Herbal Medicines

Question 1

Dietary supplements a special category under dietary medicines. True or false?

Answer 1

False,

Dietary supplements a special category under food – NOT drugs.

Question 2

The FDA is responsible for safety of dietary supplements. True or false?

Answer 2

False.

The manufacturer is responsible for safety. The FDA is responsible for taking action if there is a problem.

Question 3

What are considered dietary supplements? (5)

Answer 3

Vitamins
Minerals
Amino acids
Botanicals: herbals or extracts
Glandular extracts from animals or synthetics

Question 4

What types of pts typically use herbals and dietary supplements? (8)

Answer 4

Female
Former or non-smokers
Higher incomes
Exercise regularly
Educated beyond high school
Generally good health
Presurgical patients
Patients with: cancer, liver disease, HIV, asthma, rheumatologic disorders

Question 5

What are the primary uses for aloe? (3)

Answer 5

digestion

cathartic (laxative properties)

burns, infections, wounds

Question 6

What is the potential concern for those taking aloe?

Answer 6

Hypokalemia due to diarrhea.

Question 7

What are two uses for echinacea?

Answer 7

URIs

flu

Question 8

What is the primary concern for those taking echinacea?

Answer 8

Drug toxicity!

It inhibits CYP3A4, so there is an increased risk for drug toxicity for drug metabolized by this enzyme.

Question 9

What drugs put pts taking echinacea at risk for drug toxicity? (3)

Answer 9

Xanax (alprazolam)

Calcium channel blockers

Protease inhibitors (antiviral drugs for HIV, AIDS, and Hep)

Question 10

What are the uses for garlic? (5)

Answer 10

HTN
hyperlipidemia
infections
cancer prevention
atherosclerosis

Question 11

What are the potential concerns for those taking garlic? (2)

Answer 11

Inhibits platelete aggregation
Induces CYP 450 (decreasing the effectiveness of drugs)

Question 12

What is the major drug interaction for a pt taking garlic?

Answer 12

Warfarin, increases INR which increases risk of bleeding.

Question 13

What are the uses of ginkgo biloba? (6)

Answer 13

circulatory disorders
increased mental acuity
tinnitus
vertigo
respiratory disease
sexual dysfunction

Question 14

What are the signs of ginkgo biloba toxicity? (4)

Answer 14

GI discomfort
dizziness
bleeding
seizures

Question 15

What are the major drug interactions for those taking gingko? (2)

Answer 15

Warfarin–due to increased bleeding

MAOIs

Question 16

What are the uses for ginseng? (4)

Answer 16

Immunostimulation
Improve strength and stamina
DM
Menopause

Question 17

What are the potential concerns for those taking ginseng? (5)

Answer 17

HTN
Tachycardia
Bleeding
CNS stimulation
Hypoglycemia

Question 18

What are the drug interactions for those taking ginseng? (3)

Answer 18

Warfarin
Insulin and sulfonylureas–increases hypoglycemia
MAOIs–increases manic-like episodes

Question 19

What are the uses of saw palmetto? (3)

Answer 19

BPH (benign prostatic hyperplasia)
Chronic pelvic pain
Bladder disorders

Question 20

What are the potential concerns for those taking saw palmetto? (2)

Answer 20

Intraop bleeding
N/V/D

Question 21

What drugs adversly interact with saw palmetto?

Answer 21

Anticoagulants

Question 22

What are the uses of St. John’s wort? (5)

Answer 22

Depression
Anxiety
Sleep disorders
Seasonal affective disorder (SAD)
Pre-menstrual syndrome

Question 23

What are the drug interactions of St. John’s wort?

Answer 23

St. John’s wort INDUCES CYP 450, 3A4, 2C9.

It alters the effectiveness of many drugs.

Question 24

What are the drugs of concern for anesthesia for those taking St. John’s wort? (3)

Answer 24

Calcium channel blockers

Warfarin

Digoxin

Question 25

For pts taking St. John's wort, there have been case reports of of cardiovascular collapse after induction with fentanyl, propofol, d-tubocurarine followed by maintenance with nitrous oxide, oxygen, and isoflurane. True or false?

Answer 25

true

Question 26

What are the uses of CoQ10? (7)

Answer 26

CHF CAD HTN Hyperlipidemia DM Increases energy Antioxidant

Question 27

What are the potential concerns/drug interactions for pts taking CoQ10? (3)

Answer 27

Decrease effectiveness of warfarin Hypoglycemia Statins--can cause a decrease in natural amounts in body

Question 28

What are the uses of dong quai? (2)

Answer 28

Menopausal symptoms Gyn issues like dysmenorrhea

Question 29

What is the potential concern for pts taking dong quai?

Answer 29

Possible inhibition of platelet aggregation

Question 30

What are the drug interactions for pts taking dong quai? (2)

Answer 30

Increase INR with warfarin Possible risks with hormone meds because may have estrogen-like effects

Question 31

What dietary supplements increase the risk of bleeding?

Answer 31

Ginkgo biloba Dong quai Vitamin E Garlic Ginseng Most everything we studied affects bleeding and Jenny stated that things that start with "G".

Question 32

In general, when should pts discontinue herbal medicins prior to surgery?

Answer 32

2-3 weeks prior

Question 33

When should garlic, ginseng, and St. John's wort be discontinued prior to surgery?

Answer 33

7 days