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CLINIC HERBAL > FINAL EXAM > Flashcards

FINAL EXAM Flashcards

1
Q

Key features of a treatment strategy

A
  • Holistic
  • Patient-centred
  • Individualised
  • Rational
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2
Q

What are physiological enhancement objectives?

A

create or support robust health; optimise function of an organ or physiological system
eg. Improve digestive capability
• Normalise intestinal motility

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3
Q

What are physiological compensation objectives?

A

reduces symptoms; breaks vicious cycle of pathophysiology
Eg. Reduce colonic water secretion
• Reduce colonic spasm

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4
Q

What are perceived cause objectives?

A

addresses predisposing, excitatory, or sustaining causes
Eg. Reduce anxiety
• Eliminate irritating foods

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5
Q

What are multi-system disorders?

A

conditions with a core fundamental pathophysiological process, but the result of that process affects multiple body systems
Eg systemic lupus erythematosus (SLE)

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6
Q

What are comorbidities?

A

Two or more conditions occurring at the same time in one patient that may or may not be directly related to each other, but do contribute to the total disease burden in that individual

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7
Q

What are cognitive errors?

A 
mistakes which affect the accuracy & effectiveness of clinical decision making
Types 
- Availability error
- Representation error
- Premature closure error
-  Anchoring error
- Confirmation bias
- Attribution error
- Affective error
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8
Q

Explain Availability error?

A
  • Choosing the first thing that comes to mind, often due to past clinical experience
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9
Q

Explain Representation error?

A

Focusing on symptoms and signs only, and not taking into consideration prevalence of the condition

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10
Q

Explain premature closure error?

A

The clinician assumes shortness of breath and vague chest pain in a patient with existing lupus to be lung inflammation, and doesn’t ask any further questions or examine other possibilities

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11
Q

Explain anchoring error?

A

clinging to an impression or decision despite contradictory or conflicting information

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12
Q

Explain confirmation bias?

A

seeking and selectively accepting information which supports a decision; often compounds an anchoring error

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13
Q

Explain attribution error?

A

decisions based on (often negative) stereotypes

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14
Q

Explain affective error?

A

personal feelings towards the patient affecting decisions

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15
Q

Constituent exhibiting Anti-inflammatory action of Salix alba?

A

Salicylate glycosides - COX-inhibiting activity

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16
Q

Constituent exhibiting Anti-inflammatory action of Zingiber officinale?

A

oleoresin - COX and LOX inhibiting activity, and circulatory stimulant activity

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17
Q

Constituent exhibiting cholagogue & Bitter action of Berberis vulgaris?

A

Isoquinoline alkaloids - berberine

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18
Q

Constituent exhibiting Bulk laxative action of Plantago lanceolata?

A

Polysaccharides

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19
Q

Constituent exhibiting Bitter action of Gentiana lutea?

A

Bitter iridoid glycosides

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20
Q

What other action to prescribe when dosing with anthraquinone glycosides?

A

Anthraquinone glycosides are laxative - prescribe with carminative to reduce griping pains associated

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21
Q

Patient factors affecting dosage?

A 
Age
Body weight
Physiological state (strong/debilitated etc)
Acute or chronic presentation
Interaction with other treatments
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22
Q

Drug factors affecting dosage?

A

Raw material quality
Extraction method
Preparation form
Pysiochemical interactions between drugs

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23
Q

Fried’s Rule for modifying dose for an infant?

A

(Age in months x adult dose) / 150

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24
Q

Actions for treatment of pain

A 
Anti-inflammatory
Analgesic
Antispasmodic (skeletal or visceral)
Adaptogen
Nervines
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25
Q

What is components of Bone & Mills therapeutic strategy?

A 
Prime Movers (Base and/or specific)
 - focus on main objective - high reliability. Prescribe in upper end of range
Adjuvants (Synergist)
 - Assist prime mover or work on lower objectives - prescribe in lower end of range
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26
Q

What is socratic questioning?

A
  • Qs for clarification
  • Qs that probe assumptions
  • Qs that probe reason & evidence
  • Qs about viewpoints & perspectives
  • Qs that probe implications & consequences
  • Qs about the question
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27
Q

Define Evidence based practice

A

Evidence-based medicine (EBM) requires integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances

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28
Q

Red flags in GIT issues?

