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CDM1 > Exam 1: Herbals > Flashcards

Exam 1: Herbals Flashcards

1
Q

Acai: Uses

A

Weight loss

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2
Q

Acai: Efficacy

A

Insufficient evidence

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3
Q

Acai: Adverse effect

A

Generally well tolerate

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4
Q

Acai: Other information to know

A

Chagas disease (parasitic protozoan) from raw fruit and juice

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5
Q

Bitter orange: Uses

A

Weight loss

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6
Q

Bitter orange: adverse effects

A

Prolongs QT interval

Potential cardiac adverse effects

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7
Q

Bitter orange: What other drug is it related to?

A

Ephedrine

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8
Q

Herbals: The use of ____ has been banned by many sport organizations

A

Bitter orange

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9
Q

Black cohosh: Uses

A

Menopause (hot flashes)

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10
Q

Black cohosh: efficacy

A

questionable – may reduce frequency compared to baseline but not placebo?
Not effective for hot flashes related to cancer

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11
Q

Black cohosh: adverse effects

A 
Reports of liver damage (if long-term use, check LFTs)
Weight gain
Breast tenderness
Headache 
Rash
GI complaints
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12
Q

Black cohosh: contraindication

A

Pregnancy (causes uterine contractions, increased risk of miscarriages)

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13
Q

Black cohosh: MOA

A

More like SSRIs than phytoestrogens

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14
Q

Caffeine: Uses

A

Mental acuity

Weight loss

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15
Q

Caffeine: Efficacy

A

Possibly effective when combined with thermogenic agents

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16
Q

Caffeine: Adverse effects

A

Increased HR
Diuretic effects
Increased BP

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17
Q

Caffeine: What happens when you have high doses?

A

Increase anxiety and decrease in mental acuity

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18
Q

Cranberry: Uses

A

UTI

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19
Q

Cranberry: efficacy

A

Prevention: mixed results on pt population
Treatment: not effective

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20
Q

Cranberry: Adverse effects

A

Well tolerated

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21
Q

Cranberry: MOA

A

Not related to acidification of urine but rather prevents bacterial adhesion to uroepithelial cells

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22
Q

Cranberry: Interactions

A

May inhibit CYP3A4

Warfarin (increases INR)

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23
Q

Echinacea: Uses

A

Common cold

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24
Q

Echinacea: Efficacy

A

Limited effectiveness for prevention

Doesn’t affect duration

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25
Q

Echinacea: Adverse effects

A

GI complaints
Rash (especially children)
Allergic reactions

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26
Q

Echinacea: contraindications

A 
Autoimmune disorders
Asthma
Ragweed allergy
Atopy
Allergic rhinitis
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27
Q

Which herbal is contraindicated with pregnancy?

A

Black cohosh – increases uterine contractions, potential miscarriage risk

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28
Q

Which herbal is contraindicated with ragweed allergy?

A

Echinacea

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29
Q

Ephedra: Use

A

Weight loss

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30
Q

Ephedra: Adverse effect

A 
Heart attack
Arrhythmia
Stroke
Psychosis
Seizures
Death
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31
Q

Ephedra: Other

A

BANNED, DO NOT RECOMMEND

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32
Q

Fish Oil: Uses

A

Cholesterol

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33
Q

Fish oil: 2 types

A

EPA and DHA

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34
Q

Fish oil: Uses

A

Hyperlipidemia: decreases TG (high doses, Rx)
Reduces BP modestly (2-5 SBP/1-3 DBP)
Mental development (infants)
Dietary fish oil reduces risk of CHF by 15%

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35
Q

Fish oil: Dietary fish oil reduces risk of _____

A

CHF by 15%

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36
Q

Fish oil: adverse effects

A 
Fishy burp
Halitosis
Heartburn
Loose stool
May increase LDL slightly
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37
Q

Fish oil: Tips for AE

A

Take with meals, freeze caps, use EC to minimize AE

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38
Q

Fish oil: What happens if you take a dose >3g/day?

