Herbal

Question 1

herbal medications: biggest use among what popns?

Answer 1

whites, women, higher income and education levels, ages 35-49

Question 2

herbal meds used most for what purpuse?

Answer 2

for general wellness/to improve health

Question 3

2 info sources for herbal med?

Answer 3

NCCAM (part of NIH)

National Standard ($, has efficacy rating system)

Question 4

problems with herbal meds and most typical adverse effect?

Answer 4

• adverse effects
• interactions with drugs
• no controlled trials to show efficacy
• sometimes heterogeneous mixtures, may not be standardized/consistent

most typical adv effect: blood thinning

Question 5

are herbal meds regulated as food or drugs?

Answer 5

food

Question 6

at an office visit, what should i ask about?

Answer 6

• about supplement/tea usage
• for what concerns being used
• seeing another provider to monitor
• any changes noted since taking?

Question 7

Milk Thistle: claimed uses?

Answer 7

protective effect on liver, lowering cholesterol, reduce insulin resistance in T2 diabetics

Question 8

Glucosamine/Chondroitin: claimed uses

Answer 8

anti-inflammatory, anto-osteoarthritis

Question 9

St John’s Wort: claimed uses

Answer 9

antidepressant, antianxiety

Question 10

Ginger: claimed uses, conclusions of studies

Answer 10

Uses: anti-emetic, treatment of nausea/vomiting, motion sickiness

Study: useful for N/V w preg

Question 11

Ginko: claimed uses, studies

Answer 11

uses: memory, concentration, alzheimer’s other dementias

some studies have shown improved cog performance in healthy adults

Question 12

Tyramine: what is it, where is it found?

Answer 12

naturally occuring monoamine found in fermented food (ie cheese)

Question 13

Tyramine: how is it metabolized? what is the drug interaction?

Answer 13

metabolized by MAO (monoamine oxidase).

tyramine metabolism is blocked when taking a MAO inhibitor (antidepressant)

advise patients taking MAOIs to avoid high tyramine foods

can cause MAOI hypertensive crisis

Question 14

Grapefruit juice: what is the interaction?

Answer 14

can inhibit intestinal cytochrome P450 enzyme (CYP3A4) which metabolizes many drugs. inhibiting this cytochrome P450 enzyme can lead to increased plasma lifetimes of drugs to very different degrees.

AUC increases for various drugs from baseline when drinking grapefruit juice.

Question 15

Tyramine: what is the mechanism

Answer 15

Indirect adrenergic, stimulates NE and dopamine release

Question 16

The FDA has the authority to regulate what about supplements?

Answer 16

the manufacturing processes

Question 17

Dietary supplement production must adhere to what?

Answer 17

dietary supplement production must adhere to good manufacturing practices and be prepared with controls that result in a product free of contamination, with accurate labeling.

Question 18

manufacturers are required to report what to the FDA?

Answer 18

any serious supplement-related adverse events