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Pharm Part II > E5: Herbie Hancock-Herbal Drugs > Flashcards

E5: Herbie Hancock-Herbal Drugs Flashcards

1
Q

Important things to consider for your herbal patient: Beware of and assess the truthfulness of _________

A

non-disclosure

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2
Q

Important things to consider for your herbal patient: Do not _______ or criticize and maintain their ________

A

judge….condfidentiality

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3
Q

Important questions for your herbal pt: How _____ have you been using one or more herbs?

A

LONG

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4
Q

Important questions for your herbal pt: Are you using herbs for: Promotion or maintenance of _______? Treatment of _______ problems?

A

oral health

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5
Q

Important questions for your herbal pt: Have you had any _______ from herbs?

A

side effects

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6
Q

Important questions for your herbal pt: Which herbs do you take _______ (at least once a week)?

A

regularly

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7
Q

Important questions for your herbal pt: Have you recently ______ taking any herbs?

A

stopped

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8
Q

Important questions for your herbal pt: Have you _______ herbs for Rx or OTC drugs?

A

substituted

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9
Q

What are the three main groups that could see adverse effects of Herbals?

A

peds, gerris, pregos

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10
Q

A national survey conducted in 2007 found that _____ of American adults had used “natural products” in the past 12 months

A

17.7%

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11
Q

What are the 5 most popular herbal products used?

A

1.Fish oil/omega 3/DHA 2.Glucosamine 3.echinacea 4.flaxseed oil 5.ginseng

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12
Q

___% of adult respondents said they had used some type of SUPPLEMENT in the last 30 days….what are 4 examples?

A

52%…1. mutivitamins 2.vit E and C 3.Calcium 4.B vitamins

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13
Q

____% (n = 41) were at risk of having at least one possible drug and herbal-supplement INTERACTION

A

31.5%!!!

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14
Q

What are the 4 most common reasons patients take an herbal product/dietary supplement?

A

1.Improve generall wellness 2.manage arthritis 3.prevent/manage colds 4.improve memory

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15
Q

What are the 5 most common herbal meds that have documented drug interactions???

A
  1. St. John’s Wort 2.Magnesium 3.Calcium 4.Iron 5.Ginkgo
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16
Q

What are the three main systemic conditions that people used herbal meds/supps for?

A

1.CNS disorders 2.CardioVascular Sys disorders 3.Systemic Anti-Infectives

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17
Q

What is the #1 Rx med that has interactions with herbal meds? What about the rest of the top 5?

A

1.WARFARIN (100+ interactions with herbal meds/supps) 2.Insulin 3.Aspirin 4.Digoxin 5.Ti-Clo-pid-ine (antiplatelet)

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18
Q

HDS products containing _____ were more likely to have documented interactions with medications and contraindications than _____, ______ and other types of dietary supplements.

A

herbs more likely than vitamins, minerals

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19
Q

What is the main way that herbal meds interfere with Rx meds? Like what does it do to their “safety”?

A

Patients using medications that have a NARROW THERAPUTIC RANGE (i.e. warfarin, digoxin) = greater risk for adverse outcomes because of HDS–drug interactions

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20
Q

Important for patients on __________ who concomitantly took Herbals

A

anticoagulants

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21
Q

It is estimated that GREATER THAN ____% of patients with chronic diseases or cancers use HDS

A

50% !!!!!

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22
Q

Many herbs act as ________ or ________ medications

A

anti-platelet…anticoagulant

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23
Q

Effects may be _______ if taking one or more of these herbs and/or if taking aspirin, ibuprofen, warfarin, etc.

A

ADDITIVE

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24
Q

Patients are _______ of these effects

A

unaware

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25
Q

Many herbal products contain ________: patients may not always know what is contained within their supplements

A

multiple herbs

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26
Q

What kind of evidence is used for supporting the bleeding effects of herbal meds? (4)

A

1.Anecdotal 2.Case Studies 3.Animal Studies 4.Lab studies

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27
Q

What are the 4 common herbs that cause bleeding issues? WHY do they cause these issues?

A

the 4 G’s!!! 1.Ginkgo 2.Garlic 3.Ginseng 4.Ginger….They ANTAGONIZE PLATELET ACTIVATING FACTOR (PAF)

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28
Q

Should herbal meds be discontinued before surgery? If so how long before?

