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PHAR154 > Herbals > Flashcards

Herbals Flashcards

1
Q

What is the biggest question we will probably always get asked about herbals?

A

“is this good for _____?”
-probably wont ever have someone ask you about side effects,
what dose to use, or drug interactions

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2
Q

If decide to go the route of giving a herbal a try, what are some questions to ask the patient or things to keep in mind?

A

what has been tried so far?
have they tried the standard therapies?
what is the risk this will delay MD input?
patient frustration level

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3
Q

How do we control the risk of herbal use?

A

does the dose seem reasonable?
-often unknown, we are stuck with the label dosing
if not better in [days/weeks/months] get help
-need to have a time frame
is the patient under MD care?
-especially for osteoarthritis, insomnia, menopause,
depression

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4
Q

Which drug requires us to always search up drug interactions with herbals?

A

warfarin
also DOACs

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5
Q

When there’s a tv sign off with statements like “take ginger daily” or “add cinnamon to your water, its good for blood sugar”, what is never mentioned on these sign offs?

A

how much?
how long?
better than other measures?
any downside?
value vs effort/cost?
indication?

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6
Q

True or false: dark chocolate is fairly low calories and full of antioxidants

A

true
tv ads wont tell you that it has to be dark chocolate, they will just say “chocolate is full of antioxidants”

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7
Q

During a herbal consult, what must we always keep in mind?

A

has this person tried standard therapy for this situation
ex: premarin for menopause or celecoxib for arthritis

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8
Q

Differentiate between rheumatoid arthritis and osteoarthritis.

A

rheumatoid arthritis:
-more severe than OA
-immune system attacking the body
-people of any age, most commonly between age 20-60
-symptoms felt throughout entire body
-affects women more than men
-morning stiffness >1hr
osteoarthritis:
-generally less severe than RA
-caused by wear and tear on the body
-generally affects people over age 40
-usually only affects the joints
-commonly in both genders
-morning stiffness <1hr, returns at end of the day

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9
Q

What do the joints of an osteoarthritis sufferer look like? What about the joints of a rheumatoid arthritis sufferer?

A

osteoarthritis: bone ends rubbing together, thinned cartilage
rheumatoid arthritis: swollen inflamed synovial membrane,
bone erosion

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10
Q

What are the common sites for osteoarthritis?

A

neck
shoulder
lower back/SPINE
elbow
HIP
base of thumb
tips of fingers
KNEE
ankle
base of big toe

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11
Q

What is a location of joint pain that worries us and requires referral?

A

neck

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12
Q

What is the main use of glucosamine and chondroitin?

A

osteoarthritis

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13
Q

Describe the progression of osteoarthritis.

A

wear and tear–>loss of cartilage–>friction between bones–>pain/swelling/less ROM

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14
Q

What can contribute to the development of osteoarthritis?

A

age
obesity
genetics

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15
Q

What is the MOA of glucosamine and chondroitin?

A

normal component of cartilage matrix and synovial fluid
may prevent joint-space narrowing

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16
Q

What are glycosaminoglycans?

A

normal component of cartilage/connective tissue
water sticks to GAGs (cushioning action)

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17
Q

What is the dosage regimen for glucosamine?

A

try for 3-6 months
500mg TID
-can be 750mg BID or all 3 caps at once

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18
Q

What are the patient expectations for glucosamine?

A

dont stop other meds
will take 4-8 weeks (if it even works)

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19
Q

Describe the efficacy of glucosamine.

A

likely not good for arthritis of low back pain
if it works, likely still need NSAID for flare-ups

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20
Q

Why is glucosamine not good for back pain?

A

glucosamine tries to fix the interface between joints
these interfaces are not really present in the back
more likely to work on somewhere like a knee joint

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21
Q

Describe the efficacy of chondroitin.

A

little benefit (alone or with glucosamine)
beneficial effect on joint space (at 2 years)
can help, but less than glucosamine
AGAIN, LOTS OF BACK AND FORTH
mainly an add-on to glucosamine

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22
Q

What is MSM?

A

found in humans (and foods) but NOT a normal component of joints

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23
Q

True or false: MSM has great value

A

false
questionable value

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24
Q

What is the dosing of chondroitin?

A

400mg TID

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25
Q

What are the side effects of glucosamine?

A

excellent safety record
maybe GI or derm

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26
Q

What are the drug interactions with glucosamine?

A

very minimal
warfarin interference is possible but unlikely
blood glucose impact unlikely

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27
Q

When you have the choice between glucosamine, chondroitin, MSM, or a combo product, which would you choose?

