Chapter 7 OTC and Herbal meds

Question 1

Aloe Vera

Answer 1

1. Topical anti inflammatory, analgesic, and cathartic•
2. INTERACTIONS
   a. Digoxin, diuretics, corticosteroids and antidysrhythmic
3. NURSING ADMINISTRATION
   a. Teach clients to recognize manifestations of fluid and electrolyte imbalance if using as a laxative

Question 2

ECHINACEA

Answer 2

1. ADVERSE EFFECTS
   a. Bitter taste, Mild GI symptoms or fever, Allergic reactions (especially in patients allergic to plants such as ragweed or others in the daisy family)
2. INTERACTIONS With chronic use (more than 6 months), echinacea can decrease positive effects of medications for tuberculosis, HIV, or cancer.
3. NURSING ADMINISTRATION
   a. Echinacea is available in many forms, including dried roots, plants, extracts, and teas
   b. Question clients who have tuberculosis, cancer, HIV, lupus erythematosus, and rheumatoid arthritis about concurrent use. Advise these clients to talk to the provider.

Question 3

FEVERFEW

Answer 3

1. ADVERSE EFFECTS AND PRECAUTIONS
   a. Mild GI symptoms, Post feverfew syndrome can occur, causing agitation, tiredness, inability to sleep, headache, and joint discomfort.
   b. Can cause allergic reactions in patients allergic to ragweed or Echinacea
2. INTERACTIONS•
   a. Increased risk of bleeding in clients taking NSAIDs, heparin, and warfarin
   b. Discontinue 2 weeks before elective surgery.
3. NURSING CONSIDERATIONS
   a. Question clients about concurrent use of NSAIDs, heparin, and warfarin

Question 4

GARLIC

Answer 4

1. ADVERSE EFFECTS
   a. GI symptoms•
2. INTERACTIONS
   a. Increase risk of bleeding in clients taking NSAIDs, warfarin, and heparin•
   b. Decreases levels of saquinavir (a medication for HIV treatment) and cyclosporine
3. NURSING CONSIDERATIONS
   a. Question clients about concurrent use of NSAIDs, heparin, and warfarin.
   b. Have clients who are taking antiplatelet or anticoagulant medication, cyclosporine, or saquinavir contact their provider.

Question 5

GINGER ROOT

Answer 5

1. ADVERSE EFFECTS AND PRECAUTIONS
   a. Use cautiously in clients who are pregnant
   b. Adverse effects are unknown
   c. Potential CNS depression and cardiac dysrhythmias with very large overdose.
2. INTERACTIONS
   a. Medications that interfere with coagulation (NSAIDS, warfarin, and heparin). •Increase hypoglycemic effects of diabetes medications
3. NURSING CONSIDERATIONS
   a. Question clients about concurrent use with NSAIDs, heparin, and warfarin.
   b. Monitor for hypoglycemia if the client takes insulin or other medication for diabetes.

Question 6

GINKGO BILOBA

Answer 6

1. ADVERSE EFFECTS AND PRECAUTIONS
   a. Mild GI upset, headache, lightheadedness
   b. Use with caution in clients at risk for seizures
2. INTERACTIONS
   a. Medications that lower the seizure threshold (antihistamines, antidepressants, and antipsychotics)
   b. Can interfere with coagulation
3. NURSING CONSIDERATIONS
   a. Question clients regarding history of antidepressant use (imipramine), which causes a decrease in seizure threshold.
   b. Question clients about concurrent use with NSAIDs, heparin, and warfarin

Question 7

GLUCOSAMINE

Answer 7

1. ADVERSE EFFECTS AND PRECAUTIONS
   a. Mild GI upset (nausea, heartburn) •Use with caution with shellfish allergy•
2. INTERACTIONS
   a. Use caution if taking antiplatelet or anticoagulant medication
3. NURSING CONSIDERATIONS
   a. Question clients about concurrent use with NSAIDs, heparin, and warfarin

Question 8

KAVA

Answer 8

1. ADVERSE EFFECTS AND PRECAUTIONS
   a. Chronic use - dry, flaky skin and jaundice.
   b. Chronic use and large doses - liver damage, including severe liver failure.
2. INTERACTIONS •Sedation when taken concurrently with CNS depressants.
3. NURSING CONSIDERATIONS
   a. Question clients taking any CNS depressant, including alcohol, about use of kava.
   b. Ask clients who have any liver condition about concurrent use.

Question 9

ST. JOHN’S WORT

Answer 9

1. ADVERSE EFFECTS•
   a. Mild - dry mouth, lightheadedness, constipation, GI symptoms
   b. Skin rash when exposed to sunlight
2. INTERACTIONS
   a. Other antidepressants, amphetamine, and cocaine
   b. Oral contraceptives, cyclosporine, warfarin, digoxin, calcium channel blockers, steroids, HIV protease inhibitors, and some anticancer medications
3. NURSING ADMINISTRATION
   a. Question patients taking any of the medications with which this substance interacts about concurrent use.
   b. Prevent prolonged sun exposure and use sunscreen.

Question 10

SAW PALMETTO

Answer 10

1. ADVERSE EFFECTS AND PRECAUTIONS
   a. Mild GI effects
2. INTERACTIONS
   a. Possible additive effects with finasteride
   b. Can interact with antiplatelet and anticoagulant medications
   c. Pregnancy Risk Category
3. NURSING ADMINISTRATION
   a. Question patients about use before prostate specific antigen tests
   b. Question patients about concurrent use with aspirin, heparin, and warfarin

Question 11

VALERIAN

Answer 11

1. ADVERSE EFFECTS AND PRECAUTIONS
   a. Drowsiness, lightheadedness, depression
   b. Risk of physical dependence
2. PRECAUTION•
   a. Patients who have mental health disorders - use with caution
   b. Pregnant or lactating women should avoid
3. INTERACTIONS
   a. May potentiate effects of CNS depressants
4. NURSING CONSIDERATIONS
5. Alert patients to the possibility of drowsiness when operating