Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Nurs 575 Anesthesia Pharmacology > Alternative medications/Herbs > Flashcards

Alternative medications/Herbs Flashcards

1
Q

How are herbal medications classified

A

Dietary supplements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Whose burden is it to prove an herbal (CAM) product is unsafe?

A

Food & Drug Administration
* Before it can be withdrawn from Market

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Factors leading to unpredictable pharmacologic effects of herbal preparations

5

A
  • inaccurate labeling
  • misidentified plants
  • adulterants
  • variations in natural potency
  • unstandardized processing methods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

2 major problems of herbal medicine in research

A
  • quality control
  • added adulterants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the six most common CAMs in order?

A
  1. Natural products (17.7%)
  2. Deep Breathing (12.7%)
  3. Meditation (9.4%)
  4. Chiropractic/Osteopathic manipulation (8.6%)
  5. Massage (8.3%)
  6. Yoga (6.1%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If a person is taking herbal medicine, what percent take multiple herbs @ a time? How many users take prescripton drugs concomitantly?

A
  1. 50%
  2. 25%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Because so many herbal users take multiple herbs along with their prescribed medications, what complication does this cause?

A

Difficult to attribute adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What percent of surgical candidates take herbal medications?

A

22-32%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

By what mechanisms do herbal medications affect the perioperative period?

A
  1. Via direct pharmacological effects
  2. Alteration of action of conventional drugs @ receptor sites
  3. Alteration of ADME of conventional drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What % of anesthesia professionals do not routinely check herbal use? What % of pts are forthcoming about their herbal use?

A

90% of Anesthetists/Anesthesiologists do not ask
70% of pts are not forthcoming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should we request to determine herbal medication use in pts? Why?

A

Ask pts to bring their herbal/dietary supplements with them during the pre-op evaluation
* 1 in 5 (20%) of pts are unable to identify the herbals they take

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

You’re performing a pre-op evaluation on a non-elective surgery pt. They have not been compliant with instruction to d/c their herbals. Can anesthesia proceed safely?

A

Usually can proceed safely @ discretion of anesthesia provider, who should be familiar with common herbals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When should most herbal medications be discontinued before surgery?

A

2 weeks prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Echinacea and what is it used for?

A

Member of the daisy family (purple coneflower)
* Prophylaxis/treatment of viral, bacterial, & fungal (doubtful) infection
* Particularly URIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Biological activity of Echinacea?

A

Can be (depending on extraction method):
* Anti-inflammatory
* Immunostimulatory
* Immunosuppressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What patients should be counseled to avoid Echinacea

A

Those who require perioperative immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Besides pts who require immunosuppression, what other pts should avoid Echinacea?

A

Liver pts or at risk of reduced hepatic function/blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ephedra is native where, and what is it called?

A

Central asia
* ma huang in chinese medicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Ephedra used for?

A
  • Promote weight loss
  • Increase energy
  • Tx of respiratory conditions (asthma/bronchitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Ephedra contains what alkaloids?

A
  • Ephedrine
  • Pseudo-ephedrine
  • Nor-ephedrine
  • Methyl-ephedrine
  • Norpseudo-ephedrine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How are ephedra commercial preparations standardized?

A

To a fixed ephedrine content

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What occurred in 2004 to Ephedra?

A

FDA barred it’s sale due to publicity surrounding adverse reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Ephedra’s effects on hemodynamics, and primary reason for these effects?

A

Inc. in arterial BP & HR
* (Predominant reason) Due to ephedrine noncatecholamine sympathomimetic effects via α1, β1, & β2 receptors (direct and indirect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

By what mechanism may a pt taking ephedra cause perioperative hemodynamic instability?

