Exam 1: Herbals Flashcards
1
Q
Acai: Uses
A
Weight loss
2
Q
Acai: Efficacy
A
Insufficient evidence
3
Q
Acai: Adverse effect
A
Generally well tolerate
4
Q
Acai: Other information to know
A
Chagas disease (parasitic protozoan) from raw fruit and juice
5
Q
Bitter orange: Uses
A
Weight loss
6
Q
Bitter orange: adverse effects
A
Prolongs QT interval
Potential cardiac adverse effects
7
Q
Bitter orange: What other drug is it related to?
A
Ephedrine
8
Q
Herbals: The use of ____ has been banned by many sport organizations
A
Bitter orange
9
Q
Black cohosh: Uses
A
Menopause (hot flashes)
10
Q
Black cohosh: efficacy
A
questionable – may reduce frequency compared to baseline but not placebo?
Not effective for hot flashes related to cancer
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
12
Q
Black cohosh: contraindication
A
Pregnancy (causes uterine contractions, increased risk of miscarriages)
13
Q
Black cohosh: MOA
A
More like SSRIs than phytoestrogens
14
Q
Caffeine: Uses
A
Mental acuity
Weight loss
15
Q
Caffeine: Efficacy
A
Possibly effective when combined with thermogenic agents
16
Q
Caffeine: Adverse effects
A
Increased HR
Diuretic effects
Increased BP
17
Q
Caffeine: What happens when you have high doses?
A
Increase anxiety and decrease in mental acuity
18
Q
Cranberry: Uses
A
UTI
19
Q
Cranberry: efficacy
A
Prevention: mixed results on pt population
Treatment: not effective
20
Q
Cranberry: Adverse effects
A
Well tolerated
21
Q
Cranberry: MOA
A
Not related to acidification of urine but rather prevents bacterial adhesion to uroepithelial cells
22
Q
Cranberry: Interactions
A
May inhibit CYP3A4
Warfarin (increases INR)
23
Q
Echinacea: Uses
A
Common cold
24
Q
Echinacea: Efficacy
A
Limited effectiveness for prevention
Doesn’t affect duration
25
Echinacea: Adverse effects
GI complaints
Rash (especially children)
Allergic reactions
26
Echinacea: contraindications
```
Autoimmune disorders
Asthma
Ragweed allergy
Atopy
Allergic rhinitis
```
27
Which herbal is contraindicated with pregnancy?
Black cohosh -- increases uterine contractions, potential miscarriage risk
28
Which herbal is contraindicated with ragweed allergy?
Echinacea
29
Ephedra: Use
Weight loss
30
Ephedra: Adverse effect
```
Heart attack
Arrhythmia
Stroke
Psychosis
Seizures
Death
```
31
Ephedra: Other
BANNED, DO NOT RECOMMEND
32
Fish Oil: Uses
Cholesterol
33
Fish oil: 2 types
EPA and DHA
34
Fish oil: Uses
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%
35
Fish oil: Dietary fish oil reduces risk of _____
CHF by 15%
36
Fish oil: adverse effects
```
Fishy burp
Halitosis
Heartburn
Loose stool
May increase LDL slightly
```
37
Fish oil: Tips for AE
Take with meals, freeze caps, use EC to minimize AE
38
Fish oil: What happens if you take a dose >3g/day?
Many inhibit platelet aggregation
39
Fish oil: AHA recommendation
2 servings/week, non-fried fish in place of other proteins
40
Flaxseed: Uses
Menopause (40g/day)
41
Flaxseed: Efficacy
Questionable (most people unwilling/unable to take dose needed for efficacy)
42
Flaxseed: Adverse effects
Bloating
Flatulence
Abdominal pain
Diarrhea
43
Flaxseed: What is the efficacious dose and what is the issue?
40g/day, has high fat and calorie content (most people unwilling, it's a lot)
May take 1-2 months to see beneficial effects
44
Flaxseed: Can you see beneficial effects right away?
No -- takes 1-2 months
45
Garcinia: Uses
Weight loss
46
Garcinia: Efficacy
2020 review found no significant effect on weight loss
47
Garcinia: Adverse effect
```
Mild GI
Hepatotoxicity (requiring transplant[!] - not worth)
Abdominal pain
Jaundice
Confusion
```
48
Garcinia: Active ingredient
Hydroxycitric acid (HCA)
49
Garlic: Uses
HTN
| Cholesterol
50
Garlic: Efficacy
HTN: Limited (decreases SBP 7-8%)
Cholesterol: None (recent studies)
51
Garlic: Adverse effects
Heartburn
Flatulence
N/V
Contact dermatitis
52
Garlic: How long do you have to take it for benefits?
