Herbals Flashcards
Pseudoephedrine derivative at a baseball player overdosed on?
Ephedra
Natural Salicylate product that eventually led to the development of Aspirin?
Willow Bark
Prescription drug that we must monitor very closely for widespread Herbal interactions?
Warfarin
Osteoarthritis vs. Rheumatoid Arthritis… How do they present differently?
OA: Morning stiffness < 1hr & normalizes; bone on bone & thinning cartilage.
RA: Morning stiffness > 1hr; swollen / inflamed synovial membrane.
How are Glucosamine / Chondroitin proposed to work?
Stickiness effect (water molecules stick to their GAG sugar molecules, which serves as a cushion for joints).
How long should Glucosamine be tried out for (if used at all)?
3-6mths (& takes at least 4-8wks to even have effects)
How much Glucosamine should be taken per day?
500mg TID (or can take all 1500mg OD)
MSM: Good for arthritic pains?
Useless (ditch it).
Chondroitin Sulfate dosing?
400mg TID
T or F: Chondroitin is available as a solo agent.
False… In Glucosamine combo products.
Name of bullshit Pineapple Enzyme product that claims lots of things (including anti-cancer properties)?
Bromelain
Around what daily amount of Curcumin (spice found in Turmeric products) has been indicated for relief of arthritic pain?
2g / day (which equates to about 30g of Turmeric per day).
Fatty Acids that we desire to increase in the diet for cardioprotective measures?
Omega 3s
Conversion rate of ALA to EPA & DHA?
5% (super low)
Traditional North American diets have an abundance of Omega 6s in them… How does this excess of Omega 6 intake impact the body?
Promotes inflammation… Healthy diets 2-4x more Omega 6s to Omega 3s (but we’re at more like 11-30x Omega 6 to Omega 3).
Benefits of upping Omega 3 FA intake in the diet?
-Anti-Inflammatory
-Less Platelet Adhesion
What is the current stance on Omega 3 usage for CV protection?
“This doesn’t look as good as we once thought, but worth trying if you want.”
T or F: Omega 3 FA intake has more promise for Secondary Prevention than it does Primary Prevention of adverse CV events.
True!
T or F: If one is on prescribed Myocardial Infarction medications, concurrent use of Omega 3s will further decrease their risk of experiencing a subsequent event.
False (likely)… Would potentially benefit them if they were on nothing at all (but concurrent use with Rx meds is of little benefit).
Only side effect worth mentioning for those on Omega 3 supplements?
Fishy Taste
The AHA recommends consumption of how many grams of combined EPA + DHA per day for those with documented Coronary Heart Disease?
1g / day (if secondary prevention)
As a primary prevention measure for CHD or other adverse CV events, what is a suitable amount of combined EPA + DHA that one should take per day?
500mg / day (or 2 servings of fatty fish per week)
T or F: Jackfish / Pike intake (via lakes in Northern Saskatchewan) is a great source of dietary EPA / DHA.
False… Need to consume fatty fish (ie. Bluefish, Herring, Salmon, Halibut).
As Secondary Prevention of adverse CV events, how much Fish Oil (via Jamieson Capsules) should be taken per day to get close to the 1g EPA + DHA?
1000mg TID (delivers a combined 300mg per dose of EPA + DHA)
As Primary Prevention of adverse CV events, how much Fish Oil (via Jamieson Capsules) should be taken per day to get close to the 500mg EPA + DHA?
1000mg OD (one capsule delivers 300mg per dose of EPA + DHA, which is close enough to the desired 500mg / day).
Given Flax is a form of Omega 3 FA, would it be suitable to take for either Primary or Secondary Prevention of an adverse CV event (instead of Fish Oil)?
No… Flax is ALA, & conversion factor discussed prior is way too low (5%) to have substantial effects.
Between Rheumatoid & Osteoarthritis, which one would Omega 3 consumption benefit more?
Rheumatoid Arthritis (AI properties are somewhat beneficial to the progression of the disease)
Omega 3s: Good for Depression, Dry Eyes, ADHD?
Depression: Inconclusive (mixed).
Dry Eyes: Potentially (but inconclusive).
ADHD: Some promise.
Daily intake of combined EPA + DHA required to have TG lowering effects?
2-4g
1) Metamucil (10g / day)
2) Becel Butter (4tsps = 2g)
3) Soy Milk (4 cups / day = 25g)
-Which one has the most substantial effects on lowering TG’s?
Becel Butter (10% at that 4tsp daily intake)…
-Metamucil is 5% & Soy Milk is 5% at their respective doses.
What use does Co Q-10 supplementation have with those on Statins?
Some link that replenishing Co Q-10 lost from Statin medication reduces muscle pains. However, evidence is inconclusive at best (so tamper expectations).
Suggested 1st line therapy for those with Insomnia?
Cognitive Behavioral Therapy (CBT)
T or F: The Tryptophan found in Turkey is why I’m more tired after eating at Thanksgiving than after a normal supper.
False… Sheerly the volume of food you eat that makes you fatigued (turkey has no more effects on drowsiness than other meats).
Chamomile: Does it make me sleepier?
Highly unlikely
T or F: Tolerance can be developed to the sedation that Benadryl offers.
True!
When do Melatonin levels in the body peak? When are they at their lowest?
Highest: Middle of the night (around 2am)
Lowest: Upon waking (8am)
T or F: Melatonin provides significant efficacy in terms of improving sleep quality and duration.
False…
If one desires to take Melatonin for Insomnia, what would be an advisable dosing regimen?
1) 1-2mg HS x 2wks, then:
2) 5mg HS x 2wks & re-assess.
Am I safe to take Melatonin long-term? Will I develop a tolerance to it? What other s/e’s can occur?
-Safe for LT use.
-No evidence of tolerance.
-Mild GI / Headache / Additive Drowsiness (if added on to other agents).
Why is there a shift to move away from Nytol & towards Melatonin (especially in elderly)?
-On BEERS list to avoid.
-Also, tolerance can develop to DPH.
Is it appropriate to step in and recommend Melatonin right away for a child with sleep problems?
FALSE (!!!)… Dr.’s call.
Full effects of Circadin (SR Oral Melatonin Tabs) are seen after how long?
21d (3wks)
Flaxseed contains natural estrogenic compounds called ______ that are proposed to have effects on menopausal symptoms.
Lignans
Flaxseed: CV Protective? Good for Constipation?
CV: Likely not (levels of converted Omega 3s way too low as seen prior).
Constipation: Fine (is just dietary fiber so why not).
For Mild-Moderate Depression, is St. John’s Wort effective?
Just as effective & safe as SSRIs.
Is St. John’s Wort effective for severe depressive cases?
Less value than mild-moderate.
In terms of tolerance, are TCAs better tolerated than Herbal St. John’s Wort?
Nope… St. John’s Wort actually better tolerated (& as good or better tolerated than even SSRIs).
Why is screening a patient prior to advising St. John’s Wort so important?
Hundreds of drug-drug interactions… As a solo entity, is safe (but interacts with sooooo many things).
Major drug-drug interactions to be wary of with St. John’s Wort?
-Birth Ctrl Pills (reduces contraceptive / hormonal regulatory effectiveness).
-Other Antidepressants (Serotonin Syndrome).
-Warfarin (decreases levels).
-Simvastatin (decreases levels).
-Alprazolam (decreases levels).
Standard St. John’s Wort dosing?
300mg TID
Cranberry Juice / Tablets good as a preventative measure for UTIs? As a treatment measure?
Prevention: Some chance for effectiveness (may need 1-2mths for effectiveness).
Treatment: Unlikely it helps.