A

SKIP MSM
JT goes glucosamine and skips the combo
cant really find chondroitin alone, left with solo glucosamine or the combo
chondroitin may be additive

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28
Q

What do we make of SierraSil and bromelain?

A

hot trash

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29
Q

Differentiate between curcumin and turmeric.

A

curcumin is a naturally occurring chemical compound found in turmeric
turmeric is the yellow powder and curcumin is found within the powder

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30
Q

What is the dose of curcumin used for relief of pain in arthritis?

A

2g

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31
Q

How much turmeric is needed to achieve the beneficial dose of curcumin?

A

1stp=3g turmeric=200mg curcumin
therefore:
10tsp=30g turmeric=2g curcumin

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32
Q

What is arnica often advertised for?

A

bruising, inflammation, soreness
GARBAGE
often seen in homeopathic preps and food additives

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33
Q

What are the essential fatty acids?

A

omega-3
omega-6

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34
Q

Name sources of the following omega-3 fatty acids: ALA, EPA, DHA

A

ALA: canola, soybeans, walnuts, flaxseed
EPA: oily fishes such as cod liver, herring, mackerel, salmon,
sardines
DHA: oily fishes “ “, also from algal fermentation

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35
Q

True or false: ALA can be converted by humans into EPA/DHA

A

true but only minimally thus ingesting a marine source is key

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36
Q

Name sources of the following omega-6 fatty acids: LA (linoleic acid), AA (arachidonic acid)

A

LA: soybean oil, corn oil, safflower oil, sunflower oil
AA: peanut oil, meat, eggs, and dairy products

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37
Q

What can an excess of omega-6 lead to?

A

promotion of inflammation which can contribute to development of diseases such as coronary heart disease, cancer, and arthritis

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38
Q

What does a healthy balance of omega-6 to omega-3 look like?

A

2-4x more omega-6 than omega-3
the average diet today is 11-30x more omega-6 than omega-3 which is contributing to the rise of inflammatory diseases

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39
Q

Describe omega-9.

A

unsaturated fats found in vegetable and animal fats
also known as oleic acids or monounsaturated fats
sources: canola, sunflower, olive, and nut oils
produced by the body

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40
Q

What are the effects of DHA/EPA?

A

anti-inflammatory
less platelet adhesion

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41
Q

What are the effects of ALA?

A

5% converted to DHA/EPA (thus get DHA/EPA from diet)
used for cell membranes and hormones

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42
Q

What are the effects of omega-6 fatty acids?

A

energy production
undesirable PGs
inflammation

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43
Q

What are the main uses of omega-3 fatty acids?

A

cardiovascular:
-1 prevention (prevent 1st MI)
-2 prevention (prevent 2nd MI)
-high TGs
REPORTS NOW SHOWING THAT THE VALUE IS PROBABLY NOT GREAT (flashcard coming up on its efficacy)

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44
Q

Describe the efficacy of omega-3 fatty acids in regards to its main uses.

A

modest or no benefit from supplements
-more hope for secondary prevention than primary
-likely less helpful if taking full MI medicine regimen
helpful for elevated TGs

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45
Q

What is the best source of omega-3 fatty acids?

A

fish

46
Q

What are the side effects of omega-3 supplements?

A

fishy taste (only se that JT mentions)
unlikely risk of bleeding

47
Q

Is there a concern of drug interaction between omega-3 supplements and agents with risk of bleeding?

A

no sir

48
Q

What is the recommendations for omega-3 intake for patients without documented cardiovascular heart disease?

A

eat a variety of fish 2x per week
include oils and foods rich in ALA

49
Q

What is the recommendations for omega-3 intake for patients with documented cardiovascular heart disease?

A

1g of EPA+DHA per day, preferably from fatty fish
EPA+DHA supps can could be considered in consultation with a physician

50
Q

What is the recommendations for omega-3 intake for patients who need to lower TGs?

A

2-4g of EPA+DHA per day provided as capsules under a physicians care

51
Q

What is the recommended amount of EPA/DHA per day or per week?

A

500mg a day or 3500mg a week
“two small servings”
for primary prevention

52
Q

What is the dosing of EPA/DHA supplements for primary prevention?

A

2 servings/wk of specific fish
or 500mg supp (EPA/DHA) daily

53
Q

What is the dosing of EPA/DHA supplements for secondary prevention?

