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
Garcinia Cambogia Indication/Medical Uses, Pharmacology :
Weight loss
Lipid-lowering activity
MOA of Garcinia Cambogia
Primary compound is hydroxycitric acid (HCA)
Proposed to inhibit lipogenesis, increase lipid oxidation, and reduce food intake
Possibly has antioxidant activity
Garcinia Cambogia precautions:
Adverse effects:
Headache, dizziness, dry mouth, nausea, diarrhea, hepatotoxicity when used in combination with certain combination weight-loss supplements
Drug interactions:
Diabetic/insulin medications – may lower blood sugar levels
Iron – G. cambogia contains iron –>additive adverse reactions of iron
K and Ca supplements - some commercial G. cambogia products contain K and Ca. Caution is advised for patients taking medications for heart disease, high blood pressure, or arrhythmia.
Serotonin – potential serotonergic effect. Caution is advised for patients on pain or psychiatric medications.
Leukotriene receptor antagonists - fatal liver failure reported
Statins - rhabdomyolysis reported
Warfarin – may affect INR
Feverfew:
Migraine prophylaxis and treatment and associated n/v
Secondary use in arthritis, fever, menstrual disorders
Monitor patients on antiplatelet or anticoagulant medications
Uterine stimulant activity - avoid use during pregnancy
Saw Palmetto Indication/Medical Uses :
Relief of symptoms of stage I and II BPH
Genito-urinary infections
Increase milk flow in nursing mothers
May treat female androgen excess conditions
Saw Palmetto MOA:
Inhibits 5-alpha-reductase
Blocks adrenergic receptors
Inhibits DHT-producing enzymes
Stimulates anti-estrogenic effects
Saw Palmetto Precautions:
Proper diagnosis important prior to initiation of self-therapy
Need further studies to use during pregnancy or lactation (not recommended due to hormonal effects)
May interfere with hormonal therapy such as contraceptive pills or HRT
May interfere with iron absorption
AE – Well-tolerated.
