Botanicals - Cardiovascular Flashcards
How many CV botanicals listed for NPLEX2. Name as many as you can.
There are 19 botanicals for the Cardiovascular system. Allium cepa Allium sativum Capsicum frutescens Coleus forskohlii Commiphora mukul Cordylalis ambigua Crataegus oxycantha Digitalis purpurea Gingko bilboa Leonarus cardiaca Olea europea Plantago major Rauwolfia serpentina Scutellaria baicalensis Selenicereus grandiflorus Theobroma cacao Veratrum album/viride Vinca major/minor Viscum album/flavescens
Allium cepa indications
Internal:
Urinary infections: Urgency, pus, hematuria, stones
Elevated Cholesterol & platelet aggregation; elevated BP
Inhibits cyclooxygenase (COX) & lipoxygenase (LOX) therefore useful in inflammatory conditions
Elevated blood glucose in type 2 DM: ADPS competes with insulin for degradation sites in the liver
External (Topical):
dermatophytosis, onychomycosis, warts, vaginitis, otits media
Allium cepa CI
1) Hypothyroidism: Disulphides/allyl alcohols: Reduces iodine uptake by the thyroid (goitrogenic); if patients eat lots of raw onions, limit them as it may interfere with iodine uptake; cooked onions don’t have the goitrogenic effect.
2) Bleeding disorders, anticoagulant therapy
Allium cepa Interactions
Potentiates anticoagulants (warfarin), insulin, and hypoglycemic drugs (Metformin, Glyburide, Rosiglitazone)
Allium cepa constituents
Disulphides (ADPS, s-methyl csyteine sulfoxide) [Onions smell cause of sulpher]
Phenolic acids (caffeic, sinapic, p-courmaric) [onions are round shape]
Flavonoids (quercitin) [most vegetables have flavonoids]
Sterols, saponins, pectin, oils
Allium cepa actions
Hypoglycemic, antimicrobrial, carminitive
Allium cepa pharmacology
Active components (disulfides) give the tearing properties of onions but when heated active components are destroyed, caramelized onions have no more active components
ADPS: increases half life of insulin (due to competition at degradation sites), increases insulin secretion, increases hepatic metabolism of glucose.
Inhibits bacterial reproduction (staphylococcus spp.)
Reduces platelet aggregation
antioxidant for LDL cholesterol
decreases leukotrienes due to inhibition of COX and LOX
Allium sativum indications
Upper respiratory infections: cough, catarrh, pertussis, otitis media
intestinal parasites: worms; candidiasis
Hypercholesterolemia, hyperlipidemia [reduces serum cholesterol and triglyceride levels while raising high density lipoprotein’s - HDL]. It’s antioxidant properties help prevent the peroxidation of fats which is another factor in the development of atherosclerosis. Intermittent claudication; mild to moderate hypertension; prevention of heart attack and strokes.
Allium sativum caution
Therapeutic doses of garlic may potentiate the activity of anticoagulant medication’s.
Allium sativum Actions
Antimicrobial (antifungal, antiprotozoal, antibacterial) hypotensive, hypolipidemic
Allium sativum constituents
Alliin, diallyl disulphide
Capsicum frutescens Indications
Topical: diabetic neuropathy, pruritus, psoriasis, OA, RA, migraines
Internal: hypochlorydia, H pylori, maldigestion, dyspepsia, billary insufficiency, atonic constipation, artherosclerosis, G.I. or respiratory infection, hypercoagulation, Stimulant, capillary atoni.
Capsicum frutescens Contraindications
Pregnancy; due to G.I. upset, and leaf and stem act as uterine stimulant
Capsicum frutescens interactions
Cayenne compounds the persistent dry cough side effect of ace inhibitors lisinopril
Look at the word
ACEi
cApsiCum frutEscens and remember the cough in ACE inhibitors
Too much cayenne will definitely make you cough!
