Chapter 25: Herbals, Vitamins & Supplements Flashcards
alternative medicine
not typically taught in medical schools
includes various therapies like herbals, acupuncture, mind-body therapies
complementary medicine
use of alternative medications within or alongside conventional medical practice
integrative medicine
combine the best of conventional therapy with evidence based alternative therapeutics
types of supplements
botanical
vitamins
biologically based
homeopathic
botanical medicine (phytomedicines)
preparations of whole herbs, herb parts, or extracts of herbs
what vitamin might be prescribed with metformin and why
Vitamin B12 because metformin can cause B12 deficiency
biologically based therapies
nonbotanical, nonvitamin therapies sauch as
fish oil, glucosamine, melatonin
homeopathic remedies
least dosing principle
active ingrediant can be either plant, mineral, or animal part
herbals used for infections
echinacea (common cold)
cranberry (prophylaxis for UTI)
elderberry (can reduce severity of flu)
echinacea
- mechanism of action: stimulates an increase in the production of interferons and interleukins which limits viral spread and reduces duration of illness
- side effects: low-grade malaise
- contraindications: pregnancy, autoimmune disease, HIV patients, ragweed allergy
why should fresh ederberries be avoided
they are toxic raw
probiotics
Most made from human strains of Bifidobacterium and lactobacillus
used for upset stomach, gastritis, antibiotic-induced diarrhea, IBD
can cause sepsis in compromised immune system, especially premature infants and those with short intestines
herbals used to treat menopause and menstrual disorders
black cohosh
dong quai
red clover
chaste tree berry
evening primrose oil
soy
black cohosh
improves mood, night sweats, sleep disturbance, and hot flash relief
does NOT improve bone density, reverse vaginal atrophy
superior safety and side effect profile
periodically monitor LFTs
dong quai
PMS, dymenorrhea, menopause
adverse effects: increase in menstrual blood loss, photosensitivity
contraindicated: breast cancer, warfarin
red clover
used for hot flashes
second line after failure of black cohosh
dc 10-14 days prior to surgery
chaste berry tree
used for PMS and menopause
contraindication: breast cancer, taking medicines that modulate dopaminergic system
evening primrose oil
PMS and menopause
high doses should not be used with anticoagulant therapy
soy
lowers risk of breast cancer, menopausal symptoms, and osteoporosis
side effects: occasional nausea and bloating
excessive use can cause hypothyroidism in patients with iodine deficiency
herbals used for BPH
stinging nettle
pumpkin seed extract or oil
saw palmetto
pygeum
stinging nettle
adverse effects: nausea, diarrhea, skin irritation
interactions: warfarin, hypoglycemic agents, antihypertensives, and sedatives
saw palmetto
acts as a 5-alpha reductase inhibitor preventing conversion of testosterone to DHT
contraindicate in women of childbearing age
herbals used for energy and well-being
ginseng (Panax)
dehydroepiandrostenedione (DHEA)
ashwagandha
ginseng
counteraction of antihypertensives
potentiation of hypoglycemic agents
ashwagandha
effects vary: sedation, immunomodulation, smooth muscle relaxation, thyroid stimulation
hebals used for memory enhancement and cognitive function
ginko biloba
docosahexaenoic acid (DHA)
ginko biloba
main side effects: inhibits platelet aggregation so it can increase bleeding time, can cause menorrhagia
herbals used for reflux esophagitis
slippery elm
deglycyrrhizinated licorice (DGL)
herbals used for nausea
ginger
herbals used for bloating and gas
fennel
caraway seed
herbals used for intestinal cramping
chamomile
peppermint oil
slippery elm
contains mucilage that coats irritated mucus membranes and stimulates secretion of extra mucous to soothe irritated tissues
DGL
use before meals to minize reflux
ginger
used to treat nausea in naval cadets, chemotherapy, gastroparesis, morning sickness
potential anti-inflammatory at high doses
raw ginger less effective than dried ginger
use in capsule if for inflammation as high doses can irritate esophageal mucosa
1G TID for arthritis
fennel
has GRAS status
caraway seed
reduces gastrointestinal motility
side effect when combined with peppermint are nausea and heartburn
chamomile
inhibits COX and LOX to exert anti-inflammatory effect
can cause sedation at high doses
high doses can interact with warfarin (no more than once daily)
peppermint oil
relaxes bowel motility and spacticity once past pylorus
adverse effects: heartburn, nausea, anal burning
never give to infants (can induce laryngospasm)
avoid H2 antacids
herbals used for constipation
aloe
triphala senna
cascara
konjac glucomannan
phosphate salts
aloe
not for long-tern (can cause hypokalemia and dehydration)
adverse effects: abdominal pain, cramps, diarrhea, hypokalemia
interactions: potentiation of diuretic potassium depletion and other stimulant laxatives
triphala
combination of stimulant and bulk forming laxative
senna
powerful stimulant laxative