A
  • Depletion of endogenous catecholamines due to chronic use -> tachyphylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Ephedra + MAOIs = ?
* Hyperpyrexia (>41 C) * HTN * Coma
26
In patients with depleted catecholamine stores due to ephedra use, which medications are preferred for HoTN & Bradycardia?
Direct acting sympathomimetics
27
How long prior to surgery should Ephedra be d/c'd?
24 hrs
28
What is garlic & what is it used for?
Most extensively researched medicinal plant Modify risk for atherosclerosis by reducing: * Arterial BP * Thrombus formation * Serum lipid/cholesterol concentrations
29
Where does garlic derive it's effects from?
Sulfur-containing compounds * Allicin & transformation products, primarily
30
Garlic perioperative concerns?
Increased risk of bleeding via: * Inhibit platelet aggregation * Interact w/ warfarin -> inc. INR * combined with other platelet aggregate inhibitors
31
When should garlic be d/c'd before surgery?
7 days (irreversible platelet inhibiton, like ASA)
32
Besides the laundry list of health benefits, what has Ginger been used for in healthcare?
* Anti-emetic for motion sickness & prevent N/V post laparoscopy * Reduce severity of chemotherapy induced nausea
33
Ginger's effects on coagulation?
Inhibit arachidonic acid release of platelet serotonin -> dec. platelet aggregation * Similar potency to aspirin
34
When should ginger be dc'd?
2 weeks before OR
35
Ginkgo's historical use? | 7
* Cognitive d/o * Peripheral vascular disease * Macular degeneration * Vertigo * Tinnitus * ED * Altitude sickness
36
Studies show Ginkgo may be effective in improving what?
Cognitive performance in: * pts w/ Alzheimer disease * Multi-infarct dementia
37
Ginkgo's MoA
* Alters vasoregulation * Antioxidant * modulates neurotransmitter/receptor activity * inhibits platelet activating factor
38
What kind and how many adverse events have been reported w/ perioperative ginkgo administration?
* Spontaneous Intracranial bleed - 4 cases * Spontaneous hyphema (bleeding in eye) - 1 case * Post-op bleeding s/p Lap-chole - 1 case
39
When should ginkgo be dc'd?
36 hrs - 2 weeks pre-op
40
Ginseng's purported benefit?
Labeled as an adaptogen * protects against stress * Restores homeostasis
41
Ginseng underlying mechanism
Similar to steroid hormones
42
What constituent of ginseng may have irreversible effects in humans?
Antiplatelet activity of panaxynol
43
Ginseng may decrease what?
Post-prandial blood glucose in: * Healthy pts * T2DM Leading to hypoglycemia
44
While ginseng has anti-platelet affects, how does it alter a specific drug?
Decreases warfarin anticoagulation
45
When should ginseng be dc'd before surgery? Why?
7days - 2 weeks Possibly irreversible platelet inhibition
46
What is the predominant chemical in green tea & what are it's effects?
Epigallocatechin-3-gallate (EGCG) - a catechin * Antiplatelet activty by inhibiting thromboxane A2 * Antagonize warfarin by containing Vit K
47
When should green tea be dc'd before surgery?
7 days
48
Kava's effects
* Anxiolytic * Sedative * Antiepileptic * Neuroprotective * LA properties
49
Kava MoA?
Potentiates GABA neurotransmission
50
What is a risk of continuous Kava use?
Increase γ-glutamyl transpeptidase levels * concern for hepatotoxicity
51
Kava and COX
* Inhibits COX * reduces RBF * interferes with platelet aggregation
52
When should Kava be dc'd?
24 hrs before surgery
53
What is saw palmetto traditionally used for?
Tx symptoms associated with BPH (questionable efficacy)
54
Saw palmetto MoA
Inhibits 5α-reductase Inhibits COX -> platelet dysfunction
55
When should saw palmetto be dc'd?
No data (7 days-2weeks is safety net)
56
St. John's wort's alternative name?
Hypericum perforatum
57
A multicenter clinical trial concluded what about St. John's wort?
Not effective in tx of major depression
58
St. John's wort MoA?
Inhibits reuptake of: * 5-HT (serotonin) * NE * Dopamine
59
Adverse effects of St. John's Wort?
* Use with or without SSRIs -> serotonin excess * Increase the metabolism of many drugs * Due to induction of CYP3A4, doubling metabolic activity
60
Drugs affected by St. John's Wort via 3A4? | 6
* Cyclosporine * Alfentanil * Midazolam * Lidocaine * CCBs * Ethinylestradiol
61
Other drugs affected by St. John's Wort besides 3A4?
* Reduced warfarin/NSAIDs effects via 2C9 * Decreased Digoxin levels
62
When should St. John's Wort be dc'd?
at least 5 days before OR
63
D/c of St. John's Wort especially important in what patient population(s)?
* Those awaiting organ transplant * who may require oral anticoagulation should avoid post-op as well
64
What is valerian typically used for?
Sedative * Tx of insomnia * Virtually all herbal sleep aids contain valerian
65
Probably Valerian's MoA?
Modulation of GABA neurotransmission & receptor function
66
Characteristics of Valerian withdrawl
* Mimics acute Benzo withdrawl * Delirium * Cardiac complications
67
What can be give to attenuate valerian withdrawl?
Benzos
68
Based on Valerian's MoA, it should interact with what drugs?
Potentiate sedative effects of anesthetics & other drugs that act on GABA
69
If the pt is unable to taper valerian, what recommendation may an anesthesia provider make?
Continue valerian up until the day of surgery
70
Perioperative concerns with Valerian?
* Inc. sedative effects of anesthetics * Benzo-like withdrawl * Inc. anesthetic requirements (long-term use)
71
What are some less encounter herbals? When should they be d/c'd and why?
1. Boldo 2. Danshen 3. Dong quai 4. Papaya 2 weeks before surgery due to anti-platelet activity/herb-drug interactions
72
Data on the safety of Common Dietary supplements are, what?
Scant in their use in the perioperative period
73
Toxicity concerns of vitamins
Acute and chronic toxicity in high-dose vitamine use (especially fat-soluble)
74
What dietary supplements DO have data surrounding their safety in the perioperative period?
* Coenzyme Q10 * Glucosamine * Chondroitin * Sulphate * Fish oil
75
What is Coenzyme Q10?
Antioxidant compound structurally similar to Vit K Promoted as an antioxidant
76
Coenzyme Q10 may interact with what drug? effect?
Warfarin * Increased risk of bleeding
77
Half-life and D/C recommendation for Coenzyme Q10?
38-92 Hours * D/c 2 weeks before surgery
78
Glucosamine & Chondroitin Sulfate Use?
Supplements in management of OA/joint disorders * Essential components of proteoglycan in normal cartilage
79
Perioperative concern with glucosamine & chondroitin sulfate?
May interact with Warfarin * Inc. INR -> bleeding
80
When should glucosamine & chondroitin sulfate be d/c'd?
2 weeks before surgery, especially if receiving warfarin perioperatively
81
What drug interaction has been found with Fish oil
Omega-3 fatty acids & Warfarin * Extreme elevation of INR
82
When should fish oil be d/c'd?
2 weeks before surgery, especially those taking large doses
83
Perioperative concern with Fish oil?
Omega-3 fatty acids inhibit platelet aggregation and increase bleeding risk
84
What should you know about the rest of the top 10 dietary supplements? * Flaxseed * Fiber/Psyllium * Cranberry * Melatonin * Methylsulfonylmethane (MSM) * Lutein?
No concerns have been published surrounding bleeding or other risks in the perioperative setting
85
What is a general concern surrounding the perioperative use of herbal medications?
Little direct evidence of d/c timing

Nurs 575 Anesthesia Pharmacology (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions