Herbal Medicine Flashcards
Why are supplements advertised as they are?
avoids safety and effectiveness testing required by FDA
What’s the issue with nutritional supplements?
A lot less testing, may not have the benefits alluded to, may worsen certain medical conditions or interact with medications
What is alternative medicine?
treatments not generally recognized by medical community as standard
What is herbal medicine?
plant/plant extracts
What was DSHEA (1994)?
amendment to establish standards for dietary supplements…but FDA can’t apply drug efficacy and safety to supplements :(
What did the Dietary Supplement & Non-Prescription Drug Consumer Protection Act of 2006 do?
Forced to report adverse events to FDA
What’s the issue with the supplement industry?
misidentification, lack of purity, variations in potency/purification, not enough resources to oversee
What is echinacea proposed to be used for?
decrease duration and intensity of cold symptoms
up to 300mg 3x daily
What has been found with echinacea in pharmacological studies?
virucidal/bacteriacidal against influenza, herpes, strep pyogens, h. influenzae, in vitro may inactivate avian flu & swine viruses
What are the effects of echinacea?
unpleasant taste and GI effects, maybe dizziness or headaches. Some have high alcohol content.
Avoid in immunocompromised and pregnant patients
What does evidence state regarding echinacea?
Cochrane – small risk reduction of 10-20%
Lancet – decreased risk of developing symptoms by 58% and duration by 1.25 days
so… just like tamiflu but “natural”
What is garlic’s proposed use?
cholesterol and hypertension ( A LOT is needed, 600-900 mg daily)
What is the pharmacology of garlic?
inhibit HMG-CoA reductase (stopping cholesterol production), potential antiplatelet effects uping nitric oxide synthesis
What are some effects of garlic use?
nausea, hypotension, breath and body odor
caution with anticoagulants or antiplatelet drug use as could potent the effect (just no)
What is the evidence behind garlic?
significant reduction in total cholesterol, but no impact on LDL/HDL…
cochrane - significant reduction in SBP/DBP, but without the LDL/HDL change, not really relevant
What is the proposed use for ginkgo?
intermittent claudication, cerebral insufficiency, dementia (120mg to 240mg daily)
What is the pharmacology of ginkgo?
ups blood flow, lowers blood viscosity, ups vasodilation!!
CNS: ups muscarinic receptors, downs B-adrenoreceptors, ups serum levels of acetylcholine and norepinephrine
What are some effects of ginkgo use?
GI, anxiety, insomnia, possible antiplatelet action (if on anticoagulant, probably not)
may be epileptogenic so avoid in persons with Hx of seizures
What is the evidence behind ginkgo?
Nonsignificant, no benefit, unlikely to be clinically relevant
What is ginseng’s proposed usage?
improvement of serum glucose and mental performance (200 to 400 mg daily)
What is the pharmacology behind ginseng?
modulation of immune function (activated B, T NK cells, macrophages), CNS effects include increased Ach, 5-HT, NE, DA
What are some effects of ginseng?
estrogenic effects including mastalgia and vaginal bleeding, insomnia, nervousness, HYPERTENSION –> no in patients with anticoagulants, antihypertensives, hypoglycemics, or psychiatric
What is the evidence behind ginseng?
yet to see more information, not a lot, a few studies say significant decreases in blood glucose?
What is the proposed usage of milk thistle and the basic chemistry?
For hepatic injury and antidote to Amanita mushroom poisoning.
contains flavonolignans
What do the pharmacological tests of milk thistle show?
acts as an antioxidant
What are some side effects of milk thistle?
loose stools, no significant toxicity, no reports of drug interactions
What is the evidence behind milk thistle?
No significant reduction, failed to show anything, no effect
What is the proposed use for St.John’s Wort?
treatment of mild to moderate depression (300mg to 600 mg 2x)
What is the pharmacology of St. John’s Wort?
inhibition of nerve terminal reuptake of 5-HT, NE, and DA
What are effects of St. John’s Wort?
photosensitization (sunscreen!) mild GI effects, avoid in patients with SSRIs or MAO-Is (SS syndrome), induces formation of CYP450 isoforms (3A4, 2C9, 1A2) LOWERS BIRTH CONTROL EFFECTIVENESS
What does the evidence is behind St. John’s wort?
reported to be more efficacious than placebo! equivalent to prescription reference treatments including SSRIs but with fewer side effects!!