Capsicum frutescens constituents
Capsaicinoids (up to 1.5%): capsaicin, dihydricapsaicin, carotenoids; saponins
Capsicum frutescens Actions
Circulatory and vasomotor stimulant, rubefacient/counterirritant, gastric stimulant; antimicrobial
Capsicum frutescens pharmacology
Powerful circulatory and digestive stimulant
Lowers cholesterol triglycerides and LDL;:HDL ratio
Decreases platelet aggregation
Capsaicin binds to C type vanilloid receptor (VR1) and opens a cationic channel allowing the influx of calcium. The calcium influx is an excitatory response, which releases Neuro peptides (substance P) that is responsible for chemo genic pain, Thermo regulation and neurogenic inflammation. By binding to the VR1 receptor, substance P will be depleted, and pain transmission decreases. C-fibers are related to pain, not perception of touch, temperature and pressure.
Stimulates production of collagenase as an anti-inflammatory (osteoarthritis, rheumatoid arthritis)
coleus forskohlii indications
Asthma, dilated cardiomyopathy, hypertension, allergies, glaucoma, hypothyroidism, obesity
coleus forskohlii Contraindications
Active peptic ulcer, pregnancy, lactation, children
coleus forskohlii interactions
May potentiate caridac glycosides (digoxin, Convallaria, digitalis, leonarus), anticoagulants (warfarin), insulin and hypoglycemic drugs (metformin, glyburide, rosiglitazone), antihisamines (diphenhydramine, hydroxyzine, loratidine), levothyroxine
May increase bleed with NSAIDs (apririn, ibuprofen, napoxen, celecoxib) antagonize proton pump inhibitors (esomeprazole)
coleus forskohlii constituents
Diterpene glycosides
coleus forskohlii actions
Adenylate cyclase activator, positive iontropic, vasodilator, hypotnesive, bronchodilator, anti-inflammatory, hypoglycemic, antihistamine, anti-platlet
Commiphora mukul (indian bdellium, Guggul lipid) indications
Elevated LDL, hyperipidemia; inflammation (osteoarthritis); nodulocystic acne
Commiphora mukul (indian bdellium, Guggul lipid) contraindications
Inflammatory bowel disease
Commiphora mukul (indian bdellium, Guggul lipid) interactions
May induce CYP 450, may decrease bio availability of propranolol
Commiphora mukul (indian bdellium, Guggul lipid) actions
Hypolipidemic, anti-inflammatory
Commiphora mukul (indian bdellium, Guggul lipid) Constituents
Gugglusterone E, Z
Mukul = Guggul (sterone) E,Z
Commiphora mukul (indian bdellium, Guggul lipid) pharmacology
Increase hepatic binding sites for LDL
Inhibits cholesterol synthesis in liver; decreases triglycerides (does not work for all patients)
increases fecal excretion of bile acids and cholesterol
decreases pain of osteoarthritis after one month
Convallara majalis (lily of the valley) indications
Arrhythmia, cardiac insufficiency, hypotension
Convallara majalis (lily of the valley) contradictions
Digitalis spp. and caution with other cardiac glycosides
Convallara majalis (lily of the valley) side effects
Nausea, vomiting, headache, disorders of color perception, death
treat with atropine; monitor potassium, glucose, insulin
A girl is twirling in a valley of lilies. She twirls so fast that she starts to feel nauseas and vomits, she gets a headache but keeps spinning until she sees a discolored hue and she almost dies because she has an arrhythmia, hypotension and cardiac insufficiency.
Note: digoxin (Foxglove) has a s/e of yellow/green hue around objects.
Convallara majalis (lily of the valley) interactions
Avoid hypokalemic drugs; diuretics (furosemide, hydrochlorothiazide), corticosteroids (hydrocortisone, prednisone dexamethasone),
cardiac glycosides (digoxin Convallaris, digitalis Leonurus),
antiarrhythmics (atenolol, propranolol, amiodarone),
psuedoephedrine,
Glycyrrhiza
Calcium promotes arrhythmia, potentiates beta-blockers (atenolol, carvedilol, propranolol), many others
Similar to Cardiac glycosides: Convallaria majalis, digitalis purpurea, Leonurus cardiaca
Convallara majalis (lily of the valley) constituents
Glycosides, flavonoids
The lilies have a sweet smelling flavor for flavonoids
Convallara majalis (lily of the valley) actions
Cardiac, digitalis substitute, diuretic
Convallara majalis (lily of the valley) pharmacology
The power and speed of cardiac muscle contraction is increased with reduced relaxation time. Positive ionotropic, negative chronotropic (rate), negative dromotropic (conduction), positive bathmotropic (excitability) effect.
