560P Botanicals Flashcards by Monica Salvatierra

______ increase ciliary activity, reduce mucus viscosity; liquefy pulmonary secretions
Ex: Eucalyptus, thyme

Expectorant herbs

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______ form protective coating

Ex: Mullein, Marshmallow, Plantain

Mucilaginous herbs

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What condition(s) are the tannin-containing herbs helpful in addressing?

Acute diarrhea

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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

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What constituent of licorice can raise BP and is removed in some preparations?

Glycyrrhizin

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What does a carminative do in the digestive system?

Relieves bloating and fullness

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What does a cholagogue do in the digestive system?

Promotes bile production and emptying of the gallbladder

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What does a bitter do in the digestive system?

Stimulates gastric secretions

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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

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What is the relationship between alliin, alliinase, and allicin in the pharmacokinetics of garlic?

Allianase acts on alliin to produce allicin

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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

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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

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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

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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

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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

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What is standardization about and what are its main purposes?

Standardization guarantees the content of one or more active constituents and marker compounds

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common preparation using alcohol or alcohol+water to produce extracts of a wide variety of herbs and herb combinations

Tincture

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especially useful for giving botanical medicines to children

Syrups

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alcohol-free preparation that would be expected to contain only lipid-soluble components

Medicinal Oils

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a solution of a volatile substance in alcohol of alcohol+water

Medicinal Spirits

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made from fresh plant parts and contain water-soluble components

Plant Juices

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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

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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

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covered with room temperature water, stands 6 hours, strained

Decoction
Maceration
Infusion

Maceration

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* 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? 1. Interactions between herbs and drugs 2. Excessive prices for commercial herbal products 3. Adulteration of some preparations with drugs - Lack of routine reporting of adverse events 4. Lack of standardization among herbal preparations

2. 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? 1. The U.S. has always led the way worldwide in the development and testing of botanical medicine products 2. Herbal medicines are subjected to more regulation in European countries such as Germany. 3. Herbal products are regulated as dietary supplements in the US. 4. Herbal medicines have higher stature in medical education and clinical practice in European countries such as Germany.

1. 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. 1. Cultivation 2. Climate 3. Soil quality 4. Plant genetics 5. All of the above are factors

5. 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. 1. Aqueous extracts are high in polar compounds while alcohol extracts are high in lipophilic constituents 2. Aqueous and alcohol extracts are both high in polar compounds 3. Aqueous and alcohol extracts are both high in lipophilic constituents 4. Aqueous extracts are high in lipophilic constituents while alcohol extracts are high in polar compounds 5. All are correct

1. 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? 1. Can characterize the presence and relative amounts of several herb components 2. Can be used to compare batches of the same product for quality control 3. Can confirm product identity by comparing products to standard reference samples 4. Utilizes high-performance liquid chromatography 5. All are true 6. All are false.

5. All are true

Which of the following, if any, is not an advantage of coated tablets over uncoated tablets? 1. Masks any unpleasant tastes of active ingredients 2. Allows for controlled or delayed release of active ingredients 3. Reduces the cost of the product 4. Extends shelf life Improves ease of swallowing 5. All are true 6. All are false

3. 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. 1. The Commission E was appointed by a government agency to review phytotherapeutic agents for efficacy and safety 2. Commission E monographs only review single herbs and preparations made from them 3. The Commission E continues to gather and review monographs today - - The Commission E monographs are only available in German language editions 4. All are correct 5. None are correct

1. 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: 1. Evidence of benefit only from 1 small randomized controlled trial (RCT) of inadequate size and quality of design 2. Conflicting evidence of benefit from multiple RCTs with no clear benefit from the better designed trials, 3. Evidence of benefit only from observational studies and non-randomized trials with no basic science supporting evidence 4. 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? 1. Inhibits progression of atherosclerosis 2. Lowers blood triglycerides 3. Lowers total blood cholesterol 4. Lowers blood pressure 5. All of the above are effects 6. None of the above are effects

5. 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? 1. headache, itchy eyes, gastrointestinal issues, asthma, fatigue, and drowsiness 2. anxiety, difficulty urinating, dry mouth, headache, heart damage, high blood pressure, irregular heart rhythms 3. headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skin reactions 4. breath and body odor, heartburn, upset stomach, and allergic reactions

3. 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? 1. Tension headache 2. Diabetic neuropathy 3. Chronic back pain 4. Osteoarthritis 5. Migraine headache

Osteoarthritis and Chronic back pain

Which botanical has been found more effective as the whole dried herb than as an ethanolic extract? 1. Boswellin 2. Feverfew 3. Butterbur 4. 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? 1. bilobalides 2. ginkgolic acids 3. kaempferol glycosides 4. ginkgolides

ginkgolic acids

On which two families of constituents are medicinal ginkgo extracts standardized? 1. hydroxykynurenic acids 2. terpene lactones 3. vanillic acids 4. 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? 1. Activities of daily living, social behavior, care needs 2. Global assessment of the patient by the physician 3. Psychometric assessment of cognitive abilities 4. 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 1. intermittent claudication 2. prevention of stroke 3. vertigo or tinnitus, if due to vascular or involutional etiology 4. 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) 1. Immunosuppressants 2. Anticoagulants 3. Protease and reverse transcriptase inhibitors 4. 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? 1. 70% 2. 30% 3. 15% 4. 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? 1. Liver damage 2. Carcinogenicity 3. Teratogenicity 4. 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? 1. indica 2. edulis 3. officinalis 4. japonica

officinalis

Valerian products with a high content of which constituent should not be used due to potential toxicity? 1. Acetoxyvalerenic acid 2. Valerenic acid 3. 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? 1. Lavender 2. Passion flower 3. Hops 4. Lemon balm 5. 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? 1. Reductions in blood markers of the stress response 2. Decline in EEG potentials that correlate with vigilance and alertness 3. More relaxed and less depressed self-rated mood 4. Increased "happiness" based on autonomic nervous system responses 5. 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. 1. Increase in coronary blood flow 2. Increased amplitude of myocardial contractions 3. Cardioprotective effects during recovery from cardiac ischemia, indicated by reduced release of lactate dehydrogenase 4. Increase in cardiac stroke volume 5. All of the above 6. None of the above

all of the above

How does hawthorne (Crataegus monogyna) extract differ pharmacologically from cardiac glycosides such as digitalis? 1. Hawthorne is positively inotropic yet proarrhythmic 2. Hawthorne is negatively inotropic yet proarrhythmic 3. Hawthorne is negatively inotropic yet antiarrhythmic 4. 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? 1. Lily-of-the-valley 2. Oleander 3. False hellbore 4. 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. 1. Significantly reduced foot and ankle edema after a long distance airplane flight 2. Significantly reduced symptomatic complaints in patients with chronic venous insufficiency 3. Equivalence between horse chestnut (Aesculus hippocastanum) extract and compression stocking therapy for reducing edema in patients with chronic venous insufficiency 4. Significantly reduced leg volume in patients with chronic venous insufficiency 5. All of the above 6. 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? 1. Postoperative 2. Chemotherapy 3. Morning sickness 4. 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? 1. Paparavine 2. Liquiritin 3. Glycyrrhizin 4. 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? 1. Antibiotic-associated diarrhea 2. Travel-related diarrhea 3. Nutritionally-related (feeding by gavage) 4. 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. 1. Osmotic agents 2. Anthranoid-containing herbs 3. Bulk-forming agents

Anthranoid-containing herbs

Which of the following is an FDA-approved non-prescription drug? 1. Cascara 2. Senna 3. Rhubarb 4. 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? 1. Cascara 2. Aloe 3. Senna 4. 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? 1. Aloe 2. Castor oil 3. Senna 4. 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? 1. Reduce blood prolactin levels 2. Inhibition of 5-alpha reductase enzyme 3. Inhibit prostatic aromatase 4. 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? 1. Inhibit prostatic aromatase 2. Inhibition of 5-alpha reductase enzyme 3. Anti-inflammatory effects 4. 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? 1. Inhibition of 5-alpha reductase enzyme 2. Inhibition of aromatase enzyme activity 3. 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? 1. Saw palmetto appears to affect readings of prostate-specific antigen (PSA) levels 2. Blue cohosh is an acceptable substitute for black cohosh 3. 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? 1. Expands both the adaptation phase and the exhaustion phase of the stress response. 2. Delays or prevents both the adaptation phase and the exhaustion phase of the stress response. 4. Expands the adaptation phase while delaying or preventing the exhaustion phase of the stress response. 5. 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? 1. Improved physical performance 2. Improved mood 3. Improved intellectual performance 4. 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? 1. For declining capacity for work and concentration 2. For fatigue and debility 3. To improve mood 4. As an aid to convalescence

To improve mood

What type of Cat's claw preparation was shown to be effective for osteoarthritis? 1. Essential oil 2. Alcohol-based extract 3. Dried powdered herb 4. Water-based extract

Water-based extract

Which of the following is not a source of "polyphenolic oligomers of the flavonoid type" 1. Green tea 2. Cordyceps 3. Pine bark 4. Grape seed

Cordyseps

Which herb has been extensively studied in humans as a treatment for cancer? 1. Asian ginseng 2. Echinacea 3. Astralagus 4. 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? 1. Expressed juices of the aerial parts of E. pallida 2. Alcohol extracts of the root of E. pallida 3. Expressed juices of the aerial parts of E. purpurea 4. 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? 1. alkamides 2. polysaccharides 3. 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? 1. Liquid preparations may encourage better compliance 2. Liquid preparations may have higher concentrations of active constituents 3. Liquid preparations may act locally on lymphoid tissues in the oropharynx 4. 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? 1. Headaches and sleep and gastrointestinal problems 2. Allergic reactions 3. Lower levels of blood sugar in diabetics 4. 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? 1. Ragweed, chrysanthemums, marigolds, and daisies 2. Pigweed/tumbleweed, Russian thistle and green molly 3. Mountain cedar, maple, elm 4. 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.)? 1. Elder 2. Linden 3. Ivy 4. 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? 1. Eucalyptus 2. Pine 3. Butterbur 4. 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? 1. Mullein 2. Ivy 3. Marshmallow 4. 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. 1. Chronic obstructive bronchitis in adults 2. Chronic obstructive bronchitis in children 3. Respiratory infections in children 4. Bronchial asthma in children

Respiratory infections in children

Which two of the following botanicals can contain potentially toxic pyrrolizidines? 1. Plantain 2. Butterbur 3. Coltsfoot 4. 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)