyps, DM, cocaine abuse, immune deficiency, nasal trauma, contact with kids, and swimming |
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Common cold: subjective information to collect
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past medical history, social history, family history, medication history, allergic reactions and adverse drug reactions
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Differential diagnosis: allergic rhinitis
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Watery eyes, pruritis, congestion, rhinorrhea, sneezing
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Differential diagnosis: asthma
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Cough, dyspnea, wheezing
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Differential diagnosis: bacterial throat infection
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Sore throat, fever, lymphadenopathy
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Differential diagnosis: otitis media
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Ear fullness, otalgia, otorrhea, dizziness
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Differential diagnosis: pneumonia/ bronchitis
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Chest tightness, dyspnea, productive cough, persistent fever
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Differential diagnosis: sinusitis
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Sinus tenderness, fever >101.5 °F, UR sx unresponsive to decongestants
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non-pharm for the common cold
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Increased fluid intake and a nutritious diet
Rest and de-stress Humidification Blow nose or use a nasal bulb syringe Nasal saline or saline gargle Breath Right Nasal Strips Upright position |
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soothing a sore throat
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Anesthetics/Antiseptic
Benzocaine Dyclonine HCl Camphor/Menthol Cetylpyridium chloride |
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OTC treatment of fever
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Systemic Analgesics
Aspirin Dose: Adult: 650mg q4h, MDD= 4g |
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Contraindication of treatment with aspirin
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History of a bleeding disorder and in pts with hx of gout
Children <18yrs old Pregnancy/Lactation Caution in g.i. disorders such as PUD and GERD |
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OTC treatment of fever with NSAIDs
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NSAIDs
All OTC NSAIDs have anti-inflammatory, antipyretic, and analgesic activity |
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Contraindications with NSAIDs
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DM, PUD, Bleeding Disorders
Pregnancy: 3rd trimester Renal impairment GERD HTN and CHF |
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NSAID's drug interactions
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Increase risk for bleed: Warfarin
Decreased effectiveness: Antihypertensives Promote renal deterioration: ACEI’s Increase concentrations: Lithium |
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NSAID's side effects
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Heartburn, epigastric pain, nausea, g.i. mucosal damage, edema, increase in blood pressure
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OTC treatment of fever: acetaminophen
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No anti-inflammatory activity
Adult: 325-650mg q46h OR 1g q6-8h, MDD = 4g Children <12yrs: 10-15mg/kg/dose q4-6h |
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daily and monthly amounts for sudafed
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3.6g per day and 9g monthly
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what oral decongestant is recommended for in combination with 1st generation antihistamines
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pseudophedrine
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OTC treatment of nasal decongestion: topicals
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same as oral but less side effects because not systemically absorbed.
only use for 3 to 5 days |
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combating rebound nasal congestion
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Slowly withdraw the nasal decongestant
May use nasal saline For more severe cases you may use a systemic decongestant and a topical corticosteroid Mucous membrane generally takes 1-2 weeks to return to normal |
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OTC treatment of Rhinorrea and sneezing
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1st generation antihistamines
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alternative treatments of rhinorrhea
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vitamin C. not for prevention but will reduce the duration of symptoms
Zinc Echinacea |
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what are 2 types of cough
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productive
non productive |
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etiology of cough
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Viral Infections
Bacterial Infections Medications ACEI Beta-blockers Certain Chronic Disease States COPD/Asthma GERD Post-nasal drip syndrome |
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OTC treatment of cough
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Codeine
DXM |
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robotrip
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150mg to 2g of DXM
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OTC treatment of cough. Systemic antitussives: diphenhydramine
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increases cough threshold
not the 1st line treatment |
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topical antitussives
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camphor and menthol (vicks...)
menthol and eucalyptus (breathe right shots and AYR) |
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treatment of cough associated with the common cold
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1st generation antihistamine and PSE
very little evidence supporting guaifenesin, DXM, codeine |
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cracking the code
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Nighttime”/”PM” = diphenhydramine
“Sinus” = decongestant +/- analgesic “Cough” = dextromethorphan “Non-drowsy”/”Daytime” = decongestant “Allergy” = antihistamine “AM” = decongestant “Cold”/”Flu” = decongestant +/- antihistamine |
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implications of allergic rhinitis
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20% of adults affected
40 % of children affected |
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what is allergic rhinitis
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IgE-mediated inflammation of the nose after exposure to an allergen
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what are the symptoms of allergic rhinitis
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Sneezing
Rhinorrhea Pruritus of eyes, nose, ears, and/or palate Nasal congestion Conjuntivitus |
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one airway, one disease
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share the same airway with asthma and are a continuum of inflammation
AR most important risk of asthma |
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risk factors of allergic rhinitis
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Family history of atopy
Elevated serum IgE levels Higher socioeconomic class Positive reaction to allergy skin testing |
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ARIA severity classifications: intermittent
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< 4 days/week or <4 weeks
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ARIA severity classifications: persistant
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>4 days/week or >4 weeks
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ARIA severity classifications: mild
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normal sleep
normal daily act(sports, leisure...) normal work/school no troublesome symptoms |
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ARIA severity classifications: moderate-severe
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abnormal sleep
interupted daily activities trouble at work/school troublesome symptoms (need one or more) |
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subjective information to collect for allergic rhinitis
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Past Medical History
Social History Family History Medication History Allergic Reactions and Adverse Drug Reactions |
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objective data for allergic rhinitis
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Physical exam/review of systems:
Allergic shiners Dennie’s lines- lines under lower eyelid Allergic crease- crease on nose from pushing up nose Allergic salute- pushing nose up Allergic gape- breathing with mouth open |
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common cold vs allergic rhinitis
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see slide 12 (allergic rhinitis)
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what are non allergic rhinitis SX
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Unilateral nasal symtpoms
Consistent day/night sx Nasal congestion in the absence of sneezing No pruritus Anosmia Nasal polyps Epitaxis = nose bleed |
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questions to detect uncontrolled or under diagnosed asthma
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Do you find yourself short of breath?
Do you make whistling noises (wheeze) when you breathe? Does your chest feel tight? Do you have a cough regularly? Are these symptoms particularly noticeable first thing in the morning, during the night, or with exercise? |
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treatment of allergic rhinitis: moderate/severe persistant
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Preferred is Intranasal steroid then H1 or LTRA
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