560P Botanicals Flashcards
______ increase ciliary activity, reduce mucus viscosity; liquefy pulmonary secretions
Ex: Eucalyptus, thyme
Expectorant herbs
______ form protective coating
Ex: Mullein, Marshmallow, Plantain
Mucilaginous herbs
What condition(s) are the tannin-containing herbs helpful in addressing?
Acute diarrhea
What herbs were formerly FDA-approved over-the-counter laxatives, but have since been disapproved due to modern efficacy and safety research?
Cascara and Aloe
What constituent of licorice can raise BP and is removed in some preparations?
Glycyrrhizin
What does a carminative do in the digestive system?
Relieves bloating and fullness
What does a cholagogue do in the digestive system?
Promotes bile production and emptying of the gallbladder
What does a bitter do in the digestive system?
Stimulates gastric secretions
What are the pharmaceutical medications with which St. John’s wort is most likely to interact in a significant way?
SSRIs
Protease and reverse transcriptase inhibitors Anticoagulants
Immunosuppressants
What is the relationship between alliin, alliinase, and allicin in the pharmacokinetics of garlic?
Allianase acts on alliin to produce allicin
What does it mean for an herbal to “potentiate” a pharmaceutical medication? What precautions need to be taken in cases like this?
The herb increases the power or effect of the medication
Contraindications should be noted; taken with care
- Discuss the history and evolution of the German Commission E and the development of its monographs on botanical therapeutics
The commission E was appointed by a government agency to review phytotherapeutic agents for efficacy and safety
- What is a “declared content” on a botanical label and why is it important with potentially toxic herbals?
Name of each ingredient and what it contains
- Describe current supplement labeling regulations regarding health claims and structure/function properties of herbs.
In the U.S., the label can describe an effect on the structure or function of the body if supported by a reasonable amount of scientific evidence Therapeutic claims cannot be made on the label or in the package insert
- What is an enteric coated capsule? In what ways can they be helpful and at what point should they be used in relation to a meal?
1. Allow for controlled or delayed release of active ingredients
2. Improves ease of swallowing
3. Extends shelf life
4. Masks any unpleasant tastes of active ingredients
5. Taken at least one hour before a meal
6. Coating protects the medicinal core
7. All of the above
- All of the above
- What is standardization about and what are its main purposes?
Standardization guarantees the content of one or more active constituents and marker compounds
common preparation using alcohol or alcohol+water to produce extracts of a wide variety of herbs and herb combinations
Tincture
especially useful for giving botanical medicines to children
Syrups
alcohol-free preparation that would be expected to contain only lipid-soluble components
Medicinal Oils
a solution of a volatile substance in alcohol of alcohol+water
Medicinal Spirits
made from fresh plant parts and contain water-soluble components
Plant Juices
water POURED boiling over herb and covered, STEEPED 10 minutes, then strain
(taken off the heat)
made with soft plant materials such as flowers, leaves and soft stems.
Decoction
Maceration
Infusion
Infusion
COVERED with water, boiled, SIMMER 10 minutes, strained
(left on the heat)
used for harder plant materials like roots, seeds and bark.
Decoction
Maceration
Infusion
Decoction
covered with room temperature water, stands 6 hours, strained
Decoction
Maceration
Infusion
Maceration
- What are the key arguments AGAINST increasing regulation of botanical medicines in the United States?
-difficult to reach the proof for medical efficacy
the following describe _______.
- many herbal products contain undisclosed prescription or over-the-counter drugs and heavy metals
- standardizing herbal preparations promotes batch-to-batch consistency
- more responsibility on the manufacturers of dietary supplements (evidence of good manufacturing practices)
- ensuring what?s on the label is what?s inside
- lack of routine reporting of adverse events
- interactions between herbs and drugs
the key arguments FOR increasing regulation of botanical medicines in the United States
All of the following except one are good arguments in favor of stricter regulation of botanical medicines?. Which one is not a good argument?
- Interactions between herbs and drugs
- Excessive prices for commercial herbal products
- Adulteration of some preparations with drugs - Lack of routine reporting of adverse events
- Lack of standardization among herbal preparations
- Excessive prices for commercial herbal products
Which one of the following is not a difference between the US and European countries such as Germany regarding the status of herbal medicines?
- The U.S. has always led the way worldwide in the development and testing of botanical medicine products
- Herbal medicines are subjected to more regulation in European countries such as Germany.
- Herbal products are regulated as dietary supplements in the US.
- Herbal medicines have higher stature in medical education and clinical practice in European countries such as Germany.
- The U.S. has always led the way worldwide in the development and testing of botanical medicine products
Digoxin is isolated from... Foxglove leaf (Digitalis purpurea) Opium poppy Willow bark (salicis cort) Chinchona bark
Foxglove leaf (Digitalis purpurea)
Codeine is isolated from... Foxglove leaf (Digitalis purpurea) Opium poppy Willow bark (salicis cort) Chinchona bark
Opium poppy
Aspirin is isolated from... Foxglove leaf (Digitalis purpurea) Opium poppy Willow bark (salicis cort) Chinchona bark
Willow bark (salicis cort)
Quinine (an anti parasite) is isolated from... Foxglove leaf (Digitalis purpurea) Opium poppy Willow bark (salicis cort) Chinchona bark
Chinchona bark
A typical botanical extract can be expected to concentrate active substances from the dried herb by how much in terms of an herb-to-extract ratio?
9: 1
5: 1
1: 9
1: 5
5:1
What is the volatile oil content of typical herbs that contain such oils?
1-2%
Which of the following, if any, is not one of the factors that can affect the content of active constituents of medicinal herbs.
- Cultivation
- Climate
- Soil quality
- Plant genetics
- All of the above are factors
- All of the above
True or False: Standardization of botanical preparations is simply a process of adjusting chemistry to produce the desired content.
FALSE
Choose the correct statement about the use of solvents for preparing botanical extracts.
- Aqueous extracts are high in polar compounds while alcohol extracts are high in lipophilic constituents
- Aqueous and alcohol extracts are both high in polar compounds
- Aqueous and alcohol extracts are both high in lipophilic constituents
- Aqueous extracts are high in lipophilic constituents while alcohol extracts are high in polar compounds
- All are correct
- Aqueous extracts are high in polar compounds while alcohol extracts are high in lipophilic constituents
T or F: Using marker compounds to adjust the quality of botanical extracts can always be expected to guarantee consistent therapeutic potency of the product
FALSE
Which of the following, if any, is not true regarding fingerprint chromatograms?
