Define Dietary supplement:
Not Drugs. Manufacturer responsible for safety. FDA takes action only if there is a problem. Cannot claim to "treat" on label.
Dietary supplements include:
- Nutrients: vitamins, min, amino acids
- Botanicals: herbs, extracts
- Glandular extracts: animal or synthetic
What conventional drugs were originally form a plant source?
- apsirin: willow bark
- Digoxin: foxglove
- Ephedrine: ma huang
- Atropine: belladonna alkaloids
Commonly missed on history and pre-op:
nutraceuticals. must ask the question
Aloe uses and concerns:
- Uses: digestin, cathartic (laxative), topically for burns, infections, wounds
- concerns: HYPOKALEMIA (due to diarrhea)
Echinacea uses and concerns:
- Uses: Upper RI, flu
- concerns: Immunostimulant, inhibits CYP3A4 which can cause toxicity of certain drugs, hepatic inflammation
Echinacea inhibits CYP3A4, which causes risk of toxicity with what drugs?
Alpazolam, Ca2+ channel blockers, protease inhibitors
Garlic uses and concerns:
- Uses: HTN, hyperlipidemia, infections, cancer prevention and tx, atherosclerosis
- Concerns: inhibit plt aggregation, induce CYP450, decrease effectiveness of cyclosporin and saquinavir
- Toxicity: GI and hemorrhage
- Drug interaction: INCREASE INR with warfarin
Garlic will _____ INR when used with warfarin
Ginseng uses and concerns:
- Uses: immunostim, improve stamina, DM, menopause
- Potential concerns: HTN, tachy, bledding, CNS stim, hypoglycemia.
- Toxicity causes HTN, tachycardia
- Drug interactions: decrease INR with warfarin, increase hypoglycemia fx with insulin and sulfonylureas, increase manic-like episodes with MAOIs
When taking Ginseng and warfarin, INR will be ___________.
SAW palmetto uses and concerns and drug interactions:
- Uses: BPH, chronic pelvic pain, bladder disorders
- concerns: intraop bledding, n/v diarrhea
- Drug interactions: anticoags. increase bleeding
St. John's Wort uses, concerns and drug interaction:
- Uses: Depression, anxiety, sleep disorders, seasonal affective disorder, PMS
- Concerns: weak Maoi or SSRI (risk of seratonin syndrome)
- Drug interactions: Induction of CYP450, 3A4, Cyp2C9. alters a lot of drugs.
St johns wort interacts with
- Ca2+ channel blockers, warfarin, digoxin, OCP.
- OR drugs: opioids, symapthomimetics, benzo's.
- *regional anesthesia preferred due to poptential cardiac colapse
CoQ10 uses and interactions:
- Uses: CHF, CAD, HTN, hyperlipidemia, DM, increase enery, antioxidant
- Concerns: Hypoglycemia, DECREASE effectiveness of Warfarin, decrease in Statins in body
Dong Quai uses and concerns:
- Uses: Menopause, Gyn issues
- Concerns: Plt aggregation inhibition
- Interactions: INCREASE INR with warfarin, hormone meds (b/c estrogen-like effects)
Vitamin E uses and concerns:
- Uses: Antioxidant, antiaging, heart health, cancer prophylaxis, fibrocystic breast syndrome
- concerns: Bleeding with high dose ( 800mg )
- *fat soluble vitamin from plants
How soon should dietary supplements be stopped prior to surgery?
Is dietary supplement a reason to postpone surgery?
Which drugs increase INR with warfarin?
Which drugs cause a DECREASE in INR with warfarin?
Ginkgo biloba uses and concerns:
- Uses: Circ disorders, increased mental acuity, tinnitus, vertigo, respiratory dz, sexual dysfunction
- Concerns: inhibit plt activating factor, neurotoxin in seed and leaf
- Toxicity: GI discomfort, HA, dizziness, bleeding, seizures
- Drug interactions: warfarin, MAOIs
How long should the following drugs be stopped before surgery?
St. Johns Wort
- Garlic- 7 days
- Ginkgo- 36 hours
- Ginseng- 7 days
- St. Johns Wort- 5 days