A 
Anorexia
Anaemia
Blood in stool
Fever
Dysphagia
Pain that awakens the patient
Persistent N&V
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29
Q

Primary classes of GIT medicines

A
  • Bitters
  • Carminatives
  • Aromatic digestives
  • Antispasmodics
  • Anthelmintics
  • Antimicrobials
  • Demulcents
  • GIT anti-inflamms
  • Astringents
  • Antacids
  • MM Trophorestoratives
  • Antiemetics
  • Laxatives
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30
Q

Aromatic digestive herbs?

A

Angelica archangelica
Cinnamomum verum
Citrus reticulata
Zingiber officinale

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31
Q

Nausea herbs?

A 
Zingiber
Cinnamomum
Mentha x piperita
Matricaria chamomilla
Filipendula ulmaria
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32
Q

Common contributing factors to GIT bloating?

A
  • Dysmotility - secondary to stress
  • Overeating
  • Hepatobiliary dysfunction
  • Dysbiosis
  • Food allergies/intolerances
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33
Q

What is dyspepsia?

A

sensation of pain or discomfort in the upper abdomen; it often is recurrent. It may be described as indigestion, gassiness, early satiety, postprandial fullness, gnawing, or burning

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34
Q

Principles for atonic dyspepsia?

A

Herbs that are warming, stimulating & tonifying

Eg Ginger

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35
Q

Principles for hypertonic dyspepsia?

A

Herbs that are cooling, calming & dispersing
Eg. peppermint
Avoid strong bitters

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36
Q

T or F? Mentha x piperita is indicated in GORD?

A

F. Is contraindicated - in vol oil isolation/high dose.

Can reduce lower oesophageal sphincter tone, increasing GORD risk

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37
Q

Key medicine classes in hypotonic constipation?

A

Stimulant laxatives (anthraquinone)
Bitters
Bulk laxatives

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38
Q

Key medicine classes in hypertonic bowel states?

A

Carminatives
Intestinal antispasmodics
Nervine sedatives
Low dose bulk laxatives

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39
Q

Key medicine classes in decreased biliary flow?

A

Choleretics
Cholagogues
Bitters
Bulk Laxatives

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40
Q

What herbs are in Iberogast?

A 
Iberis amara
Angelica archangelica
Matricaria chamomilla
Carum carvi dry fruit 
Silybum marianum
Melissa officinalis
Mentha x piperita
Chelidonium majus
Glycyrrhiza glabra
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41
Q

Key hepatobiliary activities?

A

Xenobiotic metabolism eg. endogenous, exogenous
Routine biochemistry eg. glycogenolysis
Digestion & assimilation eg. bile production
Immune defense eg. kupffer cells

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42
Q

Primary classes of hepatobilary medicines?

A 
Cholagogues
Choleretics
Bitters 
Immunomodulators
Hepatic anti-inflames
Antioxidants
Hepatoprotectives
Antispasmodics
Antivirals
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43
Q

Which herb is highly indicated in biliary dyskinesia and/or billiary colic secondary to choleliathliasis?

A

Chelidonium majus - cholagogue & choleretic, mild analgesic and antispasmodic

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44
Q

Why is mentha x piperita indicated in choleliathialisis?

A

Carminative and mild cholagogue action. Terpenes in vol oil may assist in dissolving cholesterol stones

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45
Q

What herb used in simplex in acute biliary dyskinesia attacks?

A

Artemisia absinthium - Sesquiterpene lactones (absinthin, artabsin, santoinin)

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46
Q

What does innate immunity involve?

A

Surface Barriers
Mucosal immunity
Normal flora
Phagocytes

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47
Q

Whats involved in acquired/adaptive immunity?

A

Cell mediated immunity

Humoral immunity

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48
Q

Is Andrographis a cold or warm herb?

A

Cold. Take in combination with warming herbs

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49
Q

Do you use the P0As chemotype of Uncaria tomentosa or the T0A chemotype?

A

important to use only the immune-enhancing
pentacyclic oxindole alkaloids (P0As).
TOAs can have an immune suppressing activity.

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50
Q

What is Uncaria tomentosa’s MOA?