- Can characterize the presence and relative amounts of several herb components
- Can be used to compare batches of the same product for quality control
- Can confirm product identity by comparing products to standard reference samples
- Utilizes high-performance liquid chromatography
- All are true
- All are false.
- All are true
Which of the following, if any, is not an advantage of coated tablets over uncoated tablets?
- Masks any unpleasant tastes of active ingredients
- Allows for controlled or delayed release of active ingredients
- Reduces the cost of the product
- Extends shelf life Improves ease of swallowing
- All are true
- All are false
- Reduces the cost of the product
When should enteric-coated tablets or capsules be taken?
At least 1 hour before a meal
T or F Pastilles and troches alternate terms for lozenges.
TRUE
Botanical product labels in the US are allowed to describe the purpose of the product according to which one of the following rules?
Can describe an effect on the structure or function of the body if supported by a reasonable amount of scientific evidence.
Indicate all of the correct statements below regarding the German Commission E.
- The Commission E was appointed by a government agency to review phytotherapeutic agents for efficacy and safety
- Commission E monographs only review single herbs and preparations made from them
- The Commission E continues to gather and review monographs today - - The Commission E monographs are only available in German language editions
- All are correct
- None are correct
- The Commission E was appointed by a government agency to review phytotherapeutic agents for efficacy and safety
The European Union relies on which agency to update critical information about phytomedicines?
European Scientific Cooperative on Phytotherapy
T or F: The authors of our text present data showing that the placebo effect does not account for much of the therapeutic effect of treating disorders such as widespread pain, insomnia, gastric symptoms, and depression.
FALSE
When a study reports only the change in outcome within each group, this is called a __________ comparison, and is a common error that may fail to detect a __________.
before and after comparison,
placebo effect.
According to the Natural Standard Evidence-Based Validated Grading Rationale described in the file Important Terms in Botanical Medicine Research, what evidence grade would be given if any one of these criteria were met:
- Evidence of benefit only from 1 small randomized controlled trial (RCT) of inadequate size and quality of design
- Conflicting evidence of benefit from multiple RCTs with no clear benefit from the better designed trials,
- Evidence of benefit only from observational studies and non-randomized trials with no basic science supporting evidence
- Support only from basic science evidence or theory.
C (Unclear or conflicting scientific evidence)
Allium sativa Is latin name for \_\_\_\_\_ : garlic Indian guar red yeast onion
garlic
Cyamopsis tetragonolobus is the latin name for\_\_\_\_ garlic Indian guar red yeast onion
Indian guar
Monascus purpureus is the latin name for\_\_\_\_ garlic Indian guar red yeast onion
red yeast
Allium cepa is the latin name for\_\_\_\_ garlic Indian guar red yeast onion
onion
What specific part of Allium saliva is used in botanical medicine? bulb leaf seed coat (bran) root bark
bulb
What specific part of Avena sativa is used in botanical medicine? bulb leaf seed coat (bran) root bark
seed coat (bran)
What specific part of Allium cepa is used in botanical medicine? bulb leaf seed coat (bran) root bark
bulb
What specific part of Ginkgo biloba is used in botanical medicine? bulb leaf seed coat (bran) root bark
leaf
Which two botanicals have been shown to increase walking distance in subjects with peripheral arterial disease? Ginkgo biloba garlic Indian guar red yeast onion
Allium sativa (garlic) Ginkgo biloba
which garlic preparation is used in used in most clinical trials
garlic powder
which garlic preparation is used in used in steam distillation product subject to enzymatic and thermal breakdown of active constituents
garlic oil
which garlic preparation is used in fermentation product subject to degradation of active constituents
aged garlic
Which of the following, if any, is NOT a therapeutic effect of garlic demonstrated in at least some clinical studies?
- Inhibits progression of atherosclerosis
- Lowers blood triglycerides
- Lowers total blood cholesterol
- Lowers blood pressure
- All of the above are effects
- None of the above are effects
- All of the above
T or F: According to human research, garlic can reduce platelet aggregation after a few days of treatment.
FALSE
What is the daily intake of alliin associated with successful lipid-lowering in most clinical studies using garlic powder?
6 -10 mg
2-5 mg
10-12mg
About 6 -10 mg
Which two adverse effects should be monitored in patients taking garlic? Muscle pain Excessive bleeding tendency Hypotension Hypertension Tenderness Weakness
Excessive bleeding tendency
Hypotension
What is the most likely mechanism for the effects of guar gum on blood cholesterol?
Inhibition of cholesterol synthesis
Inhibition of cholesterol uptake from the gut
Inhibition of cholesterol uptake from the gut
What is the most likely mechanism for the effects of red yeast rice on blood cholesterol?
Inhibition of cholesterol synthesis
Inhibition of cholesterol uptake from the gut
Inhibition of cholesterol synthesis
What is the most likely mechanism for the effects of garlic on blood cholesterol?
Inhibition of cholesterol synthesis
Inhibition of cholesterol uptake from the gut
Inhibition of cholesterol synthesis
Which family of active constituents associated with red yeast rice?
Monacolins
alpha-bisabolol
apigenin
Monacolins
Which adverse effects should be monitored in patients taking red yeast rice? Elevated liver enzymes Muscle pain Excessive bleeding tendency Hypotension Hypertension Tenderness Weakness
Elevated liver enzymes, Muscle pain, tenderness, and weakness
According to the National Institutes of Health article, garlic has been found to interfere with the effectiveness of what type of drug?
an HIV drug
Which of the following is the most accurate list of possible side effects of ginkgo biloba?