can cause dependence if use long term
works in about 8 hours
side effects: cramping, nausea, excessive potassium depletion
interacts with warfarin
cascara
long term can cause diarrhea, cramping, hypokalemia, and dependence
konjac glucomannan
most viscous water soluble fiber in nature
can block throat if not taken with a full glass of water
can improve cholesterol
phosphate salts
cause water to be drawn into the gut to increase peristalsis
herbals used for diarrhea
black and green tea
cinnamon
rhubarb
black and green tea
contain polyphenols
1 cup per diarrhea stool
use caffeine free
cinnamon
tannins reduce fluid excretion in large intestine
GRAS status
oil should not be used for diarrhea (skin irritation, dizziness, sedation)
rhubarb
GRAS status
tannin effects in low doses
high doses can cause diarrhea
supplements for sleeping and sedation
melatonin
valerian
chamomile
hops
melatonin
most effective within 30 minutes of bed at low dose
reduce light in the evening
valerian
GRAS status
acts on GABA receptors but not as potent as benzos
interacts with CNS depressants
herbals used for anxiety
passionflower
kava kava
passionflower
contains flavonoids that cause sedation
higher doses can be used for opiate withdrawal
kava kava
in high doses has anticonvulsant properties
don’t use unless certain it is root sourced as areal sourced can cause liver failure
supplements used for depression
st. john’s wort
S-adenosylmethionin (SAM-e)
st. johs wort
acts on GABA and MAO systems
many drug interactions
SAM-e
risk of serotonin syndrome with SSRIs and MAOIs
good for depression with body aches
Oral herbals for arthritis
chondoitin sulfate/glucosamine sulfate
methylsulfonylmethane (MSM)
turmeric/curcumin
ginger
glucosamine
can take up to 2 weeks to see effects
MSM
often used in combo with glucosamine
turmeric
act as COX2 inhibitors to inhibit prostaglandins, leukotrienes, and thromboxanes
effects are maxiized when taken with fat-containing food or black pepper
topical herbs used for arthritis
capsaicin
ginger and tumeric
wintergreen oil
borage
capsaicin
causes substance P release resulting in diminished pain signal over time
causes intense burning that subsides after recurrent use
ginger and turmeric as topical agents
COX inhibitors
water and oil based pastes can be made
will stain clothing but does not have burning sensation
wintergreen oil
does not cause burning sensation
drug interaction are possible if used over a large surface area
(especially warfarin)
borage
can be used topically for arthritis and also for PMS and menopausal symptoms, bronchitis, colds
yohimbe
used for impotence
has hallucinogenic properties
lots of side effects and drug interactions
herbals for headaches
feverfew
riboflavin
magnesium
feverfew
used to decrease frequency of migraines
if leaves are chewed can cause heartburn and oral ulceration
riboflavin
waer soluble B2
can cause deep yellow urine
magnesium
migraine prophylactic
most common side effect is diarrhea
can affect absorption of medications
herbal used for glycemic control
cinnamon
potentiates hypoglycemic agents
herbals used for lipid control
omega3 fish oil
olive oil
red yeast rice
phytosterols
gum
Omega-3 fish oils
contain ALA, EPA, and DHA
effective dose ranges between 1-3gm daily
side effects: fishy breath. increased bruising
interactions: potentiates anticoagulants and antihypertensives
caution against high doses of fish LIVER oil to avoid vitamin A toxicity
olive oil
reduces cholesterol levels when used as a replacement for saturated fats
also an anti-inflammatory
interactions mainly involve hypoglycemics and antihypertensives
red yeast rice
uses the same mechanism of statin drugs to lower cholesterol
side effects are mild and may include heartburn, dizziness, and gas
phytosterols (Plant sterols)
act as adsorbents in the gut to prohibit enterohepatic recirculation of conjugated cholesterol
found in margarines, liquid fiber sources, nuts, seeds, cereals, legumes, and vegetable oils
caution against more than 2-3 servings daily as excessive use can block drug absorption
gum
resin that provides soluble fiber to trap cholesterol and fats to prevent enterohepatic recircultion
side effects: nausea and bloating
interactions reduced absorption of drugs including ABTs, hypoglycemics, digoxin, and oral contraceptives
herbals used for topical wound treatment
tea tree oil
aloe vera
antioxidant and anticancer supplements
tea tree oil
topically for skin infections like acne, minor cuts and scrapes, and tinea infections
chronic use can cause dry skin
do not use in ear canal cause it may be ototoxic
full strength on nails for onychomycosis and diluted to 5-10% strength for use on skin
do not use on mucous membranes or internally
aloe vera
do not use on severe burns
may be alternated with slivadene for 2nd degree burns
antioxidant and anticancer supplements
melatonin
ashwagandha
omega-3 fatty acids
indole-3 carbinole
melatonin as antioxidant/anticancer supplement
high doses can slow solid tumor growth
