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pharma > Dietary Supplements and Herbal Medications > Flashcards

Dietary Supplements and Herbal Medications Flashcards

1
Q

What is the nature of echinacea?

A

Leaves and roots of echinacea species (Echinacea purpurea) contain flavonoids, polyacetylenes, and caffeoyl conjugates.

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2
Q

What are the main pharmacologic effects of echinacea?

A
  1. Cytokine activation and anti-inflammatory properties.

2. Some evidence for efficacy of above-ground parts of E.purpurea plants in the early treatment of colds.

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3
Q

What are the possible side effects of echinacea?

A
  1. Unpleasant taste
  2. GI effects
  3. Dizziness/headache
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4
Q

What drugs are derived from ephedra (Ma huang)?

A
  1. Ephedrine

2. Pseudoephedrine

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5
Q

Why has FDA banned the marketing of dietary supplements containing ephedrine alkaloids?

A

Due to cardiovascular risk.

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6
Q

What is the mechanism of action of ephedra?

A

Indirect acting sympathomimetic that release NE. (like ephedrine/pseudoephedrine).

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7
Q

What is the conditions in which ephedra is used?

A
  1. Nasal decongestion
  2. Asthma/bronchitis
  3. Cold/flu
  4. As mild CNS stimulants
  5. Also for weight loss and athletic performance enhancement.
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8
Q

What extra applications has ephedra in Chinese medicine?

A
  1. Diuresis

2. Relief of bone and joint pain

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9
Q

What are the major side effects of ephedra?

A

Those of ephedrine:

  1. Dizziness
  2. Insomnia
  3. Tachycardia
  4. Palpitations
  5. Flushing
  6. Anorexia
  7. Urinary retention
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10
Q

What are the contraindications for the use of ephedrine?

A
  1. Anxiety states
  2. Bulimia
  3. Arrhythmias
  4. Diabetes
  5. CHF
  6. HTN
  7. Glaucoma
  8. Hyperthyroidism
  9. Pregnancy
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11
Q

How can renal elimination of ephedra be faciliated?

A

By urinary acidification (ephedra is a weak base).

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12
Q

What is the nature of garlic?

A

Contains organic thiosulfinates that can form allicin (responsible for the characteristic odor) via enzymes activated by disruption of the garlic bulb.

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13
Q

What are the main pharmacologic effects of garlic?

A
  1. HMG-CoA reductase inhibition
  2. ACE inhibition
  3. Platelet aggregation block
  4. Incr. NO
  5. Fibrinolytic
  6. Antimicrobial
  7. Decr. carcinogen activation
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14
Q

What are the possible side effects of garlic?

A
  1. Nausea
  2. Hypotension
  3. Allergic reactions
  4. Problems with patients on anticoagulants
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15
Q

What is the nature of ginkgo?

A

Prepared from the leaves of Gingko biloba, ginkgo contains flavone glycosides and terpenoids.

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16
Q

What are the main pharmacologic effects of ginkgo?

A
  1. Antioxidant and radical-scavenging effects.
  2. Incr. NO
  3. Reduced blood viscosity
  4. Changes in CNS neurotransmitters
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17
Q

What is the common intended use of ginkgo?

A
  1. Treatment of intermittent claudication
  2. Cerebral insufficiency
  3. Dementia
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18
Q

What are the possible side effects of ginkgo?

A
  1. GI effects
  2. Anxiety
  3. Insomnia
  4. Headache
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19
Q

What are the conditions in which ginkgo is contraindicated?

A
  1. Patients receiving anticoagulants

2. Patients with a history of seizures - may be epileptogenic.

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20
Q

What is the nature of ginseng?

A

From the plant of the genus Panax, which contain multiple triterpenoid saponin glycosides (ginsenosides).

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21
Q

What are the pharmacologic effects of ginseng?

A
  1. Improve mental and physical perfomance (limited evidence).
  2. Some evidence that may have some effect in cold prevention and in lowering postprandial glucose.
22
Q

What are the side effects of ginseng?

A
  1. Estrogenic effects –> mastalgia and vaginal bleeding.

2. Insomnia, nervousness, and HTN have been reported.

23
Q

In what conditions should ginseng be used cautiously?

A 
In patients receiving:
1. Anticoagulant
2. Antihypertensive
3. Hypoglycemic
4. Psychiatric 
medications.
24
Q

What is the nature of milk thistle?

A

Derived from the fruit and sedds of Silybum marianum, which contains flavonolignans such as silymarin.