A

Many inhibit platelet aggregation

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39
Q

Fish oil: AHA recommendation

A

2 servings/week, non-fried fish in place of other proteins

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40
Q

Flaxseed: Uses

A

Menopause (40g/day)

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41
Q

Flaxseed: Efficacy

A

Questionable (most people unwilling/unable to take dose needed for efficacy)

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42
Q

Flaxseed: Adverse effects

A

Bloating
Flatulence
Abdominal pain
Diarrhea

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43
Q

Flaxseed: What is the efficacious dose and what is the issue?

A

40g/day, has high fat and calorie content (most people unwilling, it’s a lot)
May take 1-2 months to see beneficial effects

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44
Q

Flaxseed: Can you see beneficial effects right away?

A

No – takes 1-2 months

45
Q

Garcinia: Uses

A

Weight loss

46
Q

Garcinia: Efficacy

A

2020 review found no significant effect on weight loss

47
Q

Garcinia: Adverse effect

A 
Mild GI
Hepatotoxicity (requiring transplant[!] - not worth)
Abdominal pain
Jaundice
Confusion
48
Q

Garcinia: Active ingredient

A

Hydroxycitric acid (HCA)

49
Q

Garlic: Uses

A

HTN

Cholesterol

50
Q

Garlic: Efficacy

A

HTN: Limited (decreases SBP 7-8%)
Cholesterol: None (recent studies)

51
Q

Garlic: Adverse effects

A

Heartburn
Flatulence
N/V
Contact dermatitis

52
Q

Garlic: How long do you have to take it for benefits?

A

Over 2 months

53
Q

Garlic: Interactions

A

Antiplatelet agents, anticoagulants

Induces p-gp efflux pump (decrease serum conc. of p-gp substrates)

54
Q

Ginkgo: Uses

A

Dementia

Peripheral arterial disease

55
Q

Ginkgo: Efficacy

A 
May improve cognition in patients with dementia 
Recent RCTs (GEM): not effective for prevention or slowing progression
56
Q

Ginkgo: Adverse effects

A 
Allergic reactions (poison oak, poison ivy, mango rind)
Bleeding
57
Q

Ginkgo: Interactions

A

Avoid use with meds that lower seizure threshold – ginkgotoxins found in seeds can cause seizures

Induce 2C19

Anticoagulants/antiplatelet agents – increased bleeding (stop 2 weeks before surgery)

58
Q

Ginseng: Uses

A

General well being
Immune stimulant
Sexual dysfunction

59
Q

Ginseng: Efficacy

A

Minimal: depends on indication

60
Q

Ginseng: Adverse Effects

A

Headache
Insomnia
Estrogenic effects (mastalgia, vaginal bleeding, amenorrhea)

61
Q

Ginseng: Interactions

A

Antiplatlet/anticoagulants - increased bleeding risk

Diabetes meds: risk of hypoglycemia

62
Q

Glucosamine: Uses

A

Osteoarthritis

63
Q

Glucosamine: Efficacy

A

Sulfate form effective for osteoarthritis of the KNEE but not hip

64
Q

Glucosamine: Adverse effect

A

Mild GI complaints

65
Q

Glucosamine: Contraindication

A

Anaphylaxis to shellfish – derived from exoskeleton of shellfish (not meat) OR use synthetic

66
Q

Herbal T/F: Glucosamine is derived from the meat of shellfish

A

False – it is derived from the exoskeleton

67
Q

Glucosamine: interaction

A

Warfarin: increases INR

68
Q

Melatonin: Uses

A

Insomnia

Jetlag

69
Q

Melatonin: Efficacy

A

Possibly effective (better results in elderly)

70
Q

Melatonin: adverse effects

A

Well tolerated

71
Q

Melatonin: MOA

A

Regulates circadian rhythms

72
Q

Melatonin: Dosing

A

Insomnia dose: 2-3mg QHS

73
Q

Melatonin is synthetic derivation of a natural hormone that is secreted from ____

A

Pineal gland

74
Q

Red clover: Uses

A

Menopause (hot flash)