A

may involve suppression of the transcription factor TNF-kappaB

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51
Q

When is Astragalus membranaceus advised not to be used?

A

In acute infections - can exacerbate the infection & potentially cause crisis

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52
Q

What kind of viruses can Thuja assist in?

A

enveloped and non-

enveloped viruses with DNA and RNA nucleic acids.

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53
Q

Tx considerations for Candida?

A

Eliminate refined sugar, yeast containing foods o Search and eliminate food intolerances
o Support stomach acid production
o Support Immunity
o Liver Detoxification
o Support Gut repair
o Anti-fungals
o Support lifestyle-psychological stress, exercise

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54
Q

Herbs useful in Candida?

A

Origanum vulgare

Pimpinella anisum

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55
Q

Risk factors of autoimmunity?

A 
altered immune function
chemical exposure
diet & lifestyle
hormones 
Stress
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56
Q

Autoimmune diseases

A 
Ankylosing spondylitis
Graves
SLE
Insulin dependent DM
RA
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57
Q

Environmental factors of autoimmunity?

A 
Viral/bacterial infections
Certain chemicals/drugs
Molecular mimicry - unable to differentiate between self & foreign antigens
Bystander activation
Dietary antigens (coeliac)
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58
Q

What are Sustaining factors implicated in autoimmunity?

A

o A self antigen presents which is identified as still a component of the body.
o The body lacks the ability to eradicate this antigen so the disease persists.
o Dependent on the antigen involved and the mechanism of action determines the clinical expression of the disease .
o The immune reaction may be local or systemic.

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59
Q

Herbs in autoimmune diseases?

A 
Boswellia serrata
Harpagophytum procumbent
Curcuma longa 
Urtica dioca
Tylophora indica
Hemidesmus indicus
Foeniculum vulgare
60
Q

What herb is CI in Chrohns & ulcerative colitis? why?

A

Harpagophytum procumbens. Harpagosides increase gastric acid secretion

61
Q

Egs of eicosanoid synthesis modifiers?

A

Curcuma longa
Scutellaria baicalensis
Fish oil

62
Q

Objectives when treating HIV?

A
  1. Reduce viral load
  2. Strengthen immune function
  3. Reduce oxidative stress
  4. Reduce inflammation
  5. Promote naturopathic diet & lifestyle
  6. Support vitality
  7. Manage opportunistic infections
  8. Reduce wasting/[promote anabolism
  9. Manage mood & promote stress adaptation
63
Q

Aetiological factors of skin issues?

A 
Allergy - local, systemic
Irritation - local, toxic encumbrance
Infection - Local, invasive, systemic 
Stress - acute, chronic
Metabolic - hormonal, autoimmune, nut. deficiencies
64
Q

What is a depurative?

A

AKA alterative
Aids in detoxification & elimination
Aids in xenobiotic metabolism

65
Q

Examples of urinary depuratives?

A

USE LEAVES OF
Galium aparine
Urtica urens
Taraxacum officinale folia

66
Q

Examples of biliary depuratives?

A

USE ROOT/RHIZOME
Berberis aquifolium
Taraxacum officinale radix
Iris versicolor

67
Q

Examples of Bowel depuratives?

A 
ROOT/RHIZOME
Iris versicolor
Smilax ornata
Rumex crispus
Frangula purshiana
68
Q

What is atopic dermatitis?

A

chronic inflammatory and pruritic skin condition. Immunoglobulin E, eosinophils, T- helper cells and their cytokines, all play a significant role in the pathogenesis of this condition.
Hyperreactivity to environmental triggers, genetic predisposition, and defective skin barrier function are involved

69
Q

What is involved in hypersensitivity contact dermatitis?

A

T – lymphocytes are sensitized to the antigen some time after the first contact. Langerhans cells in the dermis of the skin present the Ag to T – lymphocytes. Sensitivity to the antigen lasts for life

70
Q

Herbs (topical) useful in eczema & dermatitis?

A

Matricaria chamomilla

Glycyrrhiza glabra - glycyrrhetinic acid

71
Q

What is Psoriasis?

A

chronic, recurrent disease characterized by dry, well-circumscribed, silvery, scaling papules and plaques of various sizes.

