Herbals Flashcards
Compare and contrast requirements for drugs vs. dietary supplements with respect to:
Product registration Pre-market approval Specific GMP Voluntary post-market AE reporting Mandatory AE reporting Safety related required labeling
Drugs require all of the above
Dietary supplements:
Voluntary post-market AE reporting
Some safety labeling required
Specific GMP = under development
Describe 3 major risks associated with herbal supplement use
Quality control -
proper identification + standardization of dose
Mix-up with Rx and OTC -
w/o demonstrated efficacy can compromise/delay/replace effective Tx
Toxicity -
Improper dose, allergies or herb-drug interactions
For Gingko, describe:
Major proposed benefit
Proposed physiological rationale
PVD
(Promote vasodilation, inc. blood flow, antagonism of platelet activating factor)
Dementia
(Inc. serum ACh and NE)
For Gingko, describe:
Active constituent (if known)
Flavonoids =
Quercetin
Ginkgolides
For Gingko, describe:
Major AEs
Generally safe
For Gingko, describe:
Major drug interactions
Antiplatelet properties =
Don’t combine with antiplatelet or anticoagulant medications!
Seizures =
If contamination in leaf formulation?
For St. John’s Wort describe:
Major proposed benefits
Proposed physiological rationale
Depression: mild to moderate =
Hypericin has MAO-A and MAO-B inhibitory properties while hyperforin inhibits biogenetic amine uptake (serotonin, NE, dopamine)
For St. John’s Wort, describe:
Active constituent (if known)
Hypericin
Hyperforin
For St. John’s Wort, describe:
Major AEs
Photosensitization (from hypericin)
For St. John’s Wort, describe
Major drug interactions
Drugs w/ similar MOAs (inhibition of NTs reuptake) =
Serotonin syndrome
Induce CYP450 and P-glycoproteins MDR transporter =
Subtherapeutic levels of drugs like OC’s, cyclosporine, digoxin, warfarin, theophylline, anticonvulsants
For Echinacea, describe:
Major proposed benefits
Proposed physiological rationale for these benefits
Tx and prevention of upper respiratory infections:
1) Immune modulation: enhance phagocytosis, inflammatory cells, cytokines
2) anti-inflammatory effects: inhibit COX and LOX
3) antibacterial, antifungal, antioxidant, antiviral effects
For echinacea, describe:
Active constituent (if known)
Several:
Flavonoids
Polysaccharides
Caffeoyl conjugates
For echinacea, describe:
Major AEs
Flu-like symptoms after IV dose
Oral formulations = unpleasant taste, GI upset, rash
For echinacea, describe:
Major drug interactions
Avoid in patients with immune deficiency disorders, autoimmune disorders
High alcohol content in some preparations (caution in children!)
For garlic, describe:
Major proposed benefits
Proposed physiological rationale
Lipid lowering effects =
Inhibit HMG-CoA reductase
Anti-platelet effects =
Inhibition of thromboxane synthesis
