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Pharmacology > Chapter 25: Herbals, Vitamins & Supplements > Flashcards

Chapter 25: Herbals, Vitamins & Supplements Flashcards

1
Q

alternative medicine

A

not typically taught in medical schools

includes various therapies like herbals, acupuncture, mind-body therapies

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2
Q

complementary medicine

A

use of alternative medications within or alongside conventional medical practice

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3
Q

integrative medicine

A

combine the best of conventional therapy with evidence based alternative therapeutics

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4
Q

types of supplements

A

botanical

vitamins

biologically based

homeopathic

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5
Q

botanical medicine (phytomedicines)

A

preparations of whole herbs, herb parts, or extracts of herbs

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6
Q

what vitamin might be prescribed with metformin and why

A

Vitamin B12 because metformin can cause B12 deficiency

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7
Q

biologically based therapies

A

nonbotanical, nonvitamin therapies sauch as

fish oil, glucosamine, melatonin

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8
Q

homeopathic remedies

A

least dosing principle

active ingrediant can be either plant, mineral, or animal part

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9
Q

herbals used for infections

A

echinacea (common cold)

cranberry (prophylaxis for UTI)

elderberry (can reduce severity of flu)

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10
Q

echinacea

A
  • 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
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11
Q

why should fresh ederberries be avoided

A

they are toxic raw

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12
Q

probiotics

A

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

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13
Q

herbals used to treat menopause and menstrual disorders

A

black cohosh

dong quai

red clover

chaste tree berry

evening primrose oil

soy

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14
Q

black cohosh

A

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

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15
Q

dong quai

A

PMS, dymenorrhea, menopause

adverse effects: increase in menstrual blood loss, photosensitivity

contraindicated: breast cancer, warfarin

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16
Q

red clover

A

used for hot flashes

second line after failure of black cohosh

dc 10-14 days prior to surgery

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17
Q

chaste berry tree

A

used for PMS and menopause

contraindication: breast cancer, taking medicines that modulate dopaminergic system

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18
Q

evening primrose oil

A

PMS and menopause

high doses should not be used with anticoagulant therapy

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19
Q

soy

A

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

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20
Q

herbals used for BPH

A

stinging nettle

pumpkin seed extract or oil

saw palmetto

pygeum

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21
Q

stinging nettle

A

adverse effects: nausea, diarrhea, skin irritation

interactions: warfarin, hypoglycemic agents, antihypertensives, and sedatives

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22
Q

saw palmetto

A

acts as a 5-alpha reductase inhibitor preventing conversion of testosterone to DHT

contraindicate in women of childbearing age

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23
Q

herbals used for energy and well-being

A

ginseng (Panax)

dehydroepiandrostenedione (DHEA)

ashwagandha

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24
Q

ginseng

A

counteraction of antihypertensives

potentiation of hypoglycemic agents

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25
Q

ashwagandha

A

effects vary: sedation, immunomodulation, smooth muscle relaxation, thyroid stimulation

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26
Q

hebals used for memory enhancement and cognitive function

A

ginko biloba

docosahexaenoic acid (DHA)

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27
Q

ginko biloba

A

main side effects: inhibits platelet aggregation so it can increase bleeding time, can cause menorrhagia

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28
Q

herbals used for reflux esophagitis

A

slippery elm

deglycyrrhizinated licorice (DGL)

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29
Q

herbals used for nausea

A

ginger

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30
Q

herbals used for bloating and gas

A

fennel

caraway seed

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31
Q

herbals used for intestinal cramping

A

chamomile

peppermint oil

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32
Q

slippery elm

A

contains mucilage that coats irritated mucus membranes and stimulates secretion of extra mucous to soothe irritated tissues

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33
Q

DGL

A

use before meals to minize reflux

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34
Q

ginger

A

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

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35
Q

fennel

A

has GRAS status

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36
Q

caraway seed

A

reduces gastrointestinal motility

side effect when combined with peppermint are nausea and heartburn

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37
Q

chamomile

A

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)

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38
Q

peppermint oil

A

relaxes bowel motility and spacticity once past pylorus

adverse effects: heartburn, nausea, anal burning

never give to infants (can induce laryngospasm)

avoid H2 antacids

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39
Q

herbals used for constipation

A

aloe

triphala senna

cascara

konjac glucomannan

phosphate salts

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40
Q

aloe

A

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

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41
Q

triphala

A

combination of stimulant and bulk forming laxative

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42
Q

senna

A

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

43
Q

cascara

A

long term can cause diarrhea, cramping, hypokalemia, and dependence

44
Q

konjac glucomannan

A

most viscous water soluble fiber in nature

can block throat if not taken with a full glass of water

can improve cholesterol

45
Q

phosphate salts

A

cause water to be drawn into the gut to increase peristalsis

46
Q

herbals used for diarrhea

A

black and green tea

cinnamon

rhubarb

47
Q

black and green tea

A

contain polyphenols

1 cup per diarrhea stool

use caffeine free

48
Q

cinnamon

A

tannins reduce fluid excretion in large intestine

GRAS status

oil should not be used for diarrhea (skin irritation, dizziness, sedation)

