Herbal and Nutritional Supplements Flashcards
Echinacea Indications/Medical Uses:
Anti-microbial
Immunostimulant
Anti-infective
Anti-inflammatory
MOA of Echinacea:
Nonspecific immune system activation Increase granulocytes in blood Increase phagocytosis by granulocytes and macrophages Inhibition of virus production Activation of cytokines Increase in T-lymphocytes Stimulates TNF and interferon
Echinacea Precautions :
Not recommended for patients with autoimmune diseases: Lupus, RA, MS
Rare allergic reactions
Use in pregnancy not studied
St. John’s Wort Indication/Medical Uses :
Reduces symptoms of anxiety, mild depression, apathy, anorexia
Relieves insomnia and hypersomnia
Promotes topical wound healing
Possible adjuvant for viral infections
St. John’s Wort MOA:
Inhibition of MAO Inhibition of 5HT, dopamine, and norepinephrine reuptake Inhibition of COMT Inhibition of GABA uptake and binding Broad-spectrum antimicrobial activity
St. John’s Wort Precautions:
Mild SE including GI upset, photosensitivity, sexual dysfunction, dry mouth
**CYP450 3A4 inducer
**May interact with levodopa, SSRIs, MAOIs, and numerous other medications metabolized by CYP3A4
Should not be used during pregnancy or while breastfeeding
Black Cohosh Indication/Medical Uses:
Relieves symptoms of PMS and painful menstruation
Primary indication: Diminishes physical effects of menopause
Eases psychological effects of menopause
Increases number of superficial cells in vaginal lining
Black Cohosh MOA:
Estrogen-like agonistic effects in vitro, not in vivo
? Suppresses secretion of luteinizing hormone (LH) – no double-blind placebo randomized trials
Lessens ability of LH to bind receptors in hypothalamus
May inhibit growth of estrogen-dependent breast cancer cells
Black Cohosh Precautions:
AE – Hepatotoxicity, HA, GI upset which can be relieved by taking with food
Contraindicated in 1st 2 trimesters of pregnancy
DI – CYP2D6 inhibitor (?), May intensify SE of oral contraceptives and synthetic estrogens
Cayenne Medical Uses/Indications:
Antioxidant High blood pressure Rheumatoid and osteoarthritis Fever Cluster headaches and migraines Indigestion Atherosclerosis
Cayenne MOA:
Anti-aggregation effects on platelets
Increases fibrinolytic activity
Stimulates cooling center in hypothalamus
Increases mucosal blood flow and vascular permeability
Inhibits gastric mobility and duodenal motility
Cayenne precautions:
External application can cause skin irritation
Avoid contact with eyes and other sensitive mucosa
May interfere with MAOIs
May increase hepatic metabolism of some drugs
Ma Huang (Ephedra) Indication/Medical Uses :
Weight loss/obesity – appetite supressant Athletic performance enhancement Allergies/Hey fever Colds, congestion Asthma - bronchodilatation
Ma Huang MOA:
Applicable part of ephedra is the stem and leaf
Sometimes contains parts of phenylpropanolamine (was part of Fen-phen, no longer OTC and limited Rx availability)
Was used in methamphetamine labs
Ephedrine and pseudoephedrine components: selective alpha- and beta-receptor agonists –> increased HR, BP
Directly and indirectly stimulates the sympathetic nervous system
Tmax = 2.4 hours
Half-life = 6 hours
Precautions with Ma Huang:
Can cause severe or life-threatening side effects
Adverse effects consistent with catecholamine excess - anxiety, urinary retention, irritation, vomitting, HA
No large controlled studies; information is from case reports – cannot determine incidence of side effects
Multiple cardiac effects including cardiomyopathy, MI, cardiac arrest and sudden death, cardiac arrhythmias,
Multiple CNS effects including personality changes, difficulty concentrating, psychosis, seizures
CI – multiple, including pregnancy, CV disease, DM, asthma
Banned in the U.S. – FDA found it to be unsafe