What are the proposed uses of saw palmetto?
improvement in symptoms of benign prostatic hyperplasia (increased nocturia, difficulty with stream) 150-320 mg daily
What is the pharmacology of saw palmetto?
inhibition of 5 alpha reductase and antagonist of DHT at androgen receptors
What are potential side effects of saw palmetto?
abdominal pain w GI distress, decreased libido, headache, HTN (not super prevalent)
No effect on PSA..
Any saw palmetto evidence?
No signifcant improvement
What is the proposed use of black cohosh?
relief of premenstrual and menopausal symptoms (128 mg daily)
What is the pharmacology of black cohosh?
selective estrogen receptor modulator. Suppresses cytokine-induced nitric oxide
Any side effects of black cohosh?
rash, headache, possible hepatic toxicity
What is the evidence behind black cohosh?
Similar efficacy to estrogen therapy for menopausal treatment
What is valerian root used for?
anxiety and insomnia (300-600mg)
What is the pharmacology of valerian root?
increases the GABA in the brain
What are potential side effects of valerian root?
Vivid dreams, dry mouth, GI upset, hangover effect
What does evidence show for valerian root?
shows some efficacy for sleep, minimal data for anxiety relief
What is the proposed use of Coenzyme q10?
Cardiovascular CHF, HTN, statin-induced myopathy (soreness), Parkinson’s disease
What are the side effects of Coq10?
GI disturbaces, thrombocytopenia irritability, dizziness, headache, similar to Vitamin K and can decrease warfarin effects
What is the evidence behind Coq10?
lowered significantly SBP by 11 and DBP by 7 , improve ejection fraction by 3.7%, we think it may help statin-induced myopathy
What is glucosamine proposed for?
reduction of pain associated with osteoarthiritis
What is the chemistry behind glucosamine?
amino sugar can serve as precursor for glycosamines
What is the pharmacology behind glucosamine?
Glycosaminoglycans –> major consituent of connective tissue including cartilage! Better maintenance and strengthening!
What are the potential side effects of glucosamine?
Gi issues, CROSS ALLERGY W SHELFISH, do not give to those who are allergic!
May increase INR in warfarin taking patients…monitor closely
What is the evidence behind glucosamine?
significant improvements in overall mobility, ROM, strength, but recent studies have mixed results (but not glu sulfate, the better one)
What is melatonin used for?
decrease jet lag symptoms and sleepaid
What’s the chemistry behind melatonin?
5-HT derivative, appears in regulating sleep-wake cycles
What’s the pharmacology of melatonin?
release concides with darkness, 9pm-4am usually
What is the associated reactions with melatonin?
sedation, next-day drowsiness, headache
Should NOT be used in pregnancy or women trying to concieve, can suprress a mid-cycle LH hormone, can decrease prolactin (no good in nursing moms), decreases sperm quality with chronic use, subject to drug-drug interactions
What is the evidence behind melatonin?
reported lower daytime fatigue, improved mood, quicker recovery time with jet lag
insomnia had conflicting results, may contribute to morning alertness and quality sleep if bedroom lights are off and taken at bedtime. Mostly, pts fall asleep sooner
What is fish oil’s proposed use?
lower triglycerides, reduce inflammation, reduce incidence of heart disease (4g daily)
What is rozarem (ramelton)?
prescription melatonin agonist, 17x more potent
What is fish oil’s chemistry?
Omega 3 fatty acids contain DHA & EPA dual is better
What is the pharmacology behind fish oil?
blocks active side of enzyme stopping free fatty acids formation, which reduces precursors to inflammation in the blood
What are some alternative side effects of fish oil?
elevated LDL, GI side effects, increased bleed risk
What’s the evidence behind fish oil?
Reduced triglycerides and prevented the number of heart attacks and strokes
Who should you NOT recommend echinacea to?
immunocompromised or pregnant people (high alcohol content)
Who should you NOT recommend ginseng to?
patients with HTN or on anticoagulants, anti HTNs, hypoglycemics, psychiatric (causes nervousness)
What patients should you be careful with garlic use?
Cautionary with anticoagulants or antiplatelet effects..could potent the effect
What patients should you NOT recommend ginkgo?
past seizures, on anticoagulants
What patients should you NOT recommend glucosamine?
Those with a shellfish allergy, and monitor closely with anticoagulant people…may increase INR
Who should you not recommend melatonin to?
people trying to get pregnant/are pregnant, nursing moms
