Herbal Medicines Flashcards
What is the most common CAM therapy?
Natural Products- 17.7%
What is aspirin produced from?
bark of the willow tree
What is opium produced from?
papaver somniferous
What was the dietary supplement health and education act of 1994?
- Defines and regulates dietary supplements
- a dietary supplement must contain one or more dietary ingredients including vitamines, minerals, herbs, amino acids, dietary substance, metabolist, constituent, extract or combo of above
- cannot be approved or authorized for investigation as a new drug, abx., or biologic unless labeled before investigation
- needs clinical trials before it becomes a drug
What are some interesting facts about regulation of dietary supplements?
- Manufacturers are not required to prove efficacy, safety, or quality of their products
- not required to reprot any post marketing adverse events to any central agnecy
- manufactured before 1994- grandfathered in
- after 1994- need reasonable evidence of their safety or reasonable expectation of their safety must be reviewed not approved
What did the Good Manufacturing Practices do?
- Set of guidelines by FDA to try to regulate produciton and manufacturing
- No real oversight
- variation in quality, harvesting, storage condition, processing, purity and efficacy of herbals
- some have outright substitiutions are contain things like laxatives
What did the office of alternative medicine do? Where was it housed?
Housed at NIH
- Studied and evaluated complementary and alternative medicine practices to disseminate the results
What is the National Cwenter for Complementary and Alternative Medicine?
- define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and the role in improving health and health care
- produce scientific evidence to inform decision making by the public, health care professionals and policy makers
What is echinacea?
Chemistrym, pharmacologic and clinical effects, adverse effects
- Chemistry- not a single compound but multiple comounds
- Pharmacologic and CLinical effects
- anti-inflammatory
- cancer
- immune modulation
- URI treatment
- recurrent URI preventions- shown most effective to prevent further colds
- Adverse effects:
- allergic reaction
- caution in pt with liver dysfunction
- may alter cyp (1A2, 3A4)
- caution in antipsychotic and antidepressants
- poor wound healing
- decrease effectiveness of steroids
What is ephedra?
Chemistry, pharmacology &clinical effects, adverse effects?
- Chemistry- alkaloid ephedrine
- Pharmacology & Clinical
- has both direct and indirect effects on alpha and beta receptors
- CNS stimulant
- weight loss supplement
- treatmnet of asthma
- adverse effects
- palpitation, tachycardia, HTN, CMP (chornic
- fatal arrhythmias and MI
- Hemodynamic instability intraop
- CNS: sz, stroke, psychosis
- other- hepatitis
What is ginseng?
Chemistry, pharmacology &clinical effects, adverse effects?
- CHemistry- ginsenosides- like steroids
- pharmacology &clinical effects
- memory enhancer
- physical enhancer
- lower BG
- alter coag pathway, inhibits plt aggregation
- immunomodulation
- aphrodisiac
- Adverse effects
- increased bleeding
- inhibit PLT (irreversible)
- hypoglycemia
- interacts adversely with MAOI
- increased bleeding
What is ginger?
Chemistry, pharmacology &clinical effects, adverse effects?
- Chemistry- shoagaol, gingerol, galanolactone
- antagnoizes serotinin receptors (like zofron)
- inhibits prostaglandin
- inhibita thromboxane synthetase
- pharmacology
- GI discomfort
- anti-inflammatory
- Nausea/motion
- respriatory problems
- sore throat
- increased bleeding time
- adverse effects:
- increased bleeding
- hyperglycemia
- pregnancy - possibly safe?
What is garlic?
Chemistry, pharmacology &clinical effects, adverse effects?
- Chemistry- sulfur containing compounds- alliin or ajoene
- potent abs propertieis
- hmg coa reductase
- cystein- alters arachidonic acid metabolism
- Pharm and clinical application
- decrease BP
- Decrease atheroscleosis
- decrease lipid/cholesterol
- inhibit PLT aggregation
- anti-tussive/expectorant
- adverse effects
- bleeding
- smell
- GI upset
What is Kava?
Chemistry, pharmacology &clinical effects, adverse effects?
- Chem- may potentiate GABA
- Pharmacology and clinical application
- anxiolytic
- sedative
- antiepileptic
- neuroprotective
- adverse effects
- addiction/tolerance
- withdrawal
- inhibit cytochrome p450 and 2EI
- Glutathione depletion- acetaminophen induced cytotoxicity
What is valerian?
Chemistry, indication &clinical effects, adverse effects?
- Chemistry- sesquiterpines
- modulation of GABA NT, inhibit GABA breakdown or reuptake
- indication
- insomnia
- sedation
- anxiety
- Adverse effects:
- withdrawal symptoms if stopped after long term use
- interacts with alchol/sedatives
- hepatotoxicity with long term use
taper dose, continue up to day of sx
What is St John’s Wort?
Chemistry, pharmacology &clinical effects, adverse effects?
- Chemistry- hypericin and hyperforin
- inhibit reuptake of 5HT NE DA
- Pharmacology and clinical app
- Mild to moderate depression
- insomnia
- OCD
- ADHD
- Adverse effects
- induces CYP450
- alfenta, midazolam, lidociane, CCB, serotonin receptor antagonist
- warfarin NSAIDS
- Serotonin syndrome
- fatigue
- sedation
- induces CYP450
What is hoodia gordonii?
Chemistry, pharmacology &clinical effects, adverse effects?
- Chmistry- molecule P57- neuroactiv esteroid
- has effect on hypothalamus
- may look like glucose and trikc brain into thinking you’re full
- multiple companies have tried to bring it to market without success
- has effect on hypothalamus
- pharm and clinical app
- appetitie suppressant
- adverse reactions
- n/v
- dizziness
- increased BP and HR
- Altered skin sensation
- abuse potential
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What is feverfew?
Chemistry, pharmacology &clinical effects, adverse effects?
- Chem- parhedolide
- inhibits Nf-Kb- anti-inflammatory
- inhibits prostaglandin
- Pharm
- prevent migraines
- reducing HA symptoms
- RA
- Adverse efffect
- N/V/D
- Nervousness and dizziness
- prefnancy- potential abortifacient
- induce liver enzymes
- increase risk of bleeding
Which herbal supplements can cause bleeding?
all the G’s
- ginsent
- ginger
- garlic
- ginkgo
- feverfew
What herbal supplements cause sedation?
kava
valerian
st john’s wart
What herbal supplements cause sympathetic stimulation?
ephedra
hoodia
What drugs affect the liver
Echinacea
St john’s wort
Feverfew
What drugs are cautioned in pregnancy?
Feverfew, ginger
What herbals supplements interact with MAOIs?
Ginseng
Gingko
St. John’s Wort (Serotonin syndrome)