Over 2 months
53
Garlic: Interactions
Antiplatelet agents, anticoagulants
| Induces p-gp efflux pump (decrease serum conc. of p-gp substrates)
54
Ginkgo: Uses
Dementia
| Peripheral arterial disease
55
Ginkgo: Efficacy
```
May improve cognition in patients with dementia
Recent RCTs (GEM): not effective for prevention or slowing progression
```
56
Ginkgo: Adverse effects
```
Allergic reactions (poison oak, poison ivy, mango rind)
Bleeding
```
57
Ginkgo: Interactions
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
Ginseng: Uses
General well being
Immune stimulant
Sexual dysfunction
59
Ginseng: Efficacy
Minimal: depends on indication
60
Ginseng: Adverse Effects
Headache
Insomnia
Estrogenic effects (mastalgia, vaginal bleeding, amenorrhea)
61
Ginseng: Interactions
Antiplatlet/anticoagulants - increased bleeding risk
| Diabetes meds: risk of hypoglycemia
62
Glucosamine: Uses
Osteoarthritis
63
Glucosamine: Efficacy
Sulfate form effective for osteoarthritis of the KNEE but not hip
64
Glucosamine: Adverse effect
Mild GI complaints
65
Glucosamine: Contraindication
Anaphylaxis to shellfish -- derived from exoskeleton of shellfish (not meat) OR use synthetic
66
Herbal T/F: Glucosamine is derived from the meat of shellfish
False -- it is derived from the exoskeleton
67
Glucosamine: interaction
Warfarin: increases INR
68
Melatonin: Uses
Insomnia
| Jetlag
69
Melatonin: Efficacy
Possibly effective (better results in elderly)
70
Melatonin: adverse effects
Well tolerated
71
Melatonin: MOA
Regulates circadian rhythms
72
Melatonin: Dosing
Insomnia dose: 2-3mg QHS
73
Melatonin is synthetic derivation of a natural hormone that is secreted from ____
Pineal gland
74
Red clover: Uses
Menopause (hot flash)
75
Red clover: Efficacy
Mixed evidence but most studies show no benefit over placebo
76
Red clover: Adverse effects
Nausea
Myalgia
Vaginal spotting
77
Red clover: Interactions
Increased risk of bleeding with antiplatelet agents or anticoagulants
Avoid if taking tamoxifen or hx of breast cancer
78
SAMe: Uses
Depression
79
SAMe: efficacy
Insufficient evidence
80
SAMe: Adverse Effects
Headache
Insomnia
N/V/D
81
SAMe: MOA
Increases serotonin, NE, dopamine
82
SAMe: Other issues
Issues with product quality and cost
83
Saw palmetto: Uses
BPH
84
Saw palmetto: Efficacy compared to 5-a reductase inhibitors
Similar
85
Saw palmetto: Efficacy compared to alpha-1 blockers
Less effective
86
Saw palmetto: Adverse effects
```
Dizziness
Headache
Decreased libido
GI Complaints
Prolonged bleeding time
```
87
Saw palmetto: MOA
Antiandrogenic, anti-proliferative, anti-inflammatory, 5-a reductase activity
88
Saw palmetto: How long does it take to see benefits?
1-2 months to see improvement
89
Saw palmetto: Other issues
Issues with contamination/adulteration of products in clinical trials -- raised questions about efficacy
90
Soy: Uses
Menopause (hot flashes)
| Cholesterol
91
Soy: Efficacy
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
Soy: T/F Soy protein is equivalent to soy supplements
False - soy protein (food) is better than supplements
93
Soy: Adverse effects
Well tolerated
94
Soy: Interactions
Avoid supplements if taking tamoxifen or hx of breast cancer (estrogen-dependent)
95
St. John's Wort: Uses
Depression
96
St. John's Wort: Efficacy
Effective for mild to moderate depression
| High placebo effect
97
St. John's Wort: Adverse effects
```
Dizziness
Insomnia
Vivid dreams
Restlessness
Fatigue
Dry mouth
Photosensitivity *
```
98
St. John's Wort: MOA
Similar to SSRIs/SNRIs
99
St. John's Wort: How long does it take to see benefits:?
3-4 weeks for maximal effect, taper when d/c
100
St. John's Wort: Which isoenzymes does it affect and how (induce/inhibit)
Induces 3A4/p-gp (strong):
- Digoxin, benzodiazepines, oral contraceptives, phenytoin, protease inhibitors, NNRTIs, warfarin
Induces 1A2/2C9/2C19 (mild)
101
St. John's Wort: Interactions
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
Valerian: Use
Insomnia
103
Valerian: Efficacy
Possibly effective
104
Valerian: Adverse effect
Headache
Nervousness
Excitability
Hepatotoxicity (rare)
105
Valerian: MOA
Benzodiazepine-like effects at GABA receptors
106
Valerian: How long does it take to see benefit?
May take several days/weeks to see full effect -- taper when d/c
107
Which herbals are recommended to taper when discontinuing?
St. John's wort and valerian
108
Which herbals may cause hepatotoxicity?
Valerian (rare) and Garcinia
109
Which herbals may increase bleeding risk?
Ginkgo, ginseng, red clover, and saw palmetto (prolonged bleeding time)