- headache, itchy eyes, gastrointestinal issues, asthma, fatigue, and drowsiness
- anxiety, difficulty urinating, dry mouth, headache, heart damage, high blood pressure, irregular heart rhythms
- headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skin reactions
- breath and body odor, heartburn, upset stomach, and allergic reactions
- headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skin reactions
Large amounts of a dangerous toxin are found in which ginkgo preparation?
roasted seeds
Hamamelis virginiana Is latin for _____
witch hazel
comfrey
German chamomile
witch hazel
Matricaria recutita Is latin for _____
pineapple
evening primrose
German chamomile
German chamomile
Oenotherae biennis Is latin for _____
witch hazel
evening primrose
German chamomile
evening primrose
Ananas comosus Is latin for _____
comfrey
pineapple
witch hazel
pineapple (bromelain)
Symphytum officinale Is latin for _____
German chamomile
comfrey
witch hazel
comfrey
Melaleuca alternifolia Is latin for _____
evening primrose
tea tree oil
pineapple
tea tree oil
Which specific part is used from Arnica? seed oil leaves and root flower leaves, twigs, and bark
flower
Which specific part is used from chamomile (Matricaria recutita)? seed oil leaves and root flower leaves, twigs, and bark
flower
Which specific part is used from Evening primrose (Oenotherae biennis )? seed oil leaves and root flower leaves, twigs, and bark
seed oil
Which specific part is used from Witch hazel (Hamamelis virginiana)? seed oil leaves and root flower leaves, twigs, and bark
leaves, twigs, and bark
Which specific part is used from Comfrey (Symphytum officinale)? seed oil leaves and root flower leaves, twigs, and bark
leaves and root
Name the active constituent: Evening primrose oil (Oenotherae biennis )
gamma-linolenic acid
(+)-terpinen-4-ol
apigenin
gamma-linolenic acid
Name the active constituent: Witch hazel (Hamamelis virginiana)
tannins
alpha-bisabolol
apigenin
tannins
Name the active constituent: chamomile (Matricaria recutita) - exerts anxiety-reducing effects
apigenin
helenalin
tannins
apigenin
Name the active constituent: Tea tree oil (Melaleuca alternifolia)
(+)-terpinen-4-ol
apigenin
gamma-linolenic acid
(+)-terpinen-4-ol
Name the active constituent: chamomile (Matricaria recutita) - anti-inflammatory and antiphlogistic properties
apigenin
tannins
alpha-bisabolol
alpha-bisabolol
Name the active constituent: Arnica
helenalin
tannins
amma-linolenic acid
helenalin
promising or good evidence as a therapeutic intervention of post-operative or post-traumatic swelling, especially of the nose and paranasal sinuses
Bromelain (Ananas comosus)
__ has promising or good evidence as a therapeutic intervention of Psoriasis and genital herpes
Aloe vera (A. barbadensis Mill)
_____ has promising or good evidence as a therapeutic intervention for cutaneous fungal infections
Tea tree oil (Melaleuca alternifolia)
_____ has promising or good evidence as a therapeutic intervention hemorrhoidal disease. (Swollen and inflamed veins in the rectum and anus)
Witch hazel (Hamamelis virginiana)
______ has promising or good evidence as a therapeutic intervention for atopic eczema
Evening primrose oil (Oenotherae biennis )
Comfrey (Symphytum officinale) products should have declared content of what potentially-toxic constituent?
unsaturated pyrrolizidine alkaloids
Which botanical medicine may potentiate (increase power) the effects of anticoagulant and platelet-inhibiting medications?
Bromelain (Ananas comosus)
___ from Germany has shown positive results in the treatment of several types of skin disorders, including decubitus ulcers.
Chamomile (Matricaria recutita)
Which preparation of Aloe vera (A. barbadensis Mill) is suitable for topical treatment of skin conditions?
gel
An anti-inflammatory product called Phlogenzym (marketed in North America as Wobenzym PS) contains several ingredients, one of which is ___________.
bromelain (Ananas comosus)
Which botanical is used both topically as an extract in tinctures, ointments, and oils as well as orally in homeopathic dilutions?
arnica
Which botanical agent may increase the potency of certain antibiotics?
bromelain (Ananas comosus)
______ is the latin binomial name for Devil’s claw
Petasites hybridus
Harpagophytum procumbens
Tanacetum perthenium
Harpagophytum procumbens
______ is the latin binomial name for Feverfew
Petasites hybridus
Harpagophytum procumbens
Tanacetum perthenium
Tanacetum perthenium
______ is the latin binomial name for Butterbur
Petasites hybridus
Harpagophytum procumbens
Tanacetum perthenium
Petasites hybridus
What is the specific part used for pain in botanical medicine? Devil's claw (Harpagophytum procumbens) bulb leaf tuber root bark
tuber
What is the specific part used for pain in botanical medicine for Willow? bulb leaf seed coat (bran) root bark
bark
What is the specific part used for pain in botanical medicine for Peppermint (Mentha × piperita)?
essential oil from leaf
What is the specific part used for pain in botanical medicine? Feverfew (Tanacetum perthenium) bulb leaf seed coat (bran) root bark
leaf
What is the specific part used for pain in botanical medicine?
Butterbur (Petasites hybridus)
rhizome
parthenolide is the proposed active constituent or licensed standardized extract of what botanical?
Feverfew (Tanacetum perthenium)
Willow bark (salicis cort)
Devil’s claw (Harpagophytum procumbens)
Feverfew (Tanacetum perthenium)
capsaicinoids are the proposed active constituent or licensed standardized extract for which botanical ?
Feverfew (Tanacetum perthenium)
Cayenne
Devil’s claw (Harpagophytum procumbens)
Cayenne
salacin is the proposed active constituent or licensed standardized extract for which botanical?
Butterbur (Petasites hybridus)
Devil’s claw (Harpagophytum procumbens)
Willow bark (salicis cort)
Willow bark (salicis cort)
iridoid glycosides are the proposed active constituent or licensed standardized extract for which botanical?
standardized extract for which botanical?
Butterbur (Petasites hybridus)
Willow bark (salicis cort)
Devil’s claw (Harpagophytum procumbens)
Devil’s claw (Harpagophytum procumbens)
Petadolex is the proposed active constituent or licensed standardized extract for which botanical?
Butterbur (Petasites hybridus)
Willow bark (salicis cort)
Devil’s claw (Harpagophytum procumbens)
Butterbur (Petasites hybridus)
In clinical trials using Harpagophytum (Devil’s claw) extracts with standardized active principle content, what is the minimum amount of harpagoside prescribed per day?
50 mg
T or F: Given the pharmacokinetics of harpagoside (active ingredient in Devil’s class) , both of the following statements are true: 1) a single morning dose could be expected to reduce symptoms within half an hour, and 2) relief should persist for the entire day.
FALSE
Persons allergic to members of the daisy family should be cautious consuming which TWO herbs?
Feverfew ((Tanacetum perthenium) and
Butterbur (Petasites hybridus)
Persons sensitive to aspirin should not use which herb?
Willow bark (salicis cort)
Which TWO botanicals have been shown effective against some types of pain when used topically?