75
Q

Red clover: Efficacy

A

Mixed evidence but most studies show no benefit over placebo

76
Q

Red clover: Adverse effects

A

Nausea
Myalgia
Vaginal spotting

77
Q

Red clover: Interactions

A

Increased risk of bleeding with antiplatelet agents or anticoagulants
Avoid if taking tamoxifen or hx of breast cancer

78
Q

SAMe: Uses

A

Depression

79
Q

SAMe: efficacy

A

Insufficient evidence

80
Q

SAMe: Adverse Effects

A

Headache
Insomnia
N/V/D

81
Q

SAMe: MOA

A

Increases serotonin, NE, dopamine

82
Q

SAMe: Other issues

A

Issues with product quality and cost

83
Q

Saw palmetto: Uses

84
Q

Saw palmetto: Efficacy compared to 5-a reductase inhibitors

85
Q

Saw palmetto: Efficacy compared to alpha-1 blockers

A

Less effective

86
Q

Saw palmetto: Adverse effects

A 
Dizziness
Headache 
Decreased libido
GI Complaints
Prolonged bleeding time
87
Q

Saw palmetto: MOA

A

Antiandrogenic, anti-proliferative, anti-inflammatory, 5-a reductase activity

88
Q

Saw palmetto: How long does it take to see benefits?

A

1-2 months to see improvement

89
Q

Saw palmetto: Other issues

A

Issues with contamination/adulteration of products in clinical trials – raised questions about efficacy

90
Q

Soy: Uses

A

Menopause (hot flashes)

Cholesterol

91
Q

Soy: Efficacy

A

Modest benefit (PROTEIN) – takes up to 2 months to work
Protein: modest benefit (LDL decreases 10%)
Possible benefit for BP for people with HTN

92
Q

Soy: T/F Soy protein is equivalent to soy supplements

A

False - soy protein (food) is better than supplements

93
Q

Soy: Adverse effects

A

Well tolerated

94
Q

Soy: Interactions

A

Avoid supplements if taking tamoxifen or hx of breast cancer (estrogen-dependent)

95
Q

St. John’s Wort: Uses

A

Depression

96
Q

St. John’s Wort: Efficacy

A

Effective for mild to moderate depression

High placebo effect

97
Q

St. John’s Wort: Adverse effects

A 
Dizziness
Insomnia
Vivid dreams
Restlessness
Fatigue
Dry mouth
Photosensitivity *
98
Q

St. John’s Wort: MOA

A

Similar to SSRIs/SNRIs

99
Q

St. John’s Wort: How long does it take to see benefits:?

A

3-4 weeks for maximal effect, taper when d/c

100
Q

St. John’s Wort: Which isoenzymes does it affect and how (induce/inhibit)

A

Induces 3A4/p-gp (strong):
- Digoxin, benzodiazepines, oral contraceptives, phenytoin, protease inhibitors, NNRTIs, warfarin
Induces 1A2/2C9/2C19 (mild)

101
Q

St. John’s Wort: Interactions

A

Induces 3A4/p-gp (strong): Benzodiazepines, oral contraceptives, phenytoin, protease inhibitors, NNRTIs, warfarin, other serotonergic meds
Induces 1A2/2C9/2C19 (mild)
Use with caution with other serotonergic agents

102
Q

Valerian: Use

103
Q

Valerian: Efficacy

A

Possibly effective

104
Q

Valerian: Adverse effect

A

Headache
Nervousness
Excitability
Hepatotoxicity (rare)

105
Q

Valerian: MOA

A

Benzodiazepine-like effects at GABA receptors

106
Q

Valerian: How long does it take to see benefit?

A

May take several days/weeks to see full effect – taper when d/c

107
Q

Which herbals are recommended to taper when discontinuing?

A

St. John’s wort and valerian

108
Q

Which herbals may cause hepatotoxicity?

A

Valerian (rare) and Garcinia

109
Q

Which herbals may increase bleeding risk?

A

Ginkgo, ginseng, red clover, and saw palmetto (prolonged bleeding time)

CDM1 (19 decks)

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