A

YES! 14 days prior to surgery (including oral surgery)

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29
Q

SWEET! She’s giving us a mnemonic: How do I know if an herb is assoc with a bleeding effect?

A

the “g” is followed by a VOWEL (G’i’nkgo)

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30
Q

SWEET! She’s giving us a mnemonic: How do I know if a herb is NOT a concern for bleeding?

A

the “g” is followed by a cononant (G’r’een tea)

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31
Q

SWEET! She’s giving us a mnemonic: What are the 5 examples of the ‘A Few G’s will help you’ mnemonic?

A

FeverFEW, Ginkgo biloba, Ginger, Garlic, Ginseng

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32
Q

What are the 4 ‘Anti’ effects of garlic? (BESIDES anti-vampire)

A

1.Anti-Lipiemic 2.Antimicrobial 3.Anti-asmatic 4.Anti-inflammatory

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33
Q

What are the 3 components in GARLIC implicated with bleeding?

A

AAS……1.A-joe-ne 2.Allicin 3.Sulfur containing compounds

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34
Q

The 3 components Ajoene, Allicin, and Sulfur in GARLIC have _________ effects… What are the 2 chemical mediators that they inhibit?

A

ANTI-PLATELET…..1.Platelet Activating Factor 2.Adenosine (decreasing platelet function)

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35
Q

What are the 3 benefits of GINKGO?

A

1.PREVENT decreased cerebral funciton 2.Peripheral Vascular insufficiency associated with Alzheimer’s disease or age-related dementia 3.Improve memory and cognition

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36
Q

What is the component of GINKGO implicated with anti-bleeding? They are Potent antagonists of _________ and they have _______ and ________ onset with oral dosing

A

Terpenoids!….platelet activating factor…. Long-lasting and rapid

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37
Q

The anti platelet effect of the Terpinoids of Gingko is that: Effect: antiplatelet = increases _________ and
decreases __________

A

prothrombin time…..platelet activity

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38
Q

________ has had MANY case reports of severe bleeding

A

Gingko

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39
Q

Gingko: Risk for severe spontaneous bleeding with concurrent use of _______ and ________

A

aspirin and warfarin

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40
Q

What are the 7, YES 7 (how bad do you want this?!?!) benefits of GinSeng?

A

1.Anti-Cancer 2.Slows aging 3.Prevent Heart Attack 4.Improve Digestion 5.Reduce hypertension 6.Strengthen immunity 7.CNS stimulant (wow! get me some!)

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41
Q

What are the components of Ginseng associated with bleeding?

A

Ginsen-osides

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42
Q

What are the 4 anti-platelet effects of Ginseng’s ginsenosides?

A

1.inhibit PAF 2.Inhibit Platelet Aggregation 3.inhibit thrombin 4.inhibit thromboplastin

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43
Q

Ginseng ANTAGONIZES the effect of ________

A

warfarin

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44
Q

What are the 4 drugs that when combined with GINSENG potentiate bleeding??

A

1.aspirin 2.NSAIDS 3.warfarin 4.heparin

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45
Q

What are the 4 benefits of Ginger?

A

1.Relive motion sickness 2.Releive morning sickness 3.Decrease arthritis pain/inflammation 4. Relive upset stomach

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46
Q

What are the 3 components of Ginger implicated in BLEEDING?

A

1.Pungent principles 2.Volatile oils 3.Proteolytic enzymes

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47
Q

What are the 2 ways Ginger has an antiPlatelet effect?

A

1.Reduces platelet THROMBOXANE 2.inhibits platelet aggregation

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48
Q

Ginger has _____ reports in the literature.

A

mixed

49
Q

What preparation of ginger has the most significant effects?

A

RAW ginger (sorry Max, not the ginger candy)

50
Q

What are the 3 benefits of FEVERFEW?

A

1.Anti-inflammatory (rheumatoid arthritis) 2.Preventative for migrane headache 3.muscle soreness

51
Q

What are the 2 active components that inhibit platelet aggregation in Feverfew??

A
  1. Ses-quit-er-pene Lactione 2.Parth-en-olide
52
Q

What is the herbal medication that MAY CAUSE IRRITATION to the ORAL MUCOSA and TONGUE???

A

FeverFew!!

53
Q

Feverfew also increases risk for ________!!

