Herbal

Question 1

Milk thistle

Answer 1

I: liver disorders
Effective vs: allergic rhinitis, DM, menopausal sx, 
ineffective vs: Hepatitis
likely safe
Adverse: allergic rxn, GI disresss
DDI: moderate for CYP2C9, CYPD6, CYP3A4

Question 2

glucosamine chondroitin

Answer 2

I: joint pain
Effective vs: osteoarthiritis (chondroitin)
ineffective vs: glucasamine
Likely safe
Adverse: GI distress
DDI: glucosamine increase anticoagulant of warfarin

Question 3

black cohosh

Answer 3

I: menopausal symptoms
Effective vs: menopause
ineffective vs: anything else
possible safe;
possibly unsafe: pregnancy, lactation
Adverse: go effects, rashes, estrogen sensitive conditions
DDI: moderate atorvastatin, cisplatin, hepatotoxic drugs; CYP2D6

Question 4

St. John’s Wort

Answer 4

I: depression, anxiety
Effective vs: depression, menopausal sx, plaque psoriasis, wound healing
ineffective vs: ADHD, IBS, HIV; HepC
Safe: oral and appropriate;
Unsafe: large doses, pregnancy, lactation
Adverse: GI sx; skin, fatigue, restlessness,
DDI:
Major: alprazolam; contraceptives; CYP2C19,CYP3A4; digoxin; warfarin

Question 5

Ginger

Answer 5

I: N/V motion sickness
Effective vs: morning sickness, post op N/V; vertigo, dysmenorrhea, osteoarthritis
ineffective vs: motion sickness, weight loss
likely safe
Adverse: none
DDI: Major: vifedipine combo inhibits platelet aggregation
moderate warfarin

Question 6

Ginseng

Answer 6

I: improve well being, stimulate immune
Effective vs: cognitive function, ED, sexual arousa, HTN, COPD
ineffective vs: athletic performance
possibly safe: oral appropriate, short term
possibly unsafe: long term; pregnancy
Adverse: insomnia, tachycardia, palpitations,
DDI: moderate for CYPD6 anticoagulant/antiplatelets; antidiabetes,caffeine, estrogens, insulin, warfarin

Question 7

Echinacea

Answer 7

I: colds, flue, viral infections
Effective vs: common cold
ineffective vs: otitis media, 
Safe oral and short term
possible safe: pregnancy short term oral
Adverse: gi upset, rash
DDI: moderate CYP1A2, CYP3A4; caffeine, etoposide, immunosuppressant

Question 8

Saw Palmetto

Answer 8

I: BPH
Effective vs: transurethral resection of prostate
ineffective vs:BPH
Safe: appropriately
likely unsafe: pregnancy lactation
Adverse: well tolerated
DDI: moderate anticoagulants/antiplatelets; OC, estrogens

Question 9

Ginko

Answer 9

I: cognitive disorders
Effective vs: cognitive function, dementia, glaucoma
ineffective vs:age related memory, sexual dysfunction, SAD, asthma, HTN, CVD
likely safe oral and appropriate
likely unsafe: fresh ginkgo seeds
possibly unsafe= pregnancy
Adverse: GI, headache
DDI:efavirenz (increased viral load); moderate CYP2C9, CYPD6, CYP3A4, fluoxetine, ibuprofen

Question 10

Grapefruit juice

Answer 10

CYP3A4 inhibitor

• antiarrhythmics (amiodarone, disopyramide, quindine)
• CEBs (Felodipine, nicardipine, nifidipine, nimodipine)
• statins
• immunosuppressants (cyclosporine, tacrolimus)
• protease inhibitors (saquinavir)

Question 11

Cheese reaction

Answer 11

tyramine in fermented foods
metabolized by MAO
potentiates sympathetic NE release => HTN