Natriuretic and diuretic in animal studies
dose-dependent venoconstrictive effects an animal tests
Corydalis spp (Corydalis cava, corydalis ambigua) indications
Used for pain management for severe nerve damage, emotional disturbances and tremors; used as a sedative and tranquilizer for high blood pressure and to relax spasms of the small intestines
Corydalis spp (Corydalis cava, corydalis ambigua) contraindications
Pregnancy and breast-feeding
Corydalis spp (Corydalis cava, corydalis ambigua) interactions
none reported
Corydalis spp (Corydalis cava, corydalis ambigua) side effects
Decrease menstrual flow, headaches, fatigue
Corydalis spp (Corydalis cava, corydalis ambigua) overdosage
Chronic spasms with musculature tremor occur with overdosages
Corydalis spp (Corydalis cava, corydalis ambigua) constituents
isoquinoline alkaloids (bulbocapnine, corytuberin, corydaline)
Corydalis a cord of alkaloids
remember isoquinoline
Corydalis spp (Corydalis cava, corydalis ambigua) actions
Mildly sedative, sleep inducing, spasmolytic, tranquilizing and hallucinogenic affect. It’s suppresses CNS, reduces blood pressure and decreases intestinal motility. Strong analgesic
Crataegus oxyacantha (Hawthorn) indications
Arrhythmias, cardiac weakness with valvular murmurs, capillary fragility, mild hypertension
Crataegus oxyacantha (Hawthorn) CI
N/A
Crataegus oxyacantha (Hawthorn) Interactions
Concurrent use with antiplatelet drugs may increase risk of bleeding. It may enhance the activity of cardioactive drugs like digitalis spp., Convallaria majalis and digoxin. Avoid concurrent use with arithmetic antiarrhythmic medication as Hawthorne has similar actions. May increase the side effects of beta blockers.
Crataegus oxyacantha (Hawthorn) constituents
Flavonoids, proanthocyanidins in the fruit, triterpene acids
Crataegus oxyacantha (Hawthorn) pharamacology
procyanidins and flavonoids increase coronary blood flow due to dilatory affects as well as reduces peripheral resistance. This herb is positively Ion0tropic (increase contractility) and positively chronotropic (rate and rhythm). Found to prolong refractory period and increase the action potential duration in guinea pig papillary muscle. Effect is similar to class three antiarrhythmic drugs. Due to high flavonoid content, it may be used to decrease inflammation, decrease capillary fragility and prevent collagen destruction of joints. Found to lower LDL body weight and body fat in animal studies.
Crataegus oxyacantha (Hawthorn) actions
Cardiac tonic, nutritive (for the heart), hypotensive
Digitalis purpurea (Foxglove) indications
Congestive heart failure, atrial arrhythmias
Digitalis purpurea (Foxglove) CI
First or 2nd degree AV block severe carditis, angina, arrhythmias, bradycardia, cardiac hypertrophy, aortic stenosis, kidney failure, hypokalemia, hypocalcemia, hypercalcemia, pregnancy, lactation.
Digitalis purpurea (Foxglove) side effects
Narrow therapeutic range; may experience G.I. symptoms, yellow green halo around objects
Digitalis purpurea (Foxglove) interactions
Avoid hypokalemic drugs; diuretics (furosemide, hydrocholorothiazide) corticosteroids (hydrocortisone, predinsone, dexamethosone) cardiac glycosides (digoxin convallaria, digitalis, Leonarus), antiarrhythmics (atenolol, propranol, amiodarone), pseudoephedrine, Glycyrrhiza,
calcium promotes arrhythmia, potentiates beta blockers (atenolol, carvedilol, propranolol)
Digitalis purpurea (Foxglove) constituents
Cardiac glycosides found throughout entire plant
Digitalis purpurea (Foxglove) actions
Cardiac stimulant, positively inotropic, negatively chronotropic, diuretic, emetic (at high doses)
Digitalis purpurea (Foxglove) pharmacology
Cardioactive glycosides are positively inotropic negatively chronotropic and improve contraction power of the cardiac muscle
Ginkgo bilboa indications
Atherosclerosis, intermittent claudication, impotence from insufficient blood flow, post ischemic stroke, phlebitis, cerebrovascular insufficiency (depression, dementia, poor memory).
