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PHAR 154 > Herbals > Flashcards

Herbals Flashcards

1
Q

Many herbals are…..

A

placebo

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2
Q

need to ask….

A

What has been tried so far?
Frustration level of patient?
Standard therapies tried?

The risk this will delay MD input

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3
Q

Stuff to consider

A
  • Does this seem reasonable
  • If not better in ____ seek help
  • Under MD care
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4
Q

Warfarin. We should…

A

look up every agents

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5
Q

Glucosamine

A
  • Prevent cartilage deterioration
  • Disease modifying agent
  • Makes synovial cavity more smooth
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6
Q

OA vs. Rheumatoid arthritis

A

Patients with inflammatory arthritis, typically, are very stiff and this lasts longer than 1 hour after waking. The pain and stiffness in these patients gets better with mobilisation and as the day progresses.

In contrast, osteoarthritis patients tend to be transiently stiff for seconds to minutes after waking and problems are worse through the day and on activity. Post rest stiffness called gelling is typical lasting seconds to minutes in osteoarthritis patients.

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7
Q

Glucosamine/Chondroitin Uses

A

Osteoarthritis

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8
Q

Describe the process of OA

A

Wear/tear - oss of cartilage - friction bn bones - pain swelling, less rom

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9
Q

where does oa impact?

A

knee, hip, spine

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10
Q

Oa risk factors

A

age, obesity, genetics

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11
Q

MOA of glucosamine/chondrotin

A

normal component of cartilage matrix and synovial fluid

may prevent joint-space narrowing

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12
Q

What is glucosamine/chondrotoin? What is normal in the joints?

A

GlycosAminoGlycans
normal component of cartilage / connective tissue

water sticks to GAGs (cushioning action)

glucosamine is a precursor cpd / chondroitin is a GAG

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13
Q

Is glucosamine worth a try?

A

YES

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14
Q

How long to try glucosamine? When it will work?

A

try for 3-6 months

Takes 4-8 weeks to work

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15
Q

Should one stop their other meds when taking glucosamine?

A

NO

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16
Q

glucosmaine Sulfate Dose

A

500 mg TID

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17
Q

Chondrotin Sulfate DOse

A

400 mg TID

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18
Q

S/e of glucosamine

A

ellent safety record – GI, derm

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19
Q

Drug Interactions of Glucosamine

A

minimal

warfarin interference

blood glucose impact unlikely

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20
Q

Is MSM useful/needed?

A

NO

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21
Q

Is tumeric/curcurin worth a try?

A

YES

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22
Q

Dose of curcurin for arthritis

A

1-2g of curcurin

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23
Q

What is curcurin used for?

A

Arthritis

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24
Q

Is topical arnica good for arthritis?

A

NO

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25
Q

In regards to Omegas, which are essential? can it occur in the body?

A

Omega-3 –> EPA and DHA are essential

Alpha-linolenic acid can be converted by humans to EPA/DHA, but only minimally 5%, so ingesting a marine source is key to attaining any benefit here

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26
Q

Do we need anymore omega-6’s?

A

NO –> Have more omega-6’s than 3’s which promotes inflammation

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27
Q

How are omega-9’s made?

A

Made by the body

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28
Q

Omega-3’s are useful for….

A

Cell membranes

Hormones

Anti-inflamm

Less platlet adheison

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29
Q

Omega-6’s cause….

A

Energy production

Undesirable PG’s

Inflammation

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30
Q

In CV, what is primary and secondary prevention?

A

1 - Prevent first MI

2- Prevent a second MI

31
Q

Are omega-3’s useful for CV health? What are they more hopeful for?

A

Not likely

Modest or NO benefit from supps

More hope for 2o prevention than 1o

Likely less helpful if taking full MI medicine regimen

32
Q

What is the best source of omega-3’s?

A

Dietary fish

33
Q

When are omega-3’s clinically helpful?

A

High elevated TG’s

34
Q

S/e of Omega-3’s

A

Unlikley risk of bleeding

Fishy Taste (main one)

35
Q

Drug Inetractions of Omega-3’s

A

NOT an ISSUE

36
Q

What is the delivery system of omega-3’s?

