EXAM #4: HERBAL Flashcards
What advice should you give patients on how to choose nutrient supplements?
Select supplements that:
1) Have been studied in clinical trials
2) Independently tested e.g.
- USP
3) Standardized
What are two evidence-based resources to use in evaluating supplements?
1) Natural medicines
2) NIH Office of Dietary Supplements
Why are there conflicting results regarding many supplements?
- Lack of large clinical randomized trials
- Varying drug doses and formulations
What is the intended clinical use of Echinacea?
Decrease duration and intensity of cold
What is the MOA of Echinacea in reducing the duration and intensity of a cold?
1) Increases cytokine production
2) Anti-inflammatory by inhibiting COX
3) Increased immunological blood cells produced
What supplement increased immune system activity?
Echinacea
Thus, patients that are being immunosuppressed should NOT take this medication
What are the intended clinical uses of Ginkgo biloba?
1) Improve memory
2) Treat/prevent AD
3) Treat/prevent PVD
What is the mechanism by which Gingko biloba prevents cognitive decline?
- Increases density of 5-HT1A receptors
- Increased receptor density may lead to increased cognitive function
What harmful side effect is associated with Gingko Biloba?
1) Anti-platelet effects/ bleeding
2) Uncooked seeds can INDUCE SEIZURES
Patients that are seizure prone should avoid Gingko
What is the intended clinical uses of garlic?
1) Atherosclerosis
2) High cholesterol
3) HTN
What is the MOA of garlic in lowering blood pressure?
1) ACE inhibitor
2) Increased NO bioavailbility
3) Increased H2S production
Decrease vasoconstriction and enhance vasodilation
What adverse reaction is associated with garlic?
Increased bleeding
D/c garlic 7x days prior to elective surgery
What is the intended clinical use of Ginseng?
Boost overall health/stamina and immune performance
E.g. treatment of fatigue in cancer
What major side effect is associated with Ginseng?
- CNS stimulation i.e. should be avoided in:
1) Seizure prone patients
2) Patients prone to MANIA - Anti-platelet effects
What is the intended clinical use of Milk Thistle (Silymarin)?
Prevention/ treatment of liver disease
What is the intended clinical use of St. John’s Wort?
Antidepressant
What is the MOA of St. John’s Wort as an antidepressant?
Inhibits the reuptake of DA, NE, and 5-HT
Generally, it acts like a SSRI
What major side effect is associated with St. John’s Wort?
CYP induction that decreases the serum concentrations of other drugs
What is the intended clinical use of Saw Palmetto?
Treatment of BPH
What is the MOA of Saw Palmetto in the treatment of BPH?
- Inhibits 5-a reductase
- Prevents Testosterone conversion to DHT
- Blocks DHT induced growth of the prostate
What is the intended clinical use of Glucosamine and Chondroitin?
Osteoarthritis
What drug-drug interaction is associated with Glucosamine and Chondroitin?
Enhanced anticoagulant effects of Warfarin
What is the intended clinical use of Melatonin?
Sleep-aid/ treatment of insomnia
What is Ramelteon?
Rx melatonin receptor agonist
What major adverse effect is associated with Melatonin?
Depress reproductive system function
- Reduced sperm quality
- Decreased LH levels
What is the intended clinical use of Butterbur?
Migraines
What is the intended clinical use of Feverfew?
Migraines
What are the intended clinical uses of CoQ10?
1) Reduction of statin-induced myopathy
2) HTN
3) CAD
4) Neurodegenerative Disease
5) Migraines
List the supplements that increase the risk of bleeding in patients on warfarin.
- Ginkgo biloba
- Garlic
- Ginseng
- Glucosamine and Chondrioitin
- Feverfew
- CoQ10
What drugs should NOT be used in patients on immune suppressants?
Echinacea
Ginseng