should be used only under clinical supervision as it far exceeds reccomended dosage for sedation
ashwagandha
can decrease chemotherapy induced cardiomyopathy in patients recieving doxorubicin
given after chemotherpy
may interact with CNS depressants and sedatives
omega-3 fatty acids as antioxidant/anticancer supplements
can reduce progression of adenomatous polyps in the colon
prudent for colon cancer patients
indole-3 carbinole (I3C)
found in broccoli and other cruciferous vegetables
used as a chemoproventive agent in those at high risk for breast cancer
interactions: lowers serum concentration of drugs metabolized by 1A2
fat soluble vitamins as food supplements
vitamin A (retinoic acid)
vitamin D (calcitrol)
vitamin E (tocopherols/tocotrienols)
vitamin K (phytonadione)
what two groups are vitamins divided into
fat-soluble and water-soluble
when should vitamins be taken
fat soluble - before meals
water soluble - after meals
vitamin A
needed for normal development of retina, cornea, skin, bones, teeth, and normal immune system function
deficiency is the most common cause of child blindness
toxicity can cause liver failure, hemolysis, and headaches
vitamin D
can be made in the body under optimal circumstances
deficiency syndromes include: myalgias, HTN, depression, hyperkerototic skin lesions, insuin resistance, and osteopenia
excessive intake without deficiency can cause hypercalcemia and arrhythmia
vitamin E
found in whole grains, nuts, fruits, eggs, poultry, vegetables, grain and vegetable oils
deficiency causes muscle weakness, decrease RBC survival
excessive use an cause nausea, diarrhea, and fatigue
vitamin K
fund in dark, leafy vegetables
needed for normal blood clotting, bone growth and maintenance
deficiency caused by long-term ABTs and warfarin
toxicity: hypercoagulability, soft tissues calcification in dialysis patients, hemolysis in patients with G6PD
water soluble vitamins
vitamin B1 (thiamine)
vitamin B2 (riboflavin)
vitamin B3 (niacin)
vitamin B6 (pyridoxine)
vitamin B9 (folate)
vitamin B12 (cyanocobalamine)
vitamin C (ascorbic acid)
Vitamin Coenzyme 10 (CoQ10)
vitamin B1 (thiamine)
acts as a catalyst in carbohydrate metabolism
deficiency causes beriberi (musclular weakness cardiomegaly, leg cramps)
found in pork, organ meats, brewers yeast, lean meats, eggs, leafy green vegetables, whole/enriched cereals, wheat germ, berries, nuts, legumes
deficiency is uncommon except in alcoholics (causes wernicke’s encephalopathy, korsakoff’s psychoses, and wernicke-korsakoff syndrome
vitamin B2 (riboflavin)
coenzyme in the metabolism of carbs, fats, and respiratory proteins
maintains mucus membranes
deficiency: perioral dermatitis and photosensitivity
best sources: liver, milk, meat, dark green vegetables, whole grain and enriched cereals, pasta, bread, and mushrooms
vitamin B3 (niacin)
deficiency causes pellagra (manifests as photosensitive rash, glossitis, diarrhea, mental confusion, and irritability)
best sources: liver, poultry, meat, canned tuna and salmon, whole grain and enriched cereal, dried beans and peas, and nuts
side effects: rash, flushing, GI upset
vitamin B6 (pyridoxine)
needed for absorption and metabolism of amino acids, and production of B12 and folate
deficiency: skin disorders, cracks at the mouth corners, smooth tongue, seizures, dizziness, nausea, anemia, kidney stones
best sources: whole but not enriched grains, cereals, bread, liver, avocados, spinach, green beans, and bananas
high doses (300+ mg) can cause irreversible peripheral neurotoxicity (NTE 50mg daily unless under physician supervision)
vitamin B9 (folate) deficiency
deficiency: high incidenc of neural tube defect and impaired hematopoeisis causing anemia
can also cause poor growth, tongue inflammation, gingivitis, anorexia, SOB, diarrhea, irritability, forgetfulness, and mental sluggishness
deficiency can be caused by celiac’s, chrohn’s, long term methotrexate use, disorders that cause high marrow turnover (sickle cell, spherocytosis)
vitamin B9 (folate)
childbearing: 0.4mg and continue that dose through 1st trimester
men (200mcg) postmenopausal women (180mcg)
sources: organ meat, leafy green vegetables, legumes, nuts, whole grains, brewers yeast
patients undergoing chemo should not take until cleared by oncologist because chemo may deliberately deplete folate stores
vitamin B12 (cyanocobalamin)
needed for formation of nucleoproteins, proteins, and RBCs, and for the functioning of the nervous system
deficiency often d/t inability of stomach to produce intrinsic factor (antibodies to parietal cells, prolonged PPIs and H2 blockers, aging)
symptoms: ineffective production of RBCs, faulty myelin synthesis, loss of GI tract epithelium
obtained only from animal sources (vegetarians should supplement)
vitamin C (ascorbic acid)
needed for collagen synthesis, maintenance of soft tissue structures, hemostasis, wound healing, enhances iron absorption
deficiency: scurvy (bleeding gums, loosened teeth, hemorrhagic lesions)
500-1000mg
large prolonged doses can cause kidney and bladder stones
CoQ10