Ginkgo bilboa contrindications
Intracranial bleed; severe bleeding
Ginkgo bilboa interactions
Caution in people taking blood thinners (it inhibits PAF)
Ginkgo bilboa constituents
flavone glycosides, bioflavinoids; lactones
Ginkgo bilboa actions
Anti-inflammatory, vasodilator, antiplatelet, antioxidant, inflammation modulator, antineoplastic, nootropic (may improve cognitive function, executive functions, memory and healthy individuals), bronchodilator
Ginkgo bilboa pharmacology
Arterial: vasodilation and increased circulation in medium and small arteries of the periphery
memory: inhibits cyclic nucleotide phosphodiesterases (like caffeine), increases neuronal activity and memory.
Lipid metabolism; inhibits platelet activating factor (PAF) decreasing platelet aggregation and degranulation.
Ginkgo bilboa is LAME:
Lipids- think platelets
Arterial- think vasodilator
MEmory- nootropic
Leonarus cardiaca (Motherwort) indications
Nervous, irritable individuals; restless, nervous individuals during menopause
hyperthyroidism
palpitations (anxiety), reduce coronary perfusion
Leon is playing cards with his mother (who has menopause) and she is nervous, irritable and restless because her heart is palpitating resulting in low coronary perfusion due to her hyperthyroidism.
Ginkgo bilboa CI
Intracranial bleeds, severe bleeding
caution in people taking blood thinners (it inhibits PAF)
Ginkgo bilboa reminds me of bilbo baggins in the Lord of the Rings where there is a lot of bleeding and bashing of heads.
Ginkgo bilboa constituents
Falvone glycosides; bioflavinoids, lactones
these are all of the terpenoid class
Ginkgo->Glycoside
Lame rhymes with Flame->Flavone,
Lame -> L for lactones;
Flavone think bioflavinoids
Ginkgo bilboa actions
Anti-inflammatory, vasodilator, antiplatelet, antioxidant, inflammation modulator, anti-neoplastic, nootropic (may improve cognitive function, executive functions, memory in healthy individuals), bronchodilator
Gingko is a flavone glycoside, bioflavinoid and lactone- all terpenoids
Oleo europaea (olive) indications
Oil from fruit: topically for dry skin, cradle cap; decreases heart disease risk
leaf: hypertension
olive leaf extract: malarial fever, chills, diarrhea; severe viral infection with fevers, chills
Olaf is eating at the Olive Garden in Europe. There are olive branches with leaves and fruit used as decorations. Olaf bites the leaf and it’s bitter and makes his heart blood flow. He ate the leaf because he saw there were no bugs (bacterial or viruses) on it. It was so bitter his blood pressure dropped. The waiter brings out fresh olive oil and Olaf thinks he is supposed to pour it on his head and hands to soften and smooth his ice skin. He ends up swallowing the extract and gets an upset stomach (use after meals) followed by fever, chills, and diarrhea (oil leaf extract treats). Worse he ends up getting a very large gallstone. (CI)
Oleo europaea (olive) CI
Large gallstones
Oleo europaea (olive) cautions
Olive leaf extract is a G.I. irritant so take after meals
Oleo europaea (olive) constituents
Fruit: fatty oils (75% linoleic acid), licithin and bitter. Leaf: bitter glycoside, monoterpenes
Oleo europaea (olive) pharmacology
Leaf increases phagocytosis, bitter (Oleanolic acid), bactericidal and virucidal, increases coronary blood flow.
Olive leaf extract: calcium elenolate is the active ingredient that kills viruses and has bacterial static effects. Oleuropein inhibits LDL oxidation and acts as an antioxidant free radical scavenger.
