Herbals Flashcards
What the dietary supplement and health education act does
Considers herbals food not a med. no proof of safety/quality control, no regulations. Can’t promise a cure but can claim effect
Herbals: consumers dont know what 5 things
If there are active ingredients, if ingredients are bioavailable, if dose is right, if each bottle has same components, if pill has contaminants
Example of quality control where herb potency and amount varied widely between manufacturers
Ginseng
Classes 1 and 2 of herbals
1- safe when used appropriately. 2- restrictions a- external only, b- not use if pregnant c- not used while nursing
Herbal classes 3 and 4
3- use only under expert supervision, 4- insufficient data available
Profile of herbal user: sex, age, race, education, procedures
Female, 40-60, white, college edu, neurosurgical/obstetrical/gyn procedures
How herbals affect periop period 3
Direct intrinsic effects (pts physiology), pharmacodynamics (alt action of other drugs), pharmacokinetics (alter abs/met/dist of other drugs)
Specific anesthesia concerns w herbals 6
Prolonged anesthetic effects, inc bleed risk, hypo/hypertension, hypoglycemia, hepatotoxic, interact w other meds
When to D/c herbals
14 days before
Kava kava effect
CNS depressant, sedative, anxiolytic. Prolongs anesthesia effect
Kava kava concerns
Inc sedative fx anesthesia, addiction/withdrawal, SE H/A/dizzy, long term use can discolor skin, hepatotoxic
Valerian does what
Sedative, mild anxiolytic, sleep aid
Valerian concern w anesthesia
Potentiated effects. Avoid w barbs, opioids, benzos
Valerian: SE, syndrome
HA, excitability, ataxia, gi discomfort. Withdrawal: delirium, cardiac abn
St. John’s wart- what it is
Prozac alternative, tx depression
St. John’s wart: SE, does what to liver
Allergic, HA, dizzy, restless, tired, photosensitive, additive w anesthesia. Induces cytochrome p450- inc metabolism reduces effectiveness of drugs
St. John’s wart: caution w which drugs
MAOI (central serotonin excess). Indonavir, cyclosporine, dig, CCB, BB, phenobarb, phenytoin, BC pills, benzos, Coumadin, alfentanil, lidocaine, steroids, NSAIDS
3 herbals that potentiate anesthesia
Valerian, kava, St. John’s wart
Herbals that inc bleeding risk
Ginkgo, garlic, ginseng, saw palmetto
Ginkgo: use, SE
Impairs cognition and circulation. HA, dizzy, GI, dermal
Gingko: how it increases bleed risk
Inhibits plt aggregation and plt activating factor. Enhances coag effect of Coumadin, NSAIDs, and ASA
Garlic: indication, how it inc bleed risk
Anticancer, tx htn and cholesterol. Inhibits plt aggregation and increases fibrinolysis, may be irreversible in high doses
Garlic: enhances __ effect and does what to VS
Warfarin, lowers BP
Ginseng: indication, what concerns us
Mood/energy enhances. Lowers bg and inhibits plt aggreg
Ginseng: SE
Nervousness, excitation, tachycardia, cant concentrate, insomnia, HA, htn, epistaxis, allergies, lyte disturbances, addiction
Ginseng: caution in who, avoid what, may decrease effectiveness of what
Caution if coagulopathic/on anticoags. Avoid ASA, NSAIDs. Dec effectiveness of warfarin
Saw palmetto: use, what concerns us
BPH. Inhibits COX and plt dysfunction
Ephedra: what it does
Direct and indirect sympathomimetic, CNS stimulant
Ephedra concerns
Htn, tachycardia, arrhythmias, vasospasm. MI, stroke, agit, insomnia. Tachyphylaxis of catecholamine stores. Life threat w MAOI
Echinacea: use, concerns
Immune system stim. Decreases effectiveness of immunosuppressive meds. Worsens bg control in DM- hypoglycemia. Hepatotoxic
Melatonin: how it affects us, may interact w what
Crosses BBB and inc sedative fx or hypnotics and benzos. Interacts w anticoags, immunosuppressants, dm meds, bc pills
Which herbals to D.C. And when
If coag, cns effects, or bg alt 2 weeks prior