A

1000mg fish oil (to deliver 180/120mg EPA/DHA) TID

54
Q

What is the dosing of EPA/DHA supplements for hyper-TGs?

A

2-4g of EPA/DHA

55
Q

How much EPA/DHA is in 1000mg of wild salmon fish oil supplements?

A

300mg

56
Q

We know that omega-3 has a fish aftertaste that is not desired by patients. There are liquid versions of omega-3 that try to mask the taste, what do we make of these products?

A

don’t recommend, they are super expensive
just tell the patient to take the omega-3 with food

57
Q

True or false: Neptune Krill Oil is super good for MI prevention

A

false

58
Q

What form must flaxseed be in to be absorbed?

A

ground up
must also be packaged airtight

59
Q

What are the other uses of omega-3?

A

rheumatoid arthritis: beneficial
osteoarthritis: less benefit than RA
depression: mixed reports, less so on the radar screen
-doesnt look good
dry eyes: maybe, leap of faith
-evidence is uncertain
ADHD: has promise

60
Q

What are some cholesterol lowering agents other than statins?

A

Metamucil
-10g/day (3 tsp TID), drop by 5%
omega-3s
-2-4g EPA/DHA to lower TGs only
plant sterols/stanols
-2g, drop by 10%
soy
-25g soy protein (4 cups soy milk), drops by 5%

61
Q

How does Metamucil lower cholesterol?

A

bile acids get trapped in the Metamucil gel and eliminated, the body then has to make more bile acids which uses up cholesterol to do that

62
Q

What is CoQ-10?

A

aka ubiquinone
vitamin-like
present in all cells
antioxidant
EXPENSIVE
some in meats/seafood

63
Q

What is the link between CoQ-10 and statins?

A

statins reduce the amount of CoQ-10 in the body
-maybe the reason for myopathy from statins??
JT goes 3-4mo of statins, if muscle pain shows up can try adding CoQ-10 as a supp, dont have to add it from the start

64
Q

What are the uses of CoQ-10?

A

possibly effective:
-congestive heart failure: treatment
-hypertension: treatment
-heart attack: prevention
-migraines: prevention
not sure yet:
-angina
-melanoma
-diabetes
likely ineffective:
-alzheimers
statin-induced muscle pain=worth a try

65
Q

What are the side effects of CoQ-10?

A

no major side effects
occasional stomach upset

66
Q

What is the recommended dose of CoQ-10 for supplementation?

A

30-200mg OD

67
Q

What is the difference between ubiquinone and ubiquinol?

A

ubiquinone gets converted to the active form, ubiquinol in the body
ubiquinol may yield a bit more active compound in your body

68
Q

What percent of the population experiences chronic insomnia?

A

10%

69
Q

What is JTs mindset when it comes to OTC products and insomnia?

A

attempt to curb OTC product use and shift their focus to getting medical care

70
Q

What is first line therapy for insomnia?

A

cognitive behavioural therapy
-for insomnia, the primary goal is to recognize and change
irrational thoughts and beliefs about sleep that elevate stress
and anxiety and thus cause or exacerbate sleeplessness

71
Q

True or false: turkey contains more tryptophan than other meats and is therefore more sedating

A

false
its just the volume of food

72
Q

Whats the verdict on chamomile and sleep?

A

highly unlikely to be helpful
try if you wish

73
Q

Whats the verdict on lavender and sleep?

A

not gonna help you sleep

74
Q

Whats the verdict on valerian and sleep?

A

not gonna help you sleep

75
Q

What is an important line extension of Nytol to watch out for?

A

the one that contains valerian rather than dph

76
Q

How sedating is diphenhydramine?

A

not much, a little bit drowsy
probably more psychological than therapeutic

77
Q

Does tolerance develop to diphenhydramine?

A

yes
ex: someone taking QD x 30d will see effectiveness drop around week 3-4

78
Q

What are the side effects of diphenhydramine?

A

dry mouth
constipating
urinary retention
on the BEERS List

79
Q

What stimulates melatonin production?

A

stimulated by darkness, inhibited by light

80
Q

What part of the brain produces melatonin?

A

pineal gland

81
Q

Describe melatonin.

A

hormone produced from tryptophan
ties into our circadian rhythms (seasonal/daily)
increased levels at night
levels drop as we age
humans have MT1 and MT2 receptors

82
Q

What is the main use of melatonin?

A

insomnia
others include: depression, jet lag, CV, GERD, antioxidant, cancer (but does it really work for these???)

83
Q

What is the impact of melatonin on sleep latency and total sleep time?