Oleo europaea (olive) actions
Nutritive, emollient, demulcent
Rauwolfia serpentina (Snake root, Rauwolfia) Indications
Hypertension, nervousness and insomnia
See a snake, makes your heart skip a beat and raises your blood pressure. You get so nervous, it gives you nightmares and keeps you up all night!
Rauwolfia serpentina (Snake root, Rauwolfia) CI
Rauwolfia is contraindicated in depression, Parkinson’s disease, ulceration, pheochromocytoma, pregnancy and lactation.
it lowers catecholamines
if i were to see a big wolf snake, my heart would skip a beat and my blood pressure would sky rocket. So this drop actually decreases catecholamines to decrease BP. Ajmaline in the root has anti-arrhythmic effects.
After the scare from seeing the huge snake, you get so tired you can’t get hard so you get depressed. [S/e]
So he begins to drink EtOH and take barbiturates which messes up his heart so he takes glycosides and gets Parkinson and ends up on Levodopa [interactions]
Rauwolfia serpentina (Snake root, Rauwolfia) interactions
Alcohol: increases impairment
neuroleptics and barbiturates: increase drug affect with these medication
digitalis – glycosides: severe bradycardia occurs in combination with digitalis glycosides
levodopa: herb effect is reduced in combination with levodopa along with an increase in extrapyramidal motor symptoms in combination with sympathomimetics
Rauwolfia serpentina (Snake root, Rauwolfia) side effects
Nasal congestion, depression, tiredness, erectile dysfunction
Rauwolfia serpentina (Snake root, Rauwolfia) constituents
indole alkaloids (reserpine); antihypertensive alkaloids; anti-arrythmic alkaloids (ajmaline)
Rauwolfia -> R for Risperine (indole alkaloids)
Rauwolfia serpentina (Snake root, Rauwolfia) actions
Anti-arrhythmic, antihypertensive
Selenicerus grandifloras (night-blooming cereus) indications
Impaired heart function, rapid pulse with edema
mitral regurgitation
angina, palpitations, chest pain, dyspnea, arrhythmia
prostatitis, kidney congestion and other urinary elements
Selenicerus grandifloras (night-blooming cereus) CI
Pregnancy, lactation, high doses
Selenicerus grandifloras (night-blooming cereus) Side effects
Nausea, vomiting, arrhythmia, tachycardia, confusion, headache, G.I. distress, heart failure
Think of being out in a desert for a long period of time.
Selenicerus grandifloras (night-blooming cereus) Interactions
May potentiate MAOI’s (phenelzine)
grand I fl Or A s -> Backward AOI just need to remember the M
Monoamine oxidase inhibitors- depression, panic, social phobia
Selenicerus grandifloras (night-blooming cereus) constituents
Phenylethylamine alkaloids (hordenine); amines: tyramine
Selenicerus grandifloras (night-blooming cereus) actions
Sympathetic stimulant to the heart and kidneys, diuretic
Recall the serpentina decreases catecholamines whereas the cactus increases them
Selenicerus grandifloras (night-blooming cereus) pharmacology
Has similar effects to digitalis, which includes stimulation as well as coronary and peripheral vessel dilation. It also stimulates the motor neurons of the spinal cord
Theobroma cacao (Cocoa) Indications
Broncial smooth muscle spasms, cardiovascular health, diarrhea
Theobroma cacao (Cocoa) CI
N/a
Theobroma cacao (Cocoa) side effects
Constipation and insomnia and high doses. amines can trigger migraine attacks
Theobroma cacao (Cocoa) interactions
N/a
Theobroma cacao (Cocoa) consitiuents
Purine alkaloids (theobromine, caffeine), fat (oleic acid, steric acid) proteic substances, starch, monosaccharides/oligosaccharides (glucose, fructose), isoquinoline alkaloids, catechin tannins.
Theobroma cacao (Cocoa) actions and pharmacology
Cocoa seeds can cause constipation due to the tannin content.
The herb contains methylxantines (theobromine) which have diarrhetic, broncolytic and vasodilatory affect. They also stimulate cardiac muscle performance and act as a muscle relaxant.