A

photosensitivity

54
Q

YOU READY FOR THIS?? HOW BAD DO YOU WANT IT??? What are the 8 benefits of Fish Oil?

A

1.skin disorders 2.cardioprotection 3.diabetes 4.headache 5.immune support 6.memory 7. PMS :) 8.Ulcerative colitis

55
Q

Daaaaang Fish oil has 7 effects on bleeding….what are they?

A

1.decrease platelet aggregation 2.prolong bleeding time 3.increase fibrinolysis 4.reduce Von Willebrand factor 5.reduce fibrinogen 6.reduce factor V levels 7. reduce Thrombin generation in plasma

56
Q

Intake of ___ grams per day or greater of omega-3 fatty acids may increase the risk of bleeding

A

3 grams

57
Q

Very large intakes of fish oil/omega-3 fatty acids may increase the risk of ____________

A

hemorrhagic (bleeding) stroke

58
Q

High doses of fish oil/omega-3 FA’s have also been associated with ________ and ____________.

A

nosebleed and blood in the urine

59
Q

What is the main indication of St. John’s Wort?

A

reduce mild to moderate depression

60
Q

St. John’s Wort is a _____-like plant

A

weed-like plant

61
Q

What is the MOST widely studied herb with demonstrated efficiency?

A

St. John’s Wort

62
Q

While the The exact mechanism of St. John’s Wort is _______, it is believed to involve inhibition of ________

A

unclear…serotonin (5-HT) reuptake

63
Q

What are the 2 MAJOR active anti depressive constituents in St. John’s Wort? what are the 2 ‘other’/minor biologically active constituents?

A

1.Hyper-forin(really THE major constituent) 2.Hypericin (others: 3.flavon-oids 4.tannins)

64
Q

What is the MAJOR constituent of St. John’s Wort?

A

HyperForin

65
Q

Holy Crap: the major constituent HyperForin in St. Johns Wort has been shown to inhibit 5 freaking neurotransmitters….WHICH ONES?

A

1.5-HT (seratonin) 2.dopamine 3. norepi 4.GABA 5.Glutamate

66
Q

Since the Hyperforin in St. John’s Wort is blocking all those neurotransmitters, what is the main component involved in bleeding? How does it work?

A

hypericin…it INDUCES some cytochrome P450 liver enzymes

67
Q

hypericin in St. John’s Wort ______ the anticoagulant effect of warfarin (increases _______) and lowers the ___

A

REDUCES, so it increases clotting…lowers INR

68
Q

St. John’s Wort ______ effects of MANY medications and has MULTIPLE drug _________

A

decreases….interactions

69
Q

St. John’s Wort: Renders _________ ineffective in

some users

A

ORAL CONTRACEPTIVES

70
Q

Which herbal med has an effect on general anesthetics making the patient difficult to awaken?

A

St. John’s Wort!

71
Q

St. John’s Wort increases PHOTOSENSITIVITY of _________

A

tetracyclines…so random!

72
Q

What happens to the effect of GLUCOCORTICOIDS while on St. John’s Wort?

A

Effect of glucocorticoids is reduced

73
Q

St. Johns Wort: ________ efficacy of anticoagulants

A

decreased

74
Q

REMBER: Discontinue all herbs ____ days prior to surgery

A

14 days

75
Q

Vitamin E is a ____ soluble vitamin that acts mainly as an ________

A

FAT…antioxidant

76
Q

Vitamin E as an anti-oxidant: prevents oxidation of Vitamins __ and ___

A

A and C

77
Q

Vitamin E as an anti-oxidant: Protects ___________ in MEMBRANES from free radical damage

A

polyunsaturated fatty acids

78
Q

Vitamin E as an anti-oxidant: Protects _____ against hemolysis

A

RBCs

79
Q

Which herbal med may alter the effect of vitamin K on

clotting factors

A

Vitamin E

80
Q

Which drug does Vitamin E interact with?

