1: Herbals and Supplements Flashcards
difference b/w dietary supplement and a drug
dietary supplements:
- can’t be sold as drugs
- can’t say they are good for any disease state
- CAN say helps you relax/etc.
- can’t patent
essentially don’t have definitive proof for FDA
Dietary Supplement and Non-Rx Drug Consumer Protection Act (DSHEA)
- 2006
- required manufacturer to report serious adverse effects
St. John’s Wort - where found, uses
- perennial weed in USA, Europe, Asia (hypericum perforatum)
- for mild/moderate depression
- clinical studies show efficacy
St. John’s Wort - active ingredients, mechanism, side effects
- active ingredients: hyperforin, hypericin
- induces CYP3A4, 2C9, P-gp
- AE: photosensitivity, reduced efficacy of some drugs (oral contraceptives!!)
Echinacea - uses, actions
- for common cold and flu
- immunostimulant - potential decreased Sx and duration
Echinacea - active ingredients, side effects, contraindications
- active: polysaccharides, chicoric acid, alkamides
- AE: minimal - GI upset, headache
- don’t use in kids
- don’t take more than 10d
- don’t use in patients using immunosuppressants or with immunodeficiency/autoimmune diseases
Ginkgo - uses, actions
- proven for peripheral vascular disease
- unproven to prevent cognitive impairment or dementia
- antagonize platelet activating factor
- increase NO release
Ginkgo - active ingredients, side effects, contraindications
- flavone glycosides, terpenoids, antioxidants
- AE: headache, GI upset, some bleeding
- don’t use with antiplatelet or anticoagulant drugs
- don’t use for epileptics
Ginseng - uses, actions
- some evidence for preventing colds, cancer, and reducing postprandial blood glucose levels
- stimulates immune system
- antiplatelet activity
Ginseng - active ingredients, contraindications
- triterpenoids (ginsenosides)
- methylxanthines - caffeine like effect
- don’t use with antipsychotics, estrogens, hypoglycemics, or anticoagulants
Garlic = allium sativum - uses, actions
- may reduce incidence of some cancers
- not proven to reduce LDL cholesterol
- anti-vampire
-antiplatelet, fibrinolytic, antioxidant
Garlic - active ingredients, contraindications
- contains organosulfur compounds including allicin
- don’t co-administer with anticoagulants
Milk Thistle = silybum marianum - uses, actions
- some anti-inflammatory activities
- reduced leukotriene formation
- reduced leukocyte migration
Milk Thistle - side effects
- few AE or drug interactions reported
- no clear evidence for prevention of alcoholic liver cirrhosis or other hepatotoxicities
Red clover = trifolium pratense - uses, actions
- phytoestrogen
- may prevent hot flashes, osteoporosis, and CV disease
- may bind estrogen receptor and cause selective estrogen-mediating effects
Soy bean = glycine max - uses, actions
- phytoestrogen
- may prevent hot flashes, osteoporosis, and CV disease
- may bind estrogen receptor and cause selective estrogen-mediating effects
Saw palmetto = serenoa repens - uses, actions
- no clear evidence for improvement of symptoms of BPH
- phytosterols inhibit 5a reductase in vitro (enzyme that forms active form of testosterone)
Saw palmetto - side affects, contraindications
- low incidence of side effects
- no reported drug interactions
vitamin C supplement
- MDR based on deficiency symptoms
- high doses = immunostimulant, antioxidant
- regular supplementation decreases duration of colds
vitamin E supplement
- dangerous!
- claims cardioprotective over 800 IU/day
- meta-analysis showed increased death with 400 IU
- safe up to 130 IU/day
- MDR 30 IU/day
coQ 10 (ubiquinone) - uses, actions
- electron carrier in mitochondria of all tissues
- highest in heart, some in brain
- decreases with age
- used in therapy of mitochondrial disease (ex: Leigh’s encephalomyopathy)
- some benefit in ischemic heart disease
coQ - side effects
-may increase bleeding with warfarin
Leigh’s encephalomyopathy
- ataxia, decreased growth
- familial defect in coQ 10 synthesis
melatonin - uses, actions
- principal indoleamine in pineal gland
- synthesis controlled by light
- 5 methoxy-N-acetyl tryptamine (lipid soluble)
- 0.3 - 8 mg p.o. used as sleep aid and for jet lag
- metabolized by CYP1A2
melatonin - side effects, contraindications
- drowsiness and ataxia
- synergistic with alcohol
- may interfere with warfarin action
dietary supplements for osteoarthritis
- mixed results in clinical trials for improvement of function and reduction of pain
- glucosamine: substrate for production of articular cartilage
- chondroitin sulfate: proteoglycan may modify extracellular matrix to stabilize articular cartilage
- largest clinical trial to date found no benefit
- AE: may increase bleeding in patients on warfarin
