CV Herbs

Question 1

Rauwolfia serpentina

1.) Actions & Indications

Answer 1

(Snake root) containing indole alkaloids (Reserpine)

1. ) Actions & Indications
   i. ) Strong Hypotensive
   a. ) HTN, Pre-eclampsia
   ii. ) Antiarrhythmic
   iii. ) Antipsychotic (depletes catecholamine stores)
   iv. ) Vasodilation (Raynaud’s)

Question 2

Rauwolfia serpentina

2a.) Contraindications

Answer 2

2a. ) Contraindications
i. ) Depression (b/c it depletes 5-HT)
ii. ) Parkinson’s (bc/ it depletes Dopamine)
iii. ) Hyperprolactinemia (b/c low dopamine levels sends a positive feedback mechanism to increase prolactin)
iv. ) Ulcerative colitis
v. ) Pregnancy

Question 3

Rauwolfia serpentina

2b. ) Interactions
i. ) MAOI, TCAs, SSRI - Rauwolfia counteracts these medications
ii. ) Cardiac Glycosides (Increases the risk of bradycardia, angina, arrhythmias)

Answer 3

2b. ) Interactions
i. ) MAOI, TCAs, SSRI - Rauwolfia counteracts these medications
ii. ) Cardiac Glycosides (Increases the risk of bradycardia, angina, arrhythmias)

Question 4

Rauwolfia serpentina

SE & Tox

Answer 4

SE

i. ) Nasal Congestion
ii. ) Transient Loose Stool
iii. ) Sodium retention resulting in edema

TOX

i. ) Nightmares
ii. ) Peptic ulcers & Hyperchlorhydria
iii. ) Bradycardia
iv. ) Depression & Parkinsonism

Question 5

Olea europea

1.) Actions & Indications

Answer 5

i. ) Hypotensive
ii. ) Antiviral
iii. ) Antioxidant
iv. ) Bitter Digestive Stimulant

Question 6

Viscum flavescens (American Mistletoe)

Answer 6

1. ) Actions & Indications
   i. ) Smooth muscle stimulant
   a. ) to increase blood pressure
   b. ) Increase intestinal contractions
   ii. ) Abortifacient

Question 7

Viscum flavescens (CI)

Answer 7

C: pregnancy/lactation

Question 8

Viscum flavescens (SE)

Answer 8

i. ) Nausea
ii. ) Hypertension
iii. ) Hypovolemic shock
iv. ) Cardiovascular collapse (bradycardia, hypotension)

Question 9

Digitalis purpurea
(Foxglove)
1.) Actions & Indications

Answer 9

i. ) Cardiac Glycoside (Positive Inotrope, Negative Chronotrope)
a. ) CHF, arrhythmias (but not ventricular arrhythmias)
ii. ) Vasoconstriction

Question 10

Digitalis purpurea
(Foxglove)
CI

Answer 10

i. ) Ventricular arrhythmias
ii. ) Hypokalemia, Hypomagnesemia, Hypo/hypercalcemia
iii. ) Kidney failure
iv. ) Pregnancy/Lactation

Question 11

Digitalis purpurea

Interactions

Answer 11

i. ) Potassium-depleting agents may potentiate toxicity
a. ) Corticosteroids
b. ) Diuretics
c. ) Glycyrrhiza glabra, Equisetum
d. ) Other cardiac glycosides (Digoxin)

Question 12

Digitalis purpurea

SE & Tox

Answer 12

3a. ) Side Effects
i. ) Yellow/Green halo in vision
ii. ) Bradycardia (negative chronotrope)
iii. ) Gynecomastia

3b. )Toxicity
i. ) Narrow therapeutic window
ii. ) Recirculates in enterohepatic cycle
iii. ) Toxicity may be lethal (Antidote = Potassium & digoxin antibodies)

Question 13

Ephedra sinica

1.) Actions & Indications

Answer 13

Ephedra sinica
(Ma Huang) contains ephedrine (alkaloid)
1.) Actions & Indications
       i.) Alpha Adrenergic Agonist
             a.) Secretolytic
             b.) Vasoconstrictor 
             c.) Urinary incontinence
       ii.) Mild Beta-Adrenergic Agonist
             a.) Bronchodilator (sinusitis, asthma, COPD)
             b.) Antitussive
       iii.) Mast cell stabilizer (Allergic rhinitis)
       iv.) Hypertensive
       v.) Thermogenic
             a.) Previously used for weight loss
       vi.) Circulatory stimulant

Question 14

Ephedra sinica (CI)

Answer 14

i. ) HTN, CAD
ii. ) BPH, Glaucoma (r/t anticholinergic-type effect)
iii. ) Pregnancy/Lactation
iv. ) High Doses

Question 15

Ephedra sinica (SE)

Answer 15

i. ) Increased Alertness, Nervousness, Insomnia
ii. ) Nausea, Vomiting
iii. ) Diaphoresis
iv. ) Urinary retention
v. ) Tachycardia, Palpitations
vi. ) Seizures