Veratrum album (American hellebore) indications
V. album: hypertension; topical: insecticide
V. viride: rapid full pulse, hypertension, fever, inflammation, flushed skin, blood shot eyes
Think of someone that looks like hell (hellebore)
Veratrum album (American hellebore) CI
Do not prescribe, extremely toxic, pregnancy, lactation
Veratrum album (American hellebore) side effects
Lacrimation, salvation, vomiting, burning sensation of the mouth and throat, in ability to swallow, vertigo, paralysis, convulsions, death. Prescribe atropine and transport to ER
Think of American’s burning in hell–crying, salivation, vomiting, burning in mouth and throat, inability to swallow, vertigo, paralysis (from fear), convulsions and wishing for death
Veratrum album (American hellebore) Interactions
DO NOT PRESCRIBE
Veratrum album (American hellebore) Constituents
Steroid alkaloids (protoveratrine A and B), glycoside alkaloids
Veratrum album (American hellebore) actions
Circulatory depressant, anti-spasmodic, hypotensive
Veratrum album (American hellebore) pharmacology
V. album: Protoveratrine A and B act as a sensory nerve irritants, inhibit activations of sodium channels
V. viride: Alkaloids reduces blood pressure and slows down pulse rate by inhibiting activation of sodium channels in cells that regulate cardiac activity
Vinca major/minor (V. major- greater periwinkle, V. minor- lesser periwinkle) indications
Circulatory disorders, cerebral circulatory impairment and support for the metabolism in the brain. Also used for loss of memory and hypertension. Also used in concussion management to enhance blood flow to the brain because an acute post TBI, the brain loses 30% of blood flow so it’s important to get oxygen and nutrients so the neurons do not become hypoxic and die. (do not administer antioxidants and anti-inflammatories immediately post concussion to let the microglial cells clear out the neuronal debris fields. Note: refer off for CT to check there is not a brain bleed first).
Vinca major/minor (V. major- greater periwinkle, V. minor- lesser periwinkle) CI
Pregnancy, severe cerebral hemorrhage
Vinca major/minor (V. major- greater periwinkle, V. minor- lesser periwinkle) side effects
G.I. complaints and skin flushing, but no health hazards reported with proper administration
Vinca major/minor (V. major- greater periwinkle, V. minor- lesser periwinkle) constitiuents
Indole alkaloids: vincamine, cinblastine; tannins; flavinoids
Vinca major/minor (V. major- greater periwinkle, V. minor- lesser periwinkle) Actions
Circulatory stimulant (increases blood flow to the brain), hypotensive
Vinca major/minor (V. major- greater periwinkle, V. minor- lesser periwinkle) pharmacology
Vincamine alkaloids is a hypotensive; vincopectine is a drug derived from vincamine and used for Alzheimer’s.
Viscum album (European mistletoe) Viscum flavescens (American mistletoe) Indications
Subcutaneous injections: tumors
internal: moderate to mild hypertension 160/100 mmHg; weak, irregular heart with hypertrophy, shortness of breath, valvular insufficiency; nervous tachycardias; epilepsy; tearing neuralgic or rheumatic pains.
Viscum album (European mistletoe) Viscum flavescens (American mistletoe) CI
Chronic progressive infections (TB, AIDS), tumors of CNS and or intraspinal, pregnancy, fever, known allergy
Viscum album (European mistletoe) Viscum flavescens (American mistletoe) Interactions
The tannin content may complex with iron and result in adverse sequelae on blood components
Viscum album (European mistletoe) Viscum flavescens (American mistletoe) side effects
Local inflammation around injection site. High fever, chills, headaches, death
Viscum album (European mistletoe) Viscum flavescens (American mistletoe) constituents
Lectins, flavinoids, alkaloids, tannins
Viscum album (European mistletoe) Viscum flavescens (American mistletoe) actions
Hypotensive, cerebral circulatory stimulant, tumor inhibition with injection
Viscum album (European mistletoe) Viscum flavescens (American mistletoe) pharmacology
Mistletoe lectins in the drug are hypotensive, cytotoxic and immuno stimulating. The immunostimulatory action is mainly attributed to the stimulation of mono nuclear phagocytic system and macrophage-derived cytokines. The antineoplastic activities is due to the stimulation of enzymes that repair damage DNA by lymphokines. Mistletoe has anti-inflammatory properties