72
Q

Tx Aims in acne?

A
  • Increase detoxification through all channels of elimination
  • Reduce oxidative load and improve anti-oxidant status
  • Regulate blood sugar levels
  • Reduce production of inflammatory compounds
  • Regulate sympathetic and parasympathetic nervous system activity
  • Reduce serum androgen levels
  • Reduce sebum production and sebocyte proliferation
73
Q

What is rosacea?

A 
Chronic eruption in the central region where the blood vessels enlarge of the face, typically beginning in middle age and older
Implicating factors 
– Alcoholism
– Hypochlorhydria
– Vitamin B deficiency 
– Seborrhoeic tendency
74
Q

What are Recurrent or chronic skin infections often indicative of?

A

– impaired immunological function
– sustained physical or chemical local irritation
– an attempt by the body to remove toxic encumbrance
– nutritional deficiencies in some cases

75
Q

Key medicines in alopecia areata?

A

Rosmarinus officinalis
Urtica dioca
Ginkgo biloba
Avena sativum & Scutellaria lateriflora - if nervines needed

76
Q

Primary classes of ENT medicines?

A 
Anticatarrhals
Astringents
Demulcents
Anti-inflammatories
Decongestants 
Mucolytics
Lymphatics
Antimicrobials
MM trophorestoratives
Immunomodulators
Antiallergics
Circ stimulants
Diaphoretics
77
Q

What is catarrh?

A

build up of mucous in the airways (upper or lower) or any cavity of the body (e.g. the GIT)

78
Q

What is an important DDX in chronic pharyngitis?

A

Severe GORD - can cause cough and sore throat

79
Q

Key medicines in pharyngitis?

A

Althaea officinalis radix - water extract
Olea europaea folia
Salvia officinalis - fresh leaves as gargle

80
Q

Key medicines in the common cold?

A 
Echinacea 
Andrographis paniculata
Allium sativum
Achillea millefolium
Sambucus nigra
Zingiber officinale
81
Q

Causes of chronic recurrent sinusitis?

A

Allergies
Low grade chronic or intermittent infections
Environmental irritant exposure

82
Q

Predisposing factors for otitis externa?

A

– injury to ear canal from using cotton buds or other objects
– allergies
– psoriasis or eczema (can cause a chronic otitis externa)
– irritants such as hair dyes or sprays

83
Q

Classes of medicines in pulmonary therapeutics?

A 
Expectorants
Antitussives
antimicrobials
Immunomodulators
Demulcents
Anti-inflammatories
Bronchodilators
Trophorestoratives
84
Q

Definition of expectorant?

A

Promoting or facilitating the secretion or expulsion of phlegm, mucus, or other matter from the respiratory tract

85
Q

Indications for stimulating expectorants?

A

Thick congested conditions of the lungs with unproductive cough or no cough

86
Q

Phytochemistry of stimulating expectorants?

A

Mostly saponins, sometimes alkaloids

87
Q

Action of stimulating expectorants?

A

– slight gastric irritation leading to reflexive bronchial irritation
– result is thinner bronchial secretions, and more activity in the mucociliary escalator
– increase in productive coughing

88
Q

Examples of stimulating expectorants?

A

Inula helenium
Euphorbia hirta
Viola odorata
Lobelia inflata

89
Q

Action of relaxing expectorants?

A

– reduce airway irritation and relax bronchial smooth muscle
– grey line between demulcents, respiratory antispasmodics, bronchodilators
– tend to be gentle, with wide application

90
Q

Phytochemistry of relaxing expectorants?

A

mucilage

vol. oil

91
Q

Indications for relaxing expectorants?

A

irritating cough
productive or non-productive cough
wet & dry conditions

92
Q

Examples of relaxing expectorants

A 
Glycyrrhiza glabra
Hedera helix
Verbascum thapsus
Thymus vulgaris
Plantago lanceolata
Pimpinella anisum
allium cepa
93
Q

Action of warming expectorants/mucolytics?

A

– thins and breaks down mucous, especially when thick and tenacious
– increase blood flow to respiratory mucosa
– often considered to be anticatarrhals

94
Q

Phytochemistry of warming expectorants/mucolytics?