A

decreased sleep latency by 7.1 minutes
increased total sleep time by 8.3 minutes

84
Q

What is the dosing of melatonin?

A

1-2mg HS x 2 wks, then 5mg HS x 2wks; re-assess
1-2 hours before bedtime

85
Q

Describe the efficacy of melatonin.

A

may not be dose-dependent (more is not better)
no signs of tolerance (at 1-3 years)
no signs of negative effects on sleep

86
Q

What are the side effects of melatonin?

A

mild GI
additive drowsiness to any other sedating agent
headache
safety seen over several years (up to 5mg)

87
Q

What should be your focus with a patient during a melatonin consult?

A

seen a doctor?
how long has this been a problem? (years=refer)
any link to an event? (melatonin wont cure it)
affecting quality of life? (physician care)
tips on better sleep
shift people away from Nytol to melatonin
set out a time frame of reasonable use

88
Q

What are ten tips for a better sleep?

A

maintain a consistent schedule
reduce daily caffeine intake
turn off the computer or TV
dont go to bed on a full stomach
dont go to bed on an empty stomach
engage in regular exercise
limit beverage consumption before bed
keep your bedroom dark and quiet
invest in a comfortable mattress, pillow, and bedding
go to sleep and wake up using your internal alarm clock

89
Q

Is melatonin safe for kids?

A

yes but not our call

90
Q

What is Circadin?

A

melatonin in a tablet that is Rx
in Europe
2mg SR tablet
approved for 3 months use
takes few weeks (maybe 21d) for full effect

91
Q

What are the so called “uses” of flaxseed?

A

cardiovascular (omega 3 precursor as it has ALA but remember little ALA is converted to omega-3 in the body)
=likely not
constipation (soluble fiber)
=sure
menopause (contains lignans which is an estrogenic compound)
=maybe

92
Q

What form must flaxseed be in to be absorbed?

A

ground up

93
Q

How much flaxseed is the right amount?

A

we have no idea
reported that ~50g is the therapeutic serving for menopause

94
Q

True or false: echinacea is great for the cold

A

false

95
Q

Is garlic great for the cold?

A

not at all

96
Q

Which herbal is contained within ColdFx?

A

ginseng

97
Q

What is the active ingredient within St Johns Wort?

A

0.3% hypericin

98
Q

True or false: St Johns Wort has the greatest risk of any herbal we have looked at

A

true
potential for plenty of drug interactions

99
Q

Describe the main uses and efficacy of St Johns Wort.

A

mild-moderate depression
-as effective AND safe as SSRIs
major depression
-less proof of value

100
Q

Is St Johns Wort an area for self-care?

A

not really
almost exclusively an area of MD care

101
Q

How do SSRIs work?

A

prevents re-uptake of serotonin

102
Q

What is the MOA of St Johns Wort?

A

natural SSRI-like abilities

103
Q

What are the side effects of St John Wort?

A

well tolerated (remember this)
-better than TCAs
-good as (or better) than SSRIs
GI, rash, photosensitivity, sedation, anxiety, dizziness, headache, dry mouth (JT never remembers these)

104
Q

How many drugs are known to interact with St Johns Wort?

A

100

105
Q

What are some key drug interactions with St Johns Wort?

A

induces CYP P450 and P glycoprotein
-decreases alprazolam levels
-decreases simvastatin levels
-decrease birth control pill levels (BIG ONE)
-decreases warfarin levels
other antidepressants–>serotonin syndrome

106
Q

What is the dosing for St Johns Wort?

A

300mg TID

107
Q

True or false: serotonin syndrome is quite common

A

false

108
Q

How many drugs that increase serotonin are usually involved in serotonin syndrome?

A

2 drugs

109
Q

What is the thought for an MOA of cranberry use in UTIs?

A

prevent E coli adhesion onto urinary tract
does not appear to acidify urine (need 4L for that)
may need 1-2 months for effect

110
Q

Is treatment of UTIs with cranberry likely? What about prevention?

A

treatment: unlikely to help once the UTI occurs
prevention: possibly effective

111
Q

What is the definition of recurrent UTIs?

A

3 or more culture-positive infections in 1 year
-approach is antibiotic use daily for weeks/months

112
Q

What is the issue with cranberry juice for UTIs?

A

the delivery system, lots of sugar
assuming 2 cups cranberry juice daily and the most positive data, for a 1 in 12 chance pf avoiding a UTI over 6 months=$180 + 45000 calories

PHAR154 (18 decks)

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