25
Q

What are the main pharmacologic effects of milk thistle?

A
  1. Reduces lipid peroxidation
  2. Scavenges free radicals
  3. Enhance SOD
  4. Inhibits formation of leukotrienes
  5. Increases hepatocyte RNA polymerase activity
26
Q

What is the common intended use of milk thistle?

A
  1. Limitation of hepatic injury

2. As an antidote to Amanita mushroom poisoning

27
Q

What is the only side effect that milk thistle may cause?

A

Loose stools.

28
Q

What is the nature of St.John’s wort?

A

Made from dried flowers of hypericum perforatum, which contains the active constituents hypericin and hyperforin.

29
Q

What is the pharmacologic action of St.John’s wort?

A

Hyperforin –> Decreases serotonin reuptake.

Hypericin –> When photoactivated, may have antiviral and anticancer effects.

30
Q

What is the common intended use of St.John’s wort?

A

Treatment of mild to moderate depression.

31
Q

What are the possible side effects of St.John’s wort?

A
  1. Mild GI effects

2. Photosensitization

32
Q

In what conditions should St.John’s wort be avoided?

A

In patients:

  1. Using SSRIs
  2. MAOs
  3. With history of bipolar or psychotic disorder
33
Q

What metabolic effect does St.John’s wort have?

A
  1. Induce CYP450 and P-glycoprotein drug transporters.

2. Decreases effect of –> birth control pills, cyclosporine, digoxin, HIV protease inhibitors, warfarin.

34
Q

What is the nature of saw palmetto?

A

Derived from the berries of Serenoa repens or Sabal serrulata.
Contains phytosterols, aliphatic alcohols, polyprenes, flavonoids.

35
Q

What is the pharmacologic action of saw palmetto?

A

Inhibition of 5α-reductase and antagonistic effects at androgen receptors.

36
Q

What is the common intended use of saw palmetto?

A

Improvement in symptoms of BPH.

37
Q

What are the side effects of saw palmetto?

A
  1. Abdominal pain with GI distress.
  2. Decreased libido
  3. Headache
  4. HTN
  5. Has NO effects on the PSA.
38
Q

Does saw palmetto have any effect on PSA?

A

No effect.

39
Q

What is the nature of coenzyme Q10 (also known as ubiquinone)?

A

It is a benzoquinone that serves as a cofactor in the mitochondrial electron transport chain and, in its reduced form of ubiquinol, serves as an important antioxidant.

40
Q

After digestion, what form of coenzyme Q10 predominates in the circulation?

A

The reduced form.

41
Q

What are the common intended uses of coenzyme Q10?

A
  1. Improvement of ischemic heart disease.
  2. Parkinson
  3. Statin-related myopathy
42
Q

What is the most common side effect of coenzyme Q10?

A

GI disturbances.

43
Q

Mention some rare effects of coenzyme Q10?

A
  1. Rash
  2. Thrombocytopenia
  3. Irritability
  4. Dizziness
  5. Headache
44
Q

What is the nature of glucosamine?

A

Amino sugar that serves as the precursor of nitrogen-containing sugars –> including the glycosaminoglycans (major constituent of connective tissue).

45
Q

What is the common intended use of glucosamine?

A

Reduction of pain associated with osteoarthritis.

46
Q

What are the side effects of glucosamine?

A
  1. Diarrhea
  2. Nausea
  3. Possible cross-allergenicity with shellfish.
47
Q

What is the nature of melatonin?

A

A serotonin derivative produced mainly in the pineal gland.

48
Q

What are the main actions of melatonin?

A
  1. Regulate sleep-wake cycles.
  2. Contraception
  3. Prevention of aging
  4. Protect against oxidative stress
  5. Treatment of cancer
  6. Major depression
  7. HIV infection
49
Q

What are the applications of melatonin?

A
  1. Extensively used for jet lag and insomnia.

2. Sleep disorders (ramelteon).

50
Q

What are the side effects of melatonin?

A
  1. Sedation
  2. Next-day drowsiness
  3. Headache
51
Q

In what conditions is melatonin contraindicated?

A
  1. In pregnancy
  2. In women attempting to conceive
  3. In nursing mothers
52
Q

Mention 2 examples of purified non herbal nutritional supplements that are used widely by the public in pursuit of “alternative medicine”.

A
  1. Dehydroepiandrosterone (DHEA)

2. Melatonin

pharma (11 decks)

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