Capsaicin (active constituent in Cayenne) and Peppermint (Mentha × piperita)
Which botanical has been shown clinically effective specifically against tension headache?
Peppermint (Mentha × piperita)
For which TWO painful conditions have Devil’s claw (Harpagophytum procumbens) preparations been studied in controlled trials?
- Tension headache
- Diabetic neuropathy
- Chronic back pain
- Osteoarthritis
- Migraine headache
Osteoarthritis and Chronic back pain
Which botanical has been found more effective as the whole dried herb than as an ethanolic extract?
- Boswellin
- Feverfew
- Butterbur
- Willow
Feverfew (Tanacetum perthenium)
For which botanical extract is it important to have a guarantee that it is free of pyrrolizidine alkaloids?
Butterbur (Petasites hybridus)
Interrupting which herb after taking it for a long time may result in difficulty sleeping, headaches, joint pain, nervousness, and stiff muscles?
Feverfew (Tanacetum perthenium)
T or F: The traditional use of ginkgo biloba is based on medicinal use in Asia, not in Europe.
TRUE
Which part of the plant is used? Ginkgo biloba
leaf only
Which part of the plant is used St. John's wort? bulb leaf only leaf and flowers root bark
leaf and flowers
Clinically-proven preparations are 4-7:1 concentrates:
St. John’s wort, Gingko biloba, or BOTH
St. John’s wort
Clinically-proven preparations are 35-67:1 concentrates
St. John’s wort, Gingko biloba, or BOTH
Gingko biloba
Clinically-proven preparations are acetone-water extracts:
St. John’s wort, Gingko biloba, or BOTH
Gingko biloba
Clinically-proven preparations are alcohol-water extracts:
St. John’s wort, Gingko biloba, or BOTH
St. John’s wort
Extracts contain phytochemicals from the flavonoid family:
St. John’s wort, Gingko biloba, or BOTH
BOTH
Which constituent of ginkgo must be remove because it has been shown to incite allergic responses and other toxic reactions?
- bilobalides
- ginkgolic acids
- kaempferol glycosides
- ginkgolides
ginkgolic acids
On which two families of constituents are medicinal ginkgo extracts standardized?
- hydroxykynurenic acids
- terpene lactones
- vanillic acids
- flavonoid glycosides
flavonoid glycosides and terpene lactones
T or F: Since no pharmacokinetic studies of ginkgo extracts have been done, the amount absorbed and bioavailable is unknown.
FALSE
Inhibits synaptic reuptake of neurotransmitters: Hypericum perforatum (St John's-wort) or Gingko biloba
Hypericum perforatum (St John’s-wort)
Upregulates 5-hydroxytryptamine receptors: Hypericum perforatum (St John's-wort) or Gingko biloba
Hypericum perforatum (St John’s-wort)
Increases tolerance of brain tissue to hypoxia deficiency in the amount of oxygen reaching the tissues): Hypericum perforatum (St John's-wort) or Gingko biloba
Gingko biloba
Inhibits platelet activation factor (PAF): Hypericum perforatum (St John's-wort) or Gingko biloba
Platelet-activating factor, also known as PAF, PAF-acether or AGEPC, is a potent phospholipid activator and mediator of many leukocyte functions, platelet aggregation and degranulation, inflammation, and anaphylaxis.
Gingko biloba
Reduces "behavioral despair" in animal models: Hypericum perforatum (St John's-wort) or Gingko biloba
Hypericum perforatum (St John’s-wort)
Increases skin reponse to the effects of UV radiation: Hypericum perforatum (St John's-wort) or Gingko biloba
Hypericum perforatum (St John’s-wort)
Inhibits age-related decline of choline and alpha-adrenergic receptors: Hypericum perforatum (St John's-wort) or Gingko biloba
Gingko biloba
Affects brain waves evaluated by computer-analyzed EEG: Hypericum perforatum (St John's-wort) or Gingko biloba
Gingko biloba
T or F: While ginkgo has been demonstrated to have value in the treatment of dementia, it has never been found helpful for improving cognitive function in non-demented subjects.
FALSE
According to the German Committee for Proprietary Medicinal Products, modern research on the efficacy of gingko biloba should assess all but one of the following categories of outcomes in patients with dementia. Which category is not a required outcome to assess?
- Activities of daily living, social behavior, care needs
- Global assessment of the patient by the physician
- Psychometric assessment of cognitive abilities
- Subjective self-assessment of patient’s mood state
Subjective self-assessment of patient’s mood state
The German Commission E determined that ginkgo extracts were indicated for all of the following except
- intermittent claudication
- prevention of stroke
- vertigo or tinnitus, if due to vascular or involutional etiology
- cognitive deficits due to organic brain disease
prevention of stroke
T or F: Only St. John’s wort extracts with moderate to high hyperforin content have been found effective in clinical trials
FALSE
When assessing the response to antidepressant therapies using instruments such as the Hamiliton Depression Rating Scale, what percentage score improvement is considered good evidence of a meaningful response?
50%
T or F: The placebo effect probaby accounts for at least 50% of the beneficial effects of St. John’s wort on depression
TRUE
T orF: Lower cost and fewer adverse effects are two distinct advantages of either ginkgo or hypericum extracts over pharmaceutical medicines typically prescribed for dementia or depression, respectively.
TRUE
T or F: Marked improvement in depressive symptoms can be expected to occur within one to two weeks of therapy with hypericum (SJW) extracts.
FALSE
St. John’s wort (hypericum) may interact significantly with which of the following types of drugs? (choose all of the correct answers)
- Immunosuppressants
- Anticoagulants
- Protease and reverse transcriptase inhibitors
- Selective serotonin reuptake inhibitors (SSRIs)
Immunosuppressants
Protease and reverse transcriptase inhibitors
Selective serotonin reuptake inhibitors (SSRIs)
Piper methysticum is the latin name for:
Hops
kava
ginger
Kava
Humulus lupulus is the latin name for:
Hops
kava
ginger
Hops
What is the plant part primarily used in Kava (Piper methysticum)? flowers only, any gender root aerial parts, including fruits stobiles (female flowers) rhizome
rhizome
What is the plant part primarily used in Valerian? flowers only, any gender root aerial parts, including fruits stobiles (female flowers) rhizome
root
What is the plant part primarily used in Lavender? flowers only, any gender root aerial parts, including fruits stobiles (female flowers) rhizome
flowers only, any gender
What is the plant part primarily used in Hops (Humulus lupulus)? flowers only, any gender root aerial parts, including fruits stobiles (female flowers) rhizome
stobiles (female flowers)
What is the plant part primarily used in Passion flower? flowers only, any gender root aerial parts, including fruits stobiles (female flowers) rhizome
aerial parts, including fruits
What is the active constituent of Valerian?
