Herbal Supplements Flashcards
When do you stop herbals prior to surgery?
Stop all herbals 2 weeks prior to surgery
What are the 4 Gs (a B and an F)
- what are they known to do?
- Black Cohosh
- Feverfew
- Ginko
- Garlic
- Ginger
- Ginseng
These herbal supplements are known to increase the risk of surgical and post-surgical bleeding
Herbals that has increase in sedative effects
Ginger
Kava
St. Johns Wort
Valerian
Ginkgo inhibits?
What medical requirements are increased?
platelets
bleeding time may be increased.
Barbiturate requirements are increased in
patients taking ginkgo
Other sedatives as well—ginkgo may cause sedation
GARLIC SE
Nausea, hypotension, hemodynamic instability,
impaired plt agg and bleeding times
Ginseng may increase
SE of Ginseng
- glucocoticoid synthesis
SE: Hypertension, insomnia, hemodynamic instability,epistaxis, increased bleeding time
Valerian: may cause __ on abrupt discontinuation
Abrupt discontinuation may cause benzo-
like withdrawal sx (taper)
Side effects: HA, liver dysfunction, dysrhythmias
Kava- Kava
implications with anesthetic meds
What are the SE?
Enhances the effects of GABA on its receptor
producing CNS depression
Decreases MAC, benzo, barb requirements, etc.
May potentiate Parkinsonian sx
Side effects: Nausea, addiction and tolerance, skin rash, liver failure
Echinacea: SE
Who should not take this?
Side Effects:
- May enhance effects of barbiturates
- Hepatotoxicity with long term use
- Tachyphylaxis occurs
- Immune supression with prolonged exposure
Immunocompromised patients should not take
this supplement
Drugs to avaoid with St. John’s Wort
- Has MAOI, SSRI, TCA properties, so multiple interactions
Side effects
- CYP induction, photosensitivity, N/V/D, fatigue, HA, confusion, dizziness
- Seratonin syndrome!
AVOID ephedrine, meperidine, MAOIs, SSRIs, TCAs
May interfere with digoxin absorption and
metabolism
Melatonin interaction with anesthesia
Used as a sedative, sleep aid and antioxidant
- Antianxiety effects rival those of midazolam in the pre-operative setting
Naturally occurring hormone with many
beneficial effects
- Increased fertility, brain and cardiac ischemic protection, emerging uses in cocaine addiction treatment
May prolong emergence from anesthesia
Ephedra what should you know?
Phenylephrine is more effective
SE of Niacin
Causes flushing, hyperglycemia, pruritis, hyperuricemi
Vitamin E may inhibt?
Little evidence of nutritional significance
May facilitate the absorption and storage of Vit A May play a role in hematopoiesis Anti-oxidant effect
Anticoagulant effects
May potentiate the effects of warfarin Inhibit platelet activity*
Vit K is dependent on what factors?
how do you give it?
What is the 4? Pathways of Acetaminophen?
What is the MOA?
- Glucoronidation (40-60%)
- Sulfate conjugation (20-40%)
- N-hydroxylation (<15%)
- N-acetyl-p-benzo-quinone imine alkylating metabolite
- Inhibits cycloxygenase (but there may be another mechanism to explain its effects)
- Analgesic and antipyretic effects
- Metabolite modulates endogenous cannabinoid
- system
- Indirect blockade of nociceptors
- Indirect sodium channel blockade
- However, no anti-inflammatory or anti-platelet
effects
NSAIDs MOA
Weak acids
Well absorbed from GI tract
95% albumin bound
Small Vd
Sequestered in inflamed tissues (synovial)
Weak acids in acid environment
Low 1st pass hepatic extraction
May cross BBB
NSAIDS Adverse reactions
when do you stop it?
MOA is ASA
BIG ISSUE WITH TORADOL
BLEEDING
When is Ketorolac well suited?
avoid with patients with impaired renal clearance