A

Fish Oil

37
Q

What is the starting dose recommendation of omega-3’s?

A

Go natural first

500 mg a week

38
Q

Can fish in sask give omega-3’s?

A

NO

39
Q

primary prevention omega-3 Dose

A

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

40
Q

secondary omega-3 dose

A

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

41
Q

Fish oil to omega-3 ration

A

1000 mg - 300 mg EPA/DHA

42
Q

High TG Omega-3 Dose

A

2-4 grams of EPA/DHA

43
Q

In regards to flax seed, it must be….

A

Ground up to be absorbed

44
Q

Omega-3 useful for….

A

rhemaotoid arthritis

depression (maybe)

dry eyes
ADHD

45
Q

Should omega-3’s be used to lower cholesterol?

A

2-4 g EPA/DHA to lower TGs only –> Should be physician care  extra calories

46
Q

Metamucil Cholesterol lowering

A

10g/day (= 3 level tsp TID) ~5% in cholesterol

47
Q

Plant sterols/stanols to decrease cholesterol

A

2 g ~10%

48
Q

Soy to decrease cholesterol

A

25 g soy protein (~4 cups soy milk) / day ~5%

49
Q

What can ubiquinone be used for?

A

Heart Failure
HTN
Heart attack
Migraine

50
Q

What should be the mindset for insomnia?

A

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

51
Q

What is thr first thing to try for insomnia?

A

CBT

52
Q

Does turkey make you sleepy?

A

No - Tryptophan gets credit but just feeling full

53
Q

Chamomile

A
  • Just tea for insomnia
  • Relaxing
54
Q

Does lavender work?

A

No just TLC

55
Q

Is valerian good for insomnia?

A

NO

56
Q

Should diphendydramine be given to seniors?

A

NO

57
Q

Diphenhydramine Sleep?

A

Sedating

58
Q

What should we try to do in pharmacy in regards to OTC sleep agents?

A

Shift from diphenhydramine to melatonin

59
Q

What is melatonin?

A

a hormone (produced from tryptophan)

ties into our circadian rhythms (seasonal/daily)

increased levels at night –> levels drop as we age

60
Q

What can melatonin be used for?

A

Insomnia, depression, jet lag, CV, GERD, anti-oxidant, cancer

61
Q

Is melatonin useful?

A

Not overly - give it a try

62
Q

Does one develop dependance to melatonin?

A

No

63
Q

Melatonin dose?

A

1-2 mg HS x 2 weeks then 5 mg HS x 2 weeks reasses

64
Q

Melatonin s/e

A

mild GI
additive drowsiness to any other sedating agent

headache

65
Q

Should melatonin be used in a kid?

A

Safe but referral for sure

66
Q

What is flax seed used for?

A

CV (not likely)
Constipation (dietary fiber)
Menopause (maybe)

67
Q

Is eichana good for a cold?

A

NO

68
Q

Is St. John’s Wort effective? What for?

A

yes

mild-moderate depression not major depression

69
Q

St. John’s Wort compared to other anti-depressants

A

better than TCAs
good as (or better) than SSRIs

70
Q

S/e St. John’s Wort

A

GI, rash, photosens, sedation, anxiety,
dizziness, headache, dry mouth

71
Q

Drug Interactions of St. Johns Wort

A

Induces Cyp P450

Decreases Birth control pills

Decrease warfarin

Other anti-depressants (serotonin syndrome)

72
Q

What is serotonin syndrome?

A

when you have too much serotonin (a normal chemical) in your body

agitation or restlessness.
Insomnia.
Confusion.
Rapid heart rate

Ranges from Mild to Severe

Adding specific drugs to SSRIs

1 day after increasing dose

most cases 2 drugs

73
Q

Is carnberry useful for UTI?

A

NO

  • Used for prevention (1-2 months for effect)
  • Recurrent UTI’s
74
Q

Statins and Ubiquinone

A

vitamin-likepresent in all cellsantioxidantexpensive
some in meats / seafood

reduced by statins –> worth a try to supplement

PHAR 154 (6 decks)

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