humulone and lupulone
sesquiterpenes
linalyl acetate and cineol
pyrones
sesquiterpenes
What is the active constituent of Lavender?
humulone and lupulone
sesquiterpenes
linalyl acetate and cineol
pyrones
linalyl acetate and cineol
What is the active constituent of Kava (Piper methysticum)?
humulone and lupulone
sesquiterpenes
linalyl acetate and cineol
pyrones
pyrones
What is the active constituent of Hops (Humulus lupulus)?
humulone and lupulone
sesquiterpenes
linalyl acetate and cineol
pyrones
humulone and lupulone
Human clinical studies of kava (Piper methysticum) have tested extracts with varying amounts of active constituents; what is the highest percentage content of actives tested?
- 70%
- 30%
- 15%
- 50%
70%
Which potential adverse reaction to kava (Piper methysticum) has led to a product recall in Europe and a public warning issued by the US FDA?
- Liver damage
- Carcinogenicity
- Teratogenicity
- Kidney damage
Liver damage
T or F: Aqueous and ethanol extracts of valerian root are equivalent in the quality of their actions.
FALSE
hydroalcoholic (ethanol) extracts being always more potent
Which subspecies of Valerian is recommended for use in valerian preparations?
- indica
- edulis
- officinalis
- japonica
officinalis
Valerian products with a high content of which constituent should not be used due to potential toxicity?
- Acetoxyvalerenic acid
- Valerenic acid
- Valepotriates
Valepotriates
Upon which neurotransmitter does valerian appear to exert its pharmacological effects?
Gamma-aminobutyric acid (GABA)
T or F: Kuhlmann (1999) demonstrated that valerian extract had no adverse effects on the reaction time, alertness, or concentration
TRUE
T or F: Patients with sleep disturbances can expect to achieve improvement after only a few days of valerian use.
FALSE
According to our text, which two additional herbal calmatives have been tested in combination with valerian in clinical studies?
- Lavender
- Passion flower
- Hops
- Lemon balm
- Kava
Hops (Humulus lupulus) Lemon balm (Melissa officianlis)
All of the following measures except one were affected in human studies of the effects of lavender. Which measure was not assessed?
- Reductions in blood markers of the stress response
- Decline in EEG potentials that correlate with vigilance and alertness
- More relaxed and less depressed self-rated mood
- Increased “happiness” based on autonomic nervous system responses
- Self-rated sedation
Reductions in blood markers of the stress response
What are the reported side effects of Kava (Piper methysticum)?
Breast growth in young boys
Dystonia
Headache, appetite changes, constipation
Interaction with drugs used for Parkinson’s disease
Dystonia (Involuntary muscle contractions that cause repetitive or twisting movements.)
Interaction with drugs used for Parkinson’s disease
What is the reported side effect of Lavender (oral use)?
Breast growth in young boys
Dystonia
Headache, appetite changes, constipation
Interaction with drugs used for Parkinson’s disease
Headache, appetite changes, constipation
What is the reported side effect of Lavender (topical use)?
Breast growth in young boys
Dystonia
Headache, appetite changes, constipation
Interaction with drugs used for Parkinson’s disease
Breast growth in young boys
Crataegus monogyna Horse chestnuts Hawthorne Kava Hops
Hawthorne
Aesculus hippocastanum Horse chestnuts Hawthorne Kava Hops
Horse chestnuts
Which plant part is used with the herb Hawthorne (Crataegus monogyna)? seed leaves and root leaves and flowers flower
leaves and flowers
Which plant part is used with the herb Horse chestnut (Aesculus hippocastanum)? seed leaves and root leaves and flowers flower
seed
\_\_\_\_\_ is the active constituent of Hawthorne (Crataegus monogyna)? sesquiterpenes Hops (Humulus lupulus) flavonoids or oligomeric procyanidins linalyl acetate and cineol
flavonoids or oligomeric procyanidins
\_\_\_\_\_ is the the active constituent of horse chestnut (Aesculus hippocastanum): flavonoids or oligomeric procyanidins linalyl acetate and cineol aescin flavonoids or oligomeric procyanidins
aescin
A combination of hawthorne (Crataegus monogyna) extract and what essential oil was found effective for raising blood pressure in subjects with orthostatic hypotension?
camphor oil (Cinnamomum camphora)
T or F: A single dose of hawthorne (Crataegus monogyna) extract has discernible effects on subjective complaints related to cardiac insufficiency
FALSE
Indicate all of the pharmacological effects of hawthorne (Crataegus monogyna) extracts demonstrated in preclinical research in vitro or in animal models.
- Increase in coronary blood flow
- Increased amplitude of myocardial contractions
- Cardioprotective effects during recovery from cardiac ischemia, indicated by reduced release of lactate dehydrogenase
- Increase in cardiac stroke volume
- All of the above
- None of the above
all of the above
How does hawthorne (Crataegus monogyna) extract differ pharmacologically from cardiac glycosides such as digitalis?
- Hawthorne is positively inotropic yet proarrhythmic
- Hawthorne is negatively inotropic yet proarrhythmic
- Hawthorne is negatively inotropic yet antiarrhythmic
- Hawthorne is positively inotropic yet antiarrhythmic
Hawthorne (Crataegus monogyna) is positively inotropic (agents increase the strength of muscular contraction) yet antiarrhythmic (used to suppress abnormal rhythms of the heart (used to suppress abnormal rhythms of the heart)
All but one of the following herbs is a source of digitaloids that are not recommended for phytotherapeutic use due to their pharmacokinetic and other shortcomings. Which one?
- Lily-of-the-valley
- Oleander
- False hellbore
- Foxglove
Foxglove (Digitalis purpurea)
What is the correct description of the extraction method used to produce WS 1442, the hawthorne (Crataegus monogyna) extract used in many clinical studies of heart failure?
Water and alcohol extraction
According to our text, what outcomes have been demonstrated in human studies of horse chestnut
(Aesculus hippocastanum) extract? Choose all answers that are correct.