A

Glucosinolates
Organosulfur compounds
resins, vol. oil

95
Q

Indications of warming expectorants/mucolytics?

A

Acute or chronic congestion with thick, tenacious mucous

96
Q

Examples of warming expectorants/mucolytics?

A 
Glucosinolates 
- Armoracia rusticana
- Brassica alba
Organosulfur compounds
- Allium sativum
- Allium cepa
Vol oils, resins, oleoresins
- Zingiber officinale 
- Angelica archangelica
- Inula helenium
97
Q

Key medicines in treating inflammation assc with asthma?

A

Boswellia serrata - inhibits 5-lipoxygenase, key cytokine in asthmatic inflamm
Curcuma longa
Glycyrrhiza glabra - lowers cytokines
Zingiber officinale - inhibits prostaglandin release
Astragalus membranaceus - reduce lung inflammation

98
Q

What herbs are PAF inhibiting?

A

Ginkgo biloba - PAF antagonist
Glycyrrhizin - PAF inhibition
Allium cepa - anti-PAF activity

99
Q

What herb has shown to reverse asthma?

A

Cordyceps sinensis

100
Q

Immunosuppressive herbs?

A

Tylophora indica

Hemidesmus indicus

101
Q

What other disorders are assc with Asthma?

A

Increased digestive permeability
Oesophageal reflux
Dysbiosis

102
Q

What herb may potentiate effects of corticosteroids?

A

Glycyrrhiza glabra

103
Q

What herb is effective in treating opiod & tobacco withdrawal?

A

Avena sativa

104
Q

What herbs can increase 5-HT levels?

A

Rhodiola rosea
Hypericum perforatum
Scutellaria baicalensis

105
Q

Which herbs can modify the HPA axis?

A

Eleutherococcus senticosus
Schisandra chinensis
Rhodiola rosea
Panax ginseng

106
Q

Primary classes of neurological medicines

A 
Analgesics
Nervine sedatives
Nervine trophorestoratives
Neuroprotective
Nervine stimulants
107
Q

Which herb may be CI in epilepsy?

A

Ginkgo biloba

108
Q

What constituent and which plant is known to trigger seizures?

A

Camphor.

Present in Rosmarinus officinalis, Juniper, Achillea millefolium, Salvia officinalis

109
Q

What nutrient elevates dopamine? What herb contains this?

A

Theanine elevates dopamine. Found in Camellia sinensis

110
Q

What herb is CI in Parkinson due to interaction with Levodopa?

A

Piper methysticum - Kava

May potentiate Parkinson reactions

111
Q

Types of. dementia?

A 
Vascular dementia
Alzheimer disease
Lewy body dementia
Frontotemporal dementia
HIV-associated dementia
112
Q

What is reversible dementia?

A

General cognitive decline as a secondary consequence - seen in hypothyroidism, B12 deficiency, alcohol abuse & some infections. Generally improve once underlining condition is addressed

113
Q

Aetiology of general cognitive decline?

A 
Suboptimal nutrition - B vits & EFAs
Toxicity. - pesticides, heavy metals
Physical & mental fatigue
Mental stress
Lack of personal and social stimulation 
Depression
Oxidative change in NS
114
Q

What herbs are glucocorticomimetics?

A

Rehmannia glutinosa

Glycyrrhiza glabra

115
Q

Which herbs support erythropoiesis?

A

Withania somnifera
Urtica dioca
Codonopsis pilosula

116
Q

What is Bradydysrhythmias?

A

resting HR less than 60bpm

117
Q

What is. Tachydysrhythmias

A

resting HR more than 100bpm

118
Q

What is acute atrial fibrillation?

A

new onset, lasting < 48 hours

119
Q

What is Paroxysmal atrial fibrillation?

A

Recurrent episodes, last < 48 hours, convert spontaneously to sinus rhythm without treatment

120
Q

What is Persistent atrial fibrillation?

A

episodes last > 1 week or require treatment to convert to sinus rhythm

121
Q

What is Long-standing persistent atrial fibrillation?

A

Episodes last > 1 year, with possibility of restoring sinus rhythm with treatment (usually electrical cardioversion)

122
Q

What is permanent atrial fibrillation?