A

Warfarin

81
Q

Vitamin E interacts with warfarin: increases _______________ = ______ clotting and ________ risk for spontaneous hemorrhage

A

hypoprothombinemia….DELAYS clotting and INCREASES risk

82
Q

Herbs that alter Bleeding: 2 A’s

A

ARN-ICA and ASTRA-GALUS

83
Q

Herbs that alter Bleeding: 4 B’s

A

BARberry, BILberry,BladderWrack, BRO-mel-ain

84
Q

Herbs that alter Bleeding: 2 C’s

A

Cat’s Claw and Coenzyme Q10

85
Q

Herbs that alter Bleeding: 2 D’s

A

Devil’s claw and DONG QUAI

86
Q

Herbs that alter Bleeding: 1 E

A

Evening Primrose

87
Q

Herbs that alter Bleeding: 3 F’s

A

Fennel, FeverFew, Fish Oils

88
Q

Herbs that alter Bleeding: 6 G’s

A

1.Garlic 2.Ginger 3.Ginkgo bil-oba 4.Ginseng 5.Grape Seed 6.Green Tea

89
Q

Herbs that alter Bleeding: 1 H

A

Horse Chestnut

90
Q

Herbs that alter Bleeding: 1 K

A

Kudzu

91
Q

Herbs that alter Bleeding: 2 P’s

A

Poli-co-sanol and Pyc-no-genol

92
Q

Herbs that alter Bleeding: 1 T

A

Turmeric

93
Q

What are the 3 usual uses for Echinacea?

A

common cold, cough, bronchitis

94
Q

What’s the main systemic consequence of Echinacea? When is it especially bad?

A

its Hepatotoxic…esp with other hepatotoxic meds

95
Q

Limit your use of Echinacea to ____ days

A

10 days

96
Q

What two drugs decrease the effectiveness of corticosteroids?

A

1.St. John’s Wort 2.Echinacea

97
Q

What happens if you suddenly stop taking FeverFew?

A
  1. Rebound Headaches 2.Joint Pain 3.Stiffness 4.Anxiety
98
Q

Feverfew Inhibits ______ activity

A

patelet

99
Q

Up to 15% of FeverFew users may develop _________

A

aphthous ulcers

100
Q

Which 3 herbal meds are CONTRAINDICATED in pregnancy???

A

1.FeverFew 2.Kava-Kava 3.Licorice

101
Q

What were the two herbal meds associated with photosensitivity?

A

st johns wort with tetracyclines and FeverFew with general photosen.

102
Q

What are the 4 indications for KAVA-KAVA use?

A

1.Anxiety 2.Stress Relief 3.Minor tranquilizer 4.Skeletal muscle relaxant

103
Q

Which herbal med potentiates CNS effects of other CNS depressants (EtOH, BDZ’s, barbiturates, sedatives, general anesthesia)?

A

Kava-Kava

104
Q

Which two herbals have adverse associations with anesthetics?

A

Kava-Kava and St. John’s Wort

105
Q

The FDA is currently monitoring KAVA-KAVA for _________ problems

A

hepatoToxicity

106
Q

Kava-Kava is contraindicated in pregnancy, lactation AND ________.. WHY?

A

Parkinson’s Disease…may cause dopamine antagonism)

107
Q

What do people use Licorice to treat (4)?

A

1.Gastric disorders 2.AntiTussive (cough) 3.Apthous Ulcers 4.Herpes Simplex

108
Q

Monitor vital signs when on LICORICE! Why?

A

Can cause Hypertension!

109
Q

Licorice may alter ______ aggregation

A

platelet

110
Q

Licorice is contraindicated in pregnancy, lactation, and can cause _____ or _____ impairment

A

liver or renal

111
Q

Wait, what are the (7) platelet altering herbs?

A

1.Garlic 2.Ginkgo 3.Ginseng 4.Ginger 5.FeverFew 6.Fish Oils 7.Licorice

112
Q

What is Valerian used for? (5)

A

1.mild sedative 2.mild anxiolytic 3.anxiety 4.depression 5.insomnia

113
Q

Valerian causes ________ and sedation

A

drowsiness

114
Q

Valerian potentiates the effects of CNS depressants, including _________

A

barbiturates

115
Q

Which two herbals potentiate the effects of CNS depressants?

A

kaVA-kaVA and VAlerian

116
Q

Dental Considerations: Synergistic drug effects with ______, ______: seek alternative analgesics

A

aspirin NSAIDS

117
Q

Dental Considerations: Monitor patients on ______ for herbal use and counsel appropriately

A

warfarin

118
Q

Dental Considerations: Cross-reference all herbal and prescription medications prior to prescribing to ensure _________…Like what resource?

A

compatibility…Lexicomp

Pharm Part II (28 decks)

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