- Significantly reduced foot and ankle edema after a long distance airplane flight
- Significantly reduced symptomatic complaints in patients with chronic venous insufficiency
- Equivalence between horse chestnut (Aesculus hippocastanum) extract and compression stocking therapy for reducing edema in patients with chronic venous insufficiency
- Significantly reduced leg volume in patients with chronic venous insufficiency
- All of the above
- None of the above
all
Esculin is a toxin that must be processed out of ___________, and is one reason why the raw or unprocessed herb should not be used.
Horse chestnut (Aesculus hippocastanum)
Cynarum scolymus
Turmeric
Artichoke
Licorice
Artichoke
Curcuma longa
Turmeric
Dandelion
Licorice
Turmeric
Taraxacum officinalis
Artichoke
Turmeric
Dandelion
Dandelion
Glycyrrhyza glabra
Dandelion
Artichoke
Licorice
Licorice
Which plant part is used for Gentian? Root and rhizome Rhizome only Leaves only Flowers
Root and rhizome
Which plant part is used for Artichoke? Root and rhizome Rhizome only Leaves only Flowers
Leaves only
Which plant part is used for Ginger? Root and rhizome Rhizome only Leaves only Flowers
Rhizome only
Which plant part is used for Chamomile (Matricaria recutita)?
Flowers
What is the active constituent of Peppermint (Mentha × piperita)?
Menthol
What is the active constituent of Turmeric?
Curcumin
What is the active constituent of Artichoke?
Cynarum scolymus
Cynarin
Curcumin
Cynarin
best herb for: Complaints in the upper abdomen aggravated by fat intake Licorice Caraway Peppermint oil (Mentha × piperita) Artichoke
Artichoke
best herb for: Irritable bowel syndrome Licorice Caraway Peppermint oil (Mentha × piperita) Artichoke
Peppermint oil (Mentha × piperita)
best herb for: Peptic ulcer Licorice Caraway Peppermint oil (Mentha × piperita) Artichoke
Licorice
A combination of peppermint (Mentha × piperita) oil and which other essential oil has been shown effective for treating functional dyspepsia (pain, bloating, etc)? Licorice Caraway Peppermint oil (Mentha × piperita) Artichoke
Caraway
As treatment or prevention of nausea and vomiting, the effectiveness of ginger is least convincing when which of the following is the cause?
- Postoperative
- Chemotherapy
- Morning sickness
- Sea sickness
Postoperative
T or F: In the treatment of gastrointestinal disorders, peppermint (Mentha × piperita) oil given in delayed-release (enteric-coated) formulations has more clinical evidence than conventional formulations, and may be less likely to cause side effects of nausea, heartburn, and abdominal discomfort.
TRUE
Which component of licorice has mineralocorticoid-like action, and is removed in some formulations to prevent side effects of blood pressure elevation and potassium loss?
- Paparavine
- Liquiritin
- Glycyrrhizin
- Absinthin
Glycyrrhizin
Which herb is recommended NOT to be used in large amounts during pregnancy, based on research suggesting increased risk of preterm labor?
Licorice
Vaccinium myrtillus
Psyllium
Milk thistle
Bilberry
Bilberry
Plantago species
Licorice
Psyllium
Milk thistle
Psyllium
Silybum marianum
Psyllium
Milk thistle
Licorice
Milk thistle
T or F: the mechanism of action Saccharomyces boulardii is to antagonize pathogens and stimulate enteric immune system
TRUE
What is the mechanism of action: Psyllium husk
Anthranoid stimulation of intestinal mucosa
Osmotic laxative
Bulk forming laxative
Bulk forming laxative
What is the mechanism of action: Sorbitol
Anthranoid stimulation of intestinal mucosa
Osmotic laxative
Bulk forming laxative
Osmotic laxative
What is the mechanism of action: Senna pods and leaves
Anthranoid stimulation of intestinal mucosa
Osmotic laxative
Bulk forming laxative
Anthranoid stimulation of intestinal mucosa
What is the mechanism of action: Aloe latex
Anthranoid stimulation of intestinal mucosa
Osmotic laxative
Bulk forming laxative
Anthranoid stimulation of intestinal mucosa
Tannin-containing herbs can play an important role in the control of which health condition?
Acute diarrhea
T or F: Consumption of 2 liters per day of tea by healthy subjects for four days resulted in prolonged intestinal transit time.
TRUE
The ability of apples, bananas, and carrots to help control diarrhea can be attributed to which common constituent?
Pectins
According to our text, Saccharomyces boulardii has been effective for controlling or preventing diarrhea resulting from all but one of the following causes. Which one?
- Antibiotic-associated diarrhea
- Travel-related diarrhea
- Nutritionally-related (feeding by gavage)
- Infectious diarrhea
Infectious diarrhea
T or F: Wheat bran having coarse particles will be less effective for shortening intestinal transit time than wheat bran having smaller particles.
FALSE
Which type of botanical remedy for constipation is most likely to produce adverse effects of loose stools and colicky abdominal pain.
- Osmotic agents
- Anthranoid-containing herbs
- Bulk-forming agents
Anthranoid-containing herbs
Which of the following is an FDA-approved non-prescription drug?
- Cascara
- Senna
- Rhubarb
- Buckthorn
Senna
Which TWO laxative herbs are no longer FDA-approved for use in over-the-counter medications due to lack of modern clinical and safety data?
- Cascara
- Aloe
- Senna
- Rhubarb
Cascara and aloe
Which botanical laxative is contraindicated in cases of biliary obstruction and other biliary (refers to the liver, gall bladder and bile ducts, and how they work ) disorders?
- Aloe
- Castor oil
- Senna
- Buckthorn
Castor oil
Senna may be contraindicated in people taking either diuretics, horsetail, or licorice, due to concerns about altered blood levels of ___________
Calcium
Potassium
Magnesium
Potassium
Allergic reactions to milk thistle are more common among people allergic to all of the following except one. Which one?
ragweed chrysanthemum marigold Wheat daisy
Wheat
Serenoa repens
Black cohosh
Saw palmetto
Pygeum
Saw palmetto
Urtica dioica
Nettle
Chasteberry
Wheat
Nettle
Prunus africana
Chasteberry
Pygeum
Black cohosh
Pygeum
Vitex agnus-castus
Saw palmetto
Chasteberry
Nettle
Chasteberry
Cimicifuga racemosa
Chasteberry
Pygeum
Black cohosh
Black cohosh
Which plant part is used in Saw palmetto?
Fruit
Bark
Root and/or rhizome
Fruit
Which plant part is used in Chasteberry?