A

spontaneous or treatment-induced conversion to sinus rhythm not possible

123
Q

What pharmaceutical drug is Salvia miltiorrhiza CI with?

A

Anticoagulants

124
Q

Comorbidities of MSK disorders?

A

Entrapment of nervous tissue
Lack of sleep due to pain
Mood disorders due to lack of sleep & chronic pain

125
Q

What is the aim of the process of inflammation?

A
  • Protect injuried area from further damage
  • Mobilise and direct defensive resources to injury site
  • Encourage removal of debris
  • Encourage healing and resolution
126
Q

Outcomes of acute inflammation

A
  • Resolution
  • Abscess formation
  • Healing by fibrosis
  • Chronic inflammation
127
Q

Role of Nuclear factor kappa B?

A

Found in most cell types, involved in cellular responses to many stimuli such as stress, free radicals, UV irradiation, oxidised LDL, bacterial or viral antigens, cytokines
– Key role in regulating immune function and the inflammatory response
– Rapid “first responder” activity
– May even play a role in cerebral function
(eg. memory, psychiatric disorders, addiction)

128
Q

Comorbidities of chronic Inflammation?

A 
Lethargy
Depression
Memory &amp; mood disorders
Addiction
Insulin resistance &amp; diabetes
Migraine
Alzheimer's disease
Cancer
129
Q

3 aspects to choosing right combination of anti-inflamm & antioxidants herbs in MSK issues?

A

Mediator specificity
Tissue specificity
Secondary actions

130
Q

Topical herbs for soft tissue damage?

A

Arnica montana

Symphytum officinale

131
Q

What is gout?

A

Inflammatory disease resulting from imbalance between waste production and elimination, resulting in accumulation and crystalisation of waste materials in joints and other connective tissue

132
Q

Dosage in geriatric patient?

A 
Clarks rule
(weight in kg/67) x adult dose
133
Q

Anti-prostatic herbs?

A

Serenoa repens
Urtica dioca/urens
Epilobium parviflorum

134
Q

Herbs for hyperprolactinaemia?

A 
Vitex agnus-castus
Caulophyllum thalictroides (Blue Cohosh)
135
Q

Herbs that. help with thick viscous cervical mucus?

A

Promote oestrogen with -
• Chamaelirium luteum (False Unicorn)
• Asparagus racemosus (Shatavari)
• Dioscorea villosa (Wild Yam)

136
Q

What emotion can trigger prolactin release?

A

Stress & other emotional stimuli - can affect repro function

137
Q

What are category A herbs?

A

Drugs that have been taken by many pregnant women and women without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus having been observed.
Eg. Rubus ideaus, Zingiber officinale, Echinacea, Chamomle

138
Q

What are category B1 herbs?

A

• Drugs that have been taken by only a limited number of pregnant women without an increase in the frequency of malformation or other direct or indirect harmful effects on the human foetus having been observed.
•
Studies in animals have not shown evidence of an increased occurrence of foetal damage.
Eg. Astragalus, Valerian, Gingko

139
Q

What are category D herbs?

A

• Drugs that have caused, are suspected to have caused, or may be expected to cause an increased incidence of human foetal malformations or irreversible damage.
Eg. Ruta graveolens, Phytolacca spp.

140
Q

What are category x herbs?

A

Drugs that have such a high risk of causing permanent damage to the foetus that they should not be used in pregnancy or when there is a possibility of pregnancy.
Eg. Aristolochia spp., Senecia spp., Peumus boldus

141
Q

Eg of a category b2 herb?

A

Agathosma betuline

142
Q

Eg of a category C herb?

A

Andrographis paniculata

143
Q

When is Vitex not to be used?

A

Pts with oestrogen sensitive cancers
Pts with pituitary disorders
Pts taking dopamine agonists, antagonists, synthetic oestrogen & anti-oestrogen

144
Q

Uterine spasmolytic herbs?

A

Verbena officinalis
Angelica sinesis
Rubus ideaus
Virburnum opulus

145
Q

Diuretic herbs

A 
Urtica dioca
Equisetum arvense (depurative)
Eupatorium purpurea
Elymus repens
Zea mays
146
Q

Herb for chronic UTIs?

A

Crataeva nurvala - urinary antiseptic

CLINIC HERBAL (1 decks)

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