Botanicals Exam 1

Question 1

St John’s Wort - name

Answer 1

Hypericum perforatum

Question 2

St John’s Wort - plant parts used

Answer 2

Flowering tops
Leaves
Buds
Flowers

Question 3

St John’s Wort - active constituents

Answer 3

Hypericins
Hyperforin
Flavonoids

Question 4

St John’s Wort - MOA (3)

Answer 4

Modification of neurotransmitter functions - esp serotonin, norepinephrine, and dopamine

Reuptake inhibition

Potential modification of the HPA axis

Question 5

St John’s Wort - uses

Answer 5

Antidepressant - most effective for mild-moderate depression
(65% of patients show improvement over placebo)

• Improves mood
• Improves sleep
• Reduces anxiety
• Reduces somatic sx

Somatoform disorders (psychological conditions that create or amplify pain and sx that cannot be validated by diagnostic methods)

Good for chronic pain reduction

Question 6

St John’s Wort - contraindications

Answer 6

Bipolar disorder / manic depression - may trigger mania

Question 7

St John’s Wort - drug interactions

Answer 7

Antidepressants
Birth Control pills
Blood thinners
Some drugs for cancer, HIV, or seizures

Question 8

St John’s Wort - side effects

Answer 8

Increased skin photosensitivity  
Itching / rash 
HA 
Sleep disturbance 
Fatigue

Question 9

St John’s Wort - pregnancy & lactation

Answer 9

Not enough evidence to determine safety

May increase risk of colic, drowsiness, or lethargy in infant

Question 10

Garlic - name

Answer 10

Allium sativum

Question 11

Garlic - plant parts used

Answer 11

Bulb (cloves)

Question 12

Garlic - active constituents

Answer 12

Allicin and related sulfur compounds (fresh) - cloves must be crushed to activate

Alliin + allinnase = allicin

S-ally cysteine (SAC) (aged garlic extract)

Question 13

Garlic - MOA cardiovascular (5) and other (2)

Answer 13

Antioxidant (protects LDL) 
Hypolipidemic 
Anti hypertensive 
Anti thrombotic / anti platelet (blood thinning) 
Anti plaque 

Antimicrobial
Anticancer

Question 16

Garlic - uses

Answer 16

Hyperlipidemia - reduce total LDL and Tg (powder, not extract)

Hypertension - reduce systolic and diastolic pressure (powder not extract)

Atherosclerosis Mgmt - reduce intima-media thickness, plaque volume, and improve aortic elasticity

Question 17

Garlic - contraindications

Answer 17

Increases bleeding tendency - avoid prior to surgery or with bleeding disorders

Question 18

Garlic - drug interactions

Answer 18

Isoniazid - TB drug
HIV drugs

Anticoagulants (anti-clotting effects)
Bp drugs (hypotensive effects)
Contraceptives (reduces effectiveness)
Diabetes medications (may reduce fasting glucose)

Question 19

Garlic - side effects

Answer 19

Breath
Body odor
GI upset

All may be mitigated with enteric-coating

Question 20

Garlic - pregnancy & lactation

Answer 20

Food sources safe
Only one study of supplementation - no effects found
Garlic passed in breast milk may upset infant stomach

Question 23

Valerian - name

Answer 23

Valeriana officinalis

Question 24

Valerian - plant parts used

Answer 24

Root

Question 25

Valerian - active constituents

Answer 25

Essential oils
Valerenic acid (sesquiterpenes)
Valepotriates (iridoid ester)
Linarin (flavinoid)

Question 26

Valerian - MOA (3-4)

Answer 26

Potentiation of GABA neuro activity, similar mechanism to sedative medications

• sedative, hypnotic effects
• anxiolytic effects
• anticonvulsant / antispasmodic effects
• counteracts caffeine
• EEG wave pattern changes towards mental relaxation

Question 27

Kava - name

Answer 27

Piper methysticum

Question 28

Kava - plant parts used

Answer 28

Rhizome

Question 29

Kava - active constituents

Answer 29

Kava lactones / kava-pyrones

Question 30

Kava - MOA (2-4)

Answer 30

Potentiation of GABA neuro activity

• anxiolytic effects
• sedative effects
• possible effects on dopamine / norepinephrine activity
• EEG changes similar to anti-anxiety drugs (no hypnotic effects)

Question 31

Kava - uses

Answer 31

Anxiety reduction
Mental stress reduction
Improved sleep (found in anxiety studies, not independent studies)

Question 32

Kava - contraindications

Answer 32

Anesthesia

Question 33

Kava - drug interactions

Answer 33

• CNS depressants (additional sedative effect)
• Alcohol (additional sedative effect)
• Anti-anxiety medication (benzodiazepines)
• Drugs with potential hepatotoxicity

Question 34

Kava - side effects

Answer 34

Mental impairment, similar to alcohol - inconclusive evidence

Kava dermopathy (excessive use) - dry, scaly, pigmented skin

Hepatotoxicity - may be due to low quality material, excessive use, use of inappropriate plant parts, non-water solvents - evidence is mixed

Question 35

Kava - pregnancy & lactation

Answer 35

Not recommended

Question 36

Valerian - uses

Answer 36

Insomnia

Sleep disturbances - mostly subjective benefits, objective are hard to demonstrate. Hops may improve effect

Anxiety / stress reduction - alone or with passion flower - effects inconsistently demonstrated over placebo

Question 37

Valerian - drug interactions

Answer 37

Benzodiazapines
CNS depressants (barbiturates, morphine, anesthesia)
Alcohol

Question 38

Valerian - side effects

Answer 38

GI upset

Allergic reactions

Question 39

Valerian - pregnancy & lactation

Answer 39

Not enough evidence to support safety