Fruit
Bark
Root and/or rhizome
Fruit
Which plant part is used in Nettle?
Fruit
Bark
Root and/or rhizome
Root and/or rhizome
Which plant part is used in Black cohosh?
Fruit
Bark
Root and/or rhizome
Root and/or rhizome
Which plant part is used in Pygeum?
Fruit
Bark
Root and/or rhizome
Bark
Fatty acids and sterols are the active constituents of ____
Pygeum
Saw palmetto
Black cohosh
Saw palmetto
Phytosterols, pentacyclic terpenes, and ferulic acid estersare the active constituents of ____
Pygeum
Saw palmetto
Black cohosh
Pygeum
Triterpene glycosides are the active constituents of ____
Pygeum
Saw palmetto
Black cohosh
Black cohosh
T or F: Fat soluble extract prepared with hexane or liquid carbon dioxide are the extraction features of clinically-studied preparations of Saw palmetto.
TRUE
What is the extraction features of clinically-studied preparations of Nettle?
11: 1 herb to extract ratio prepared with alcohol-water solvent
10: 1 herb to extract ratio prepared with methanol-water solvent
10: 1 herb to extract ratio prepared with alcohol-water solvent
11: 1 herb to extract ratio prepared with methanol-water solvent
10:1 herb to extract ratio prepared with methanol-water solvent
Which herb has been best demonstrated for effectiveness against benign prostatic hypertrophy, based on the largest number of total subjects enrolled in randomized controlled trials, and comparisons with both placebo and established medical therapies?
Horse chestnut
garlic
saw palmetto
Saw palmetto
All of the following mechanisms, except one, have been demonstrated for saw palmetto extracts. Which one has NOT been demonstrated for saw palmetto extracts?
- Reduce blood prolactin levels
- Inhibition of 5-alpha reductase enzyme
- Inhibit prostatic aromatase
- Anti-inflammatory effects
Inhibit prostatic aromatase
All of the following mechanisms, except one, have been identified for nettle extracts. Which one is NOT a mechanism for nettle extracts?
- Inhibit prostatic aromatase
- Inhibition of 5-alpha reductase enzyme
- Anti-inflammatory effects
- Reduce blood prolactin levels
Reduce blood prolactin levels
Two of the following mechanisms have been demonstrated for pygeum extracts, one has not. Which one has NOT been demonstrated for pygeum extracts?
- Inhibition of 5-alpha reductase enzyme
- Inhibition of aromatase enzyme activity
- Interactions with sex-hormone-binding globulin (SHBG)
Interactions with sex-hormone-binding globulin (SHBG)
The clinical effects of chasteberry probably depend on modifying the activity of which hormone?
Prolactin
A case of necrotizing hepatitis has been associated with use of which herb?
Black cohosh
Which of the following is TRUE?
- Saw palmetto appears to affect readings of prostate-specific antigen (PSA) levels
- Blue cohosh is an acceptable substitute for black cohosh
- People taking dopamine-related medications, such as certain antipsychotic drugs and Parkinson’s disease medications, should avoid using chasteberry.
People taking dopamine-related medications, such as certain antipsychotic drugs and Parkinson’s disease medications, should avoid using chasteberry.
Which of the following best describes the assumption regarding the anti-stress function of herbs such as the ginsengs?
- Expands both the adaptation phase and the exhaustion phase of the stress response.
- Delays or prevents both the adaptation phase and the exhaustion phase of the stress response.
- Expands the adaptation phase while delaying or preventing the exhaustion phase of the stress response.
- Expands the exhaustion phase while delaying or preventing the adaptation phase of the stress response.
Expands the adaptation phase while delaying or preventing the exhaustion phase of the stress response.
Eleutherococcus senticosus Siberian ginseng Gotu kola Goldenseal American ginseng
Siberian ginseng
Panax quinquefolius Siberian ginseng Cat's claw American ginseng Gotu kola
American ginseng
Unicaria tomentosa or guianensis
Siberian ginseng
Goldenseal
Cat’s claw
Cat’s claw
Centella asiatica
Cat’s claw
American ginseng
Gotu kola
Gotu kola
Hydrastis canadensis
American ginseng
Gotu kola
Goldenseal
Goldenseal
Which plant part is used in Ginseng and Eleuthero (Siberian Ginseng)?
Root
Glycosidal saponins are the active constituents in \_\_\_\_\_ Asian ginseng Eleuthero (Siberian Ginseng) Grape seed European mistletoe Goldenseal
Asian ginseng
Lignan glycosides are the active constituents in \_\_\_\_\_ Eleuthero (Siberian Ginseng) Grape seed European mistletoe Asian ginseng Goldenseal
Eleuthero (Siberian Ginseng)
Procyanidins are the active constituents in \_\_\_\_\_ Eleuthero (Siberian Ginseng) Grape seed Asian ginseng Goldenseal European mistletoe
Grape seed
Lectins are the active constituents in \_\_\_\_\_ Asian ginseng Eleuthero (Siberian Ginseng) Grape seed European mistletoe Goldenseal
European mistletoe
Berberine is the active constituents in \_\_\_\_\_ Eleuthero (Siberian Ginseng) Grape seed European mistletoe Asian ginseng Goldenseal
Goldenseal
Clinical studies of Asian ginseng before 1990, while not always meeting current standards of research methodology, suggested most of the following effects in humans. Which one of the following was NOT suggested by early clinical studies?
- Improved physical performance
- Improved mood
- Improved intellectual performance
- Improved resistance to infection
Improved resistance to infection
According to our text, what is the likely reason that western ginseng trials have not produced results as promising as Asian tradition and research has suggested?
Western trials used dosages that were too low
According to the German Commission E monograph, all of the following uses for ginseng except one are recommended. Which one is not recommended in the monograph?
- For declining capacity for work and concentration
- For fatigue and debility
- To improve mood
- As an aid to convalescence
To improve mood
What type of Cat’s claw preparation was shown to be effective for osteoarthritis?
- Essential oil
- Alcohol-based extract
- Dried powdered herb
- Water-based extract
Water-based extract
Which of the following is not a source of “polyphenolic oligomers of the flavonoid type”
- Green tea
- Cordyceps
- Pine bark
- Grape seed
Cordyseps
Which herb has been extensively studied in humans as a treatment for cancer?
