Herbal Medicines/Food Drug Interactions

Question 1

Rating system

Answer 1

likely safe (as good as you can get), possibly safe, possibly unsafe, likely unsafe, unsafe.

Question 2

Non-FDA warnings

Answer 2

all supplements not regulated by FDA cannot legally claim to have any health benefits

Question 3

NCCIH

Answer 3

government agency that handles herbal supplements. Good place to send patients

Question 4

Milk Thistle major theraputic claims

Answer 4

silybum marianum. Generally for liver disorders. Possibly effective allergic rhinitis, diabetis, dyspepsia, menopausal, radiation dermatits. Possibly ineffective hep C, heb B. Insufficient to rate, liver diseases, amanita mushroom poisoning.

Question 5

Milk Thistle safety, adverse rxns, interactions (dont memorize)

Answer 5

likely safe. can cause allergic rxns, GI distress, low blood sugar. moderate rating for drugs metabolized in CYP2C9 (diazepan, warfarin), CYPD6 (haloperidol, chloprozamine, beta blockers, tamoxifen), CYP34A (antibiotics, lovastatin etc)

Question 6

GLucosamine and Chondroitin

Answer 6

for joint pain. Possibly effective osteoarthritis, insufficient to rate osteoarthritis (glucosamine), knee pain (glucosamine

Question 7

Glucosamine and chondroitin safets, adverse effects, interactions

Answer 7

likely safe, generally well tolerated, possible GI distress. May interact with warfarin

Question 8

Black Cohosh theraputic claims

Answer 8

menopause symptoms. possibly effective menopause symptoms, insufficient evidence: breast cance, CD, cognitive function, infetility, labor, migranes, osteoporosis, RA

Question 9

Black Cohosh safety, adverse effects, drug interactions

Answer 9

possibly safe, possibly unsafe in pregnancy and lactation possible GI distress, rashes, potential effects on estrogen-sensitive conditions (bc, uc, endometriosis). May interact with atorvastatin, cisplatin, CYP2D^

Question 10

Ginkgo general claims

Answer 10

cognitive disorders or deficiencies. Possibly effective for cognitive function, dementia, glaucoma, diabetic retinopathy. Possibly ineffective: age related memory loss, antidepressant induced sexual dysfunction, seasonal affective disorder, asthma, hypertension. Likely ineffective CAD. Insufficient evidence to rate: age related macular degenration, altitude sickness ADD…etc

Question 11

Ginkgo safety

Answer 11

likely safe. LIkely unsafe when using fresh ginko orally, possibly unsafe during pregnancy. Generally well tolerated, major interactio with sustiva

Question 12

Ginseng general claims

Answer 12

improve well bieng, stimulate immune function. Possibly effective: cognitive fx, erectile dysfunction

Question 13

Ginseng safety

Answer 13

possibly safe when used short term, possibly unsafe when used long term or in pregnancy. most common side effects include insomnia, mastalgia, vaginal bleeding, tachycardia, palpitations. can interact with some anticoagulants

Question 14

Ginger claims

Answer 14

treatment of nausea, vomitting, motion sickness. possibly effective: morning sickness, postoperative nauseas, vertigo, dysmenorrrhea, osteoarthritis

Question 15

Ginger safety

Answer 15

likely safe. avoid nifedipine, warfarin

Question 16

Echinacea general uses

Answer 16

cold or flu: possibly effective for common cold

Question 17

Echinacea safety

Answer 17

likely safe in colds and for short term use. possibly safe for long term.

Question 18

St. Johns wort theraputic claims

Answer 18

depression, anxiety. Likely effective with depression

Question 19

St. Johns wort safety

Answer 19

significant number of drug interactions, always ask and check

Question 20

saw palmetto general

Answer 20

BPH: Possibly effective for transurethral resection of the prostate. possibly ineffective BPH

Question 21

saw palmetto safety

Answer 21

likely safe

Question 22

tyramine

Answer 22

metabolized by MAO. MAO inhibitors (anti-depressants), block degredation. excess tyramine can lead to hypertensive crisis

Question 23

grapefruit juice

Answer 23

inhibits intestinal cytochrome P-450 enzyme CYP3A4. Increase plasma time of certain drugs (antiayythmics, CHBs, statins, immunsuppresants, protease inhibitors), leading to several side effects.