Herbals Flashcards
What is the ASA recommendation say about when to stop herbal medications?
ASA recommendation: Stop all herbal medication TWO weeks before surgery.***
Facts about Echinacea
- –Used to prevent and treat bacterial,viral, and fungal infections.
- –Polysaccharide component enhances phagocytosis, results in non-specific immunity
- –AE- tachyphylaxis, potentiation of barbiturate toxicity, a potential for hepatotoxicity (>8weeks) and allergic reactions
- –Studies have demonstrated that it modulates cytokines and activates macrophages and natural killer cells.
- –Those on immunosuppressants should not take echinacea.
Facts about Ephedra
—Similar to Ephedrine, a commonly used vasopressor in the O.R.
—Plant extract also known as Ma Huang originally used for asthma and bronchitis.
—Currently used for increased energy, appetite suppression, CNS stimulant.
—Acts on alpha and beta receptors (like ephedrine)
Increased HR, BP, and relaxation of bronchial smooth muscle.
—Intraoperative hypotension should be treated with neosynephrine(alpha agonist) b/c there will be a decreased effect with ephedrine (catecholamine stores are depleted)
Facts about Garlic
- –Beneficial effects in infection, tumors, diabetes, hypertension, hyperlipidemia, and atherosclerosis
- –Medicinal properties due to sulfur-rich cysteine
- –AE-nausea, hypotension, increased risk for hemodynamic instability, impaired plt aggregation, increased bleeding times
- —A compound formed when garlic is crushed inhibits HMG-COA, an enzyme important in cholesterol synthesis
- –Lowers BP and decreases SVR
Facts about Ginko
- –Remember: The “Gs” (garlic, ginseng, Ginkgo) put pt at risk for increased bleeding.
- —The extract has components thought to protect vascular walls and nerve cells by acting as free radicals and by inhibiting plt activating factors
- –prevents plt activating factors from binding to receptor sites
- —used in Alzheimer’s dz and dementia
- –AE-increased bleeding and decreased effectiveness of barbiturates
Facts about Ginseng
- —Used in traditional Chinese medicine as a stimulant and diuretic
- —other effects include mood elevation which may be due to increased glucocorticoid synthesis
- —Biological activity is due to ginsenoside, a glycosylated steroid
- —AE- hypertension, insomnia, epistaxis, prolonged bleeding time, and increased hemodynamic instability
- –hypoglycemia- rat studies showed increased insulin receptors and enhanced insulin release
- –May interact with warfarin
Facts about Kava-kave
- —Derived from root of pepper plant and is used as an anxiolytic and sedative
- —Dose dependent effects on CNS such as sedation, hypnosis, anti-epileptic and neuroprotective properties
- –enhances GABA
- –may potentiate barbiturate and benzodiazepines leading to increased sedation and can also decrease MAC
- —interacts with levodopa to potentiate Parkinsonian symptoms
- –Long term use can lead to addiction and tolerance
- -Cutaneous eruptions may occur with kava use
Facts about St. John’s Wort
- –Used as an antidepressant and anxiolytic.
- –extract inhibits reuptake of serotonin, norepinephrine, dopamine, and MAO; acts as a tricyclic.
- —Increased cytochrome P450 activity***
- —May interfere with digoxin pharmacokinetics
- –avoid MAOIs, SSRIs, and ephedrine
- –AE-photosensitivity,GI upset, fatigue, dizziness, confusion, HA
Facts about Valerian Root
- –Flowered perennial
- –inhibits reuptake and degradation of GABA and is commonly used as a sleep aid
- —AE-tremor, HA, cardiac dysrhythmias when taken in high doses
- –Few reports of liver dysfunction with high doses
- –Tapered dosing b/c benzodiazepine type withdrawal symptoms may present
Summary (the quick down and dirty of herbs)
Echinacea (helps colds): Ephedra (in diet pills): The Gs: Kava and Valerian: St John’s:
Summary (the quick down and dirty of herbs)
Echinacea (helps colds): hepatotox, interferes w/immunosuppresents
Ephedra (in diet pills): catecholamine release (increased HR, BP)
The Gs: increased bleeding times (most important side effect)
Kava and Valerian: sedation via GABA potentiation; potentiates anesthesia. (like benzos, therefore withdrawal)
St John’s: happy pill via NT reuptake inhibition. Can decrease dig, induces CP450.****
Facts about Vitamins
- –Vitamin supplements are considered harmless by most people and may fail to disclose during pre-op evaluation
- –Consumption of large amounts over a long period of time of the fat soluble vitamins*, A,D,E and K can produce chronic toxicity
- –Of the water soluble vitamins niacin (feel flushed when you take this), pyridoxine and ascorbate (vitamin c) are associated with toxicity*
Facts about Vitamin A
Needed for formation of visual pigments and for the mucus secreting cells of columnar epithelium
Symptoms of hypervitaminosis A include blurred vision, appetite loss, abnormal skin pigmentation, loss of hair, dry skin, pruritus, long-bone pain, and an increased incidence of bone fractures.
Facts about Vitamin D
Two major sources, Vit. D2 ergocalciferol and D3 calciferol
Once activated by UV exposure and enzymatic processes the major role is to elevate plasma calcium and phosphorus to enable bone mineralization
Facts about Vitamin E
Various forms but alpha-tocopherol is the most active forms
It protects other foods from being oxidized and thus is called an anti-oxidant
People ingesting large amounts of vitamin E who are taking anticoagulants should be observed closely for bleeding tendencies, but those not taking anticoagulants may rarely have coagulation difficulties, except for neonates, who are more sensitive to the effects of vitamin E.
Facts about Vitamin K
Not stored in the body (only fat soluble vitamin in contrast to the others) (bi-product from bacterial degradation)
Needed for coagulation factors II, VII, IX and X
Megadoses of menadione (vitamin K3) can be toxic and produce hemolytic anemia, kernicterus, and hemoglobinuria in premature infants and renal tubular degeneration, liver damage, hypoprothrombinemia, and petechial hemorrhages in adults.
Facts about Vitamin B2 (niacin)
Part of the energy metabolic pathways including the oxidation of ethanol
Doses of over 100mg can cause a niacin flush caused by histamine release, rarely causing hypotension. Resolves in about one hour
Facts about Vitamin B6 (pyridoxine)
Required for utilization of amino acids for energy and for the synthesis of non-essential amino acids
Deficits can be caused by ingestion of antagonist (isoniazid used to treat TB)
Vitamin B6 in high doses, >5 grams/d over more than several weeks, will cause nerve damage.
Facts about Vitamin C (ascorbate)
Necessary for the formation of collagen, presence of Vit. C in the intestine increases the absorption of iron
Large doses of vitamin C can produce attacks of gout and nephrolithiasis. Intrarenal deposition of oxalate crystals has been reported to cause renal failure in patients with chronic high-dose ascorbate ingestion
Which vitamins are water soluble?
Vitamin B3 (niacin) Vitamin B6 (pyridoxine) Vitamin C (ascorbate)
Which vitamins are fat soluble?
A,D,E and K