- Asian ginseng
- Echinacea
- Astralagus
- European mistletoe
European mistletoe
T or F: Goldenseal is most appropriate for antimicrobial treatment of intestinal infections, not systemic infections, due to poor absorption of its active constituents.
TRUE
Which two preparations of Echinacea were approved by German Commission E?
- Expressed juices of the aerial parts of E. pallida
- Alcohol extracts of the root of E. pallida
- Expressed juices of the aerial parts of E. purpurea
- Alcohol extracts of the root of E. purpurea
Expressed juices of the aerial parts of E. purpurea
and Alcohol extracts of the root of E. pallida
Which constituent is apparently not present in expressed juice echinacea products?
- alkamides
- polysaccharides
- cicoric acid
cicoric acid
T or F: Studies such as Dorn (1989), showing that echinacea can shorten the duration of a cold, typically give larger amounts of the preparation when symptoms first appear, followed by a smaller dosage for the remainder of treatment.
TRUE
According to our text, why may liquid echinacea preparations be more effective than solid forms that are swallowed?
- Liquid preparations may encourage better compliance
- Liquid preparations may have higher concentrations of active constituents
- Liquid preparations may act locally on lymphoid tissues in the oropharynx
- Liquid preparations may be better absorbed
Liquid preparations may act locally on lymphoid tissues in the oropharynx
All of the following side effects have been reported for ginseng. According to NCCAM, which group may have been due to another herb or drug in the ginseng product?
- Headaches and sleep and gastrointestinal problems
- Allergic reactions
- Lower levels of blood sugar in diabetics
- Breast tenderness, menstrual irregularities, and high blood pressure
Breast tenderness, menstrual irregularities, and high blood pressure
People are more likely to experience allergic reactions to echinacea if they are allergic to which of the following groups of plants?
- Ragweed, chrysanthemums, marigolds, and daisies
- Pigweed/tumbleweed, Russian thistle and green molly
- Mountain cedar, maple, elm
- Ryegrass, timothy, blue, and orchard grasses
Ragweed, chrysanthemums, marigolds, and daisies
What is the physiological action of a Diaphoretic?
- Form protective coating over pharyngeal mucosa
- Reduce irritability and stimulation of cough receptors above and below the pharynx
- Induces perspiration
- Increase ciliary activity, reduce mucus viscosity, liquefy pulmonary secretions
- Form protective coating over pharyngeal mucosa
Induces perspiration
What is the physiological action of an Expectorant?
- Form protective coating over pharyngeal mucosa
- Reduce irritability and stimulation of cough receptors above and below the pharynx
- Induces perspiration
- Increase ciliary activity, reduce mucus viscosity, liquefy pulmonary secretions
- Form protective coating over pharyngeal mucosa
Increase ciliary activity, reduce mucus viscosity, liquefy pulmonary secretions
What is the physiological action of an Anti-tussive?
- Form protective coating over pharyngeal mucosa
- Reduce irritability and stimulation of cough receptors above and below the pharynx
- Induces perspiration
- Increase ciliary activity, reduce mucus viscosity, liquefy pulmonary secretions
- Form protective coating over pharyngeal mucosa
Reduce irritability and stimulation of cough receptors above and below the pharynx
What is the physiological action of a Mucilaginous?
- Form protective coating over pharyngeal mucosa
- Reduce irritability and stimulation of cough receptors above and below the pharynx
- Induces perspiration
- Increase ciliary activity, reduce mucus viscosity, liquefy pulmonary secretions
- Form protective coating over pharyngeal mucosa
Form protective coating over pharyngeal mucosa
Sambucus nigra
Elder
Ivy
Butterbur
Elder
Hedera helix
Elder
Ivy
Butterbur
Ivy
Petasides hybridus
Elder
Ivy
Butterbur
Butterbur
Which plant part is used in Ivy? bulb leaf leaf and flowers root bark
Leaf
Which plant part is used in Linden, elder, or meadowsweet? bulb leaf only flowers root bark
Flower
Which plant part is used in Eucalyptus? bulb leaf only leaf and flowers root bark
Leaf
What is the active constituent of Eucalyptus ?
Cineol
Saponins
Alkaloids
Cineol
What is the active constituent of Ivy?
Cineol
Saponins
Alkaloids
Saponins
What is the active constituent of Ephedra?
Cineol
Saponins
Alkaloids
Alkaloids
Which one of the following herbs has NOT been traditionally used to induce diaphoresis (sweating, especially to an unusual degree as a symptom of disease or a side effect of a drug.)?
- Elder
- Linden
- Ivy
- Meadowseet
Ivy (Hedera helix)
T or F: Research on the pain-relieving efficacy of willow bark (salicis cort) proves that virtually all of the effect is due to the salicylate content of the herb.
FALSE
Which one of the following herbs is NOT used as a source of essential oils in cough remedies and expectorants?
- Eucalyptus
- Pine
- Butterbur
- Thyme
Butterbur (Petasites hybridus)
Prospan is the brand name of the herbal product containing which botanical species?
Hedera helix (Ivy)
Which plant part(s) of petasides hybridus (butterbur) was first used for an extract called Ze 339, developed to treat allergic rhinitis? bulb leaf only leaf and flowers root bark
leaf
Which herb has potential adverse effects including palpitations, elevated blood pressure, and sleeplessness?
Ephedra
Which one of the following has NOT been traditionally used as a mucilaginous herb?
- Mullein
- Ivy
- Marshmallow
- Plantain
Ivy (Hedera helix)
Indicate which one of the clinical conditions listed that has NOT responded to treatment with ivy (Hedera helix) extract in controlled trials, according to our text.
- Chronic obstructive bronchitis in adults
- Chronic obstructive bronchitis in children
- Respiratory infections in children
- Bronchial asthma in children
Respiratory infections in children
Which two of the following botanicals can contain potentially toxic pyrrolizidines?
- Plantain
- Butterbur
- Coltsfoot
- Mallow
Coltsfoot and Butterbur (Petasites hybridus)
People are more likely to experience allergic reactions to butterbur if they are allergic to:
Ragweed
Chrysanthemums
Marigolds
Daisies
Avena sativa is the latin name for :
Oat
Hypericum perforatum is the latin name for:
St John’s Wort
Boswellia serrata is the latin name for:
Frankincense
What herbals are most known for potentiating anticoagulant medications? Bromelain (Ananas comosus) St John's Wort (Hypericum perforatum) Frankincense Oat
Bromelain (Ananas comosus), St John’s Wort (Hypericum perforatum)