49
Q

rhubarb

A

GRAS status

tannin effects in low doses

high doses can cause diarrhea

50
Q

supplements for sleeping and sedation

A

melatonin

valerian

chamomile

hops

51
Q

melatonin

A

most effective within 30 minutes of bed at low dose

reduce light in the evening

52
Q

valerian

A

GRAS status

acts on GABA receptors but not as potent as benzos

interacts with CNS depressants

53
Q

herbals used for anxiety

A

passionflower

kava kava

54
Q

passionflower

A

contains flavonoids that cause sedation

higher doses can be used for opiate withdrawal

55
Q

kava kava

A

in high doses has anticonvulsant properties

don’t use unless certain it is root sourced as areal sourced can cause liver failure

56
Q

supplements used for depression

A

st. john’s wort

S-adenosylmethionin (SAM-e)

57
Q

st. johs wort

A

acts on GABA and MAO systems

many drug interactions

58
Q

SAM-e

A

risk of serotonin syndrome with SSRIs and MAOIs

good for depression with body aches

59
Q

Oral herbals for arthritis

A

chondoitin sulfate/glucosamine sulfate

methylsulfonylmethane (MSM)

turmeric/curcumin

ginger

60
Q

glucosamine

A

can take up to 2 weeks to see effects

61
Q

MSM

A

often used in combo with glucosamine

62
Q

turmeric

A

act as COX2 inhibitors to inhibit prostaglandins, leukotrienes, and thromboxanes

effects are maxiized when taken with fat-containing food or black pepper

63
Q

topical herbs used for arthritis

A

capsaicin

ginger and tumeric

wintergreen oil

borage

64
Q

capsaicin

A

causes substance P release resulting in diminished pain signal over time

causes intense burning that subsides after recurrent use

65
Q

ginger and turmeric as topical agents

A

COX inhibitors

water and oil based pastes can be made

will stain clothing but does not have burning sensation

66
Q

wintergreen oil

A

does not cause burning sensation

drug interaction are possible if used over a large surface area

(especially warfarin)

67
Q

borage

A

can be used topically for arthritis and also for PMS and menopausal symptoms, bronchitis, colds

68
Q

yohimbe

A

used for impotence

has hallucinogenic properties

lots of side effects and drug interactions

69
Q

herbals for headaches

A

feverfew

riboflavin

magnesium

70
Q

feverfew

A

used to decrease frequency of migraines

if leaves are chewed can cause heartburn and oral ulceration

71
Q

riboflavin

A

waer soluble B2

can cause deep yellow urine

72
Q

magnesium

A

migraine prophylactic

most common side effect is diarrhea

can affect absorption of medications

73
Q

herbal used for glycemic control

A

cinnamon

potentiates hypoglycemic agents

74
Q

herbals used for lipid control

A

omega3 fish oil

olive oil

red yeast rice

phytosterols

gum

75
Q

Omega-3 fish oils

A

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

76
Q

olive oil

A

reduces cholesterol levels when used as a replacement for saturated fats

also an anti-inflammatory

interactions mainly involve hypoglycemics and antihypertensives

77
Q

red yeast rice

A

uses the same mechanism of statin drugs to lower cholesterol

side effects are mild and may include heartburn, dizziness, and gas

78
Q

phytosterols (Plant sterols)

A

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

79
Q

gum

A

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

80
Q

herbals used for topical wound treatment

A

tea tree oil

aloe vera

antioxidant and anticancer supplements

81
Q

tea tree oil

A

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

82
Q

aloe vera

A

do not use on severe burns

may be alternated with slivadene for 2nd degree burns

83
Q

antioxidant and anticancer supplements

A

melatonin

ashwagandha

omega-3 fatty acids

indole-3 carbinole

84
Q

melatonin as antioxidant/anticancer supplement

A

high doses can slow solid tumor growth

should be used only under clinical supervision as it far exceeds reccomended dosage for sedation

85
Q

ashwagandha

A

can decrease chemotherapy induced cardiomyopathy in patients recieving doxorubicin

given after chemotherpy

may interact with CNS depressants and sedatives

86
Q

omega-3 fatty acids as antioxidant/anticancer supplements

A

can reduce progression of adenomatous polyps in the colon

prudent for colon cancer patients

87
Q

indole-3 carbinole (I3C)

A

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

88
Q

fat soluble vitamins as food supplements

A

vitamin A (retinoic acid)

vitamin D (calcitrol)

vitamin E (tocopherols/tocotrienols)

vitamin K (phytonadione)

89
Q

what two groups are vitamins divided into

A

fat-soluble and water-soluble

90
Q

when should vitamins be taken

A

fat soluble - before meals

water soluble - after meals

91
Q

vitamin A

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

92
Q

vitamin D

A

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

93
Q

vitamin E

A

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

94
Q

vitamin K

A

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

95
Q

water soluble vitamins

A

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)

96
Q

vitamin B1 (thiamine)

A

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

97
Q

vitamin B2 (riboflavin)

A

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

98
Q

vitamin B3 (niacin)

A

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

99
Q

vitamin B6 (pyridoxine)

A

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)

100
Q

vitamin B9 (folate) deficiency

A

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)

101
Q

vitamin B9 (folate)

A

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

102
Q

vitamin B12 (cyanocobalamin)

A

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)

103
Q

vitamin C (ascorbic acid)

A

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

104
Q

CoQ10

A

Pharmacology (28 decks)

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