Question 16

Allium cepa & sativum

1.) Actions & Indications

Answer 16

a. ) Antiatherosclerotic
b. ) Antiplatelet
c. ) Hypolipidemic
d. ) Hypoglycemic
e. ) Antihelminthic (Garlic only)
f. ) Antimicrobial (h.pylori, candidiasis)

Question 17

Allium cepa & sativum (CI)

Answer 17

i. ) Bleeding Disorders & Anticoagulant Agents

ii. ) Hypothyroidism (b/c it inhibits the uptake of iodine)

Question 18

Allium cepa & sativum (SE)

Answer 18

Bleeding

Question 19

Vinca major/minor

1.) Actions & Indications

Answer 19

i. ) Circulatory Stimulant
a. ) Poor Memory
ii. ) Hypotensive
iii. ) Astringent
a. ) Hematuria, epistaxis
b. ) metrorrhagia

Question 20

Vinca major/minor

2.) Contraindications & Interactions

Answer 20

C: Pregnancy, constipation (b/c its astringent), hypotension

Question 21

Rosmarinus officinalis

1.) Actions & Indications

Answer 21

i. ) Hypertensive
ii. ) Circulatory stimulant
iii. ) Nootropic (Memory booster)
iv. ) Liver tonic (Induces phase 1&2 enzymes)
v. ) Topical Rubefacient

Question 22

Rosmarinus officinalis (CI and Interactions)

Answer 22

2.) Contraindications & Interactions
C: Pregnancy
I: may lead to hypertensive crisis if used with another hypertensive agent

Question 23

Centella asiatica

1.) Actions & Indications

Answer 23

i. ) Venotonic (Hemorrhoids, Varicose Veins, Venous insufficiency)
ii. ) Vulnerary & Keratolytic (Scar inhibiting)
iii. ) Nootropic (memory booster)

Question 24

Selenicereus (Cactus) grandiflorus

1.) Actions & Indications

Answer 24

i.) Antiarrhythmic

Question 25

Selenicereus (Cactus) grandiflorus (CI) and Tox

Answer 25

2.) Contraindications & Interactions
C: Pregnancy, Lactation, High dose

3. ) Toxicity
   i. ) Arrhythmia
   ii. ) Tachycardia

Question 26

Convallaria majalis

1.) Actions & Indications

Answer 26

i. ) Positive Inotrope & Negative Chronotrope (Cardiac glycoside) -> milder than Digitalis
ii. ) Diuretic
iii. ) Vasoconstrictor (Hypotension)

Question 27

Convallaria

2a.) Contraindications

Answer 27

i. ) Hypokalemia, Hypomagnesemia, Hypo/Hypercalcemia
ii. ) Ventricular arrhythmia
iii. ) Kidney Failure
iv. ) Severe carditis
v. ) Pregnancy/Lactation
vi. ) Potassium-depleting medications
a. ) Digoxin, Digitalis
b. ) Corticosteroids
c. ) Thiazides
d. ) Glycyrrhiza glabra
e. ) Stimulant laxatives

Question 28

Convallaria

2b.) Interactions

Answer 28

i. ) Calcium potentiates arrhythmias

ii. ) Diuretic effect may reduce the clearance of Lithium & lead to toxicity potentiation

Question 29

Convallaria

3a.) Side Effects

Answer 29

i. ) Yellow/Green Halo in vision
ii. ) Bradycardia
iii. ) Gynecomastia

Question 30

Crataegus oxyacantha

1.) Actions & Indications

Answer 30

i. ) Positive Inotrope & Negative Chronotrope (not from cardiac glycosides)
a. ) CHF, Angina, Arrhythmia
ii. ) Antihypertensive & Antiatherosclerotic
a. ) Capillary fragility, HTN
iii. ) Antioxidant

Question 31

Leonurus cardiaca
1.) Actions & Indications

2. ) Contraindications
   i. ) Digestive Stimulant Contraindications

Answer 31

(motherwort) contains iridoid glycosides
1. ) Actions & Indications
i. ) Antiarrhythmic
ii. ) Nervine
iii. ) Uterine Tonic
a. ) Menopausal symptoms
b. ) Uterine Fibroids
c. ) Endometriosis
iv. ) Bitter Digestive Stimulant

Question 32

Leonurus cardiaca

2.) Contraindications

Answer 32

i.) Digestive Stimulant Contraindications

Question 33

Veratrum alba (viride)
1.) Actions & Indications

Answer 33

1. ) Actions & Indications

i. ) Antihypertensive

Question 34

Veratrum

2.) Contraindications & Interactions

Answer 34

C: Pregnancy/Lactation

Question 35

Veratrum

3.) Side Effects & Toxicity

Answer 35

Cardio/Neurotoxic)
No longer used to due to extreme toxicity. Very narrow therapeutic window!
i.) Hypotension then Hypertension
ii.) Bradycardia then Tachycardia
iii.) Neuropathy
iv.) Mydriasis & Blurry Vision
v.) Weakness