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NURA 671 Advanced Pharmacology > Herbals > Flashcards

Herbals Flashcards

1
Q

Echinacea: uses, actions, pharmacokinetics

A

member of the daisy family

use: prophylaxis and treatment of viral, bacterial and fungal infections (specifically URI)
actions: immunostimulatory, immunosuppressive or anti inflammatory
pharmacokinetics: limited, stop as far in advance as possible, consider hepatic function and compromise to blood flow related to surgery type

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2
Q

Echinacea: concerns

A

immunosuppressive
-contraindicated in pts with systemic autoimmune disorders (TB, leukosis, MS, HIV, SLE, etc)

worsen metabolic control in diabetic patients - hypoglycemia

hepatotoxicity

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3
Q

Ephedra: details, uses, pharmacokinetics

A

ma huang

contains alkaloids - ephedrine, pseudoephedrine, norephedrine, norpseudoephedrine

banned in 2004, but available on internet

uses: promotes weight loss, increase energy, treats respiratory conditions

pharmacokinetics:

  • elimination half life: 5.2 hours
  • 70-80% excreted unchanged in urine
  • stop AT LEAST 24 hrs prior
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4
Q

Ephedra: concerns

A
  1. sympathomimetic effects - fatal cardiac and CNS complications
    - release of endogenous norepi
    - acts on adrenergic receptors
  2. cardiovascular function - hypersensitivity myocarditis
  3. hemodynamic instability
  4. MAOIs-interaction life threatening (increase circulating norepi —> hypertensive crisis)
  5. kidney stones
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5
Q

Garlic: details, use, actions

A

extensively researched

use: reduce BP, thrombus formation, serum lipid and cholesterol, may have anticancer properties

actions: sulfur containing compounds (allicin)
- promotes phagocytosis and stimulates T cell production —->preventing infection
- decreases LDL production and lowers cholesterol
- anti thrombotic properties

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6
Q

Garlic: concerns

A
  1. inhibits platelet aggregation
  2. interaction with warfarin (INR) tend to see increased INR
  3. decrease systemic and pulmonary vascular resistance (animals) –> hypotension
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7
Q

Garlic: pharmacokinetics

A

insufficient data

stop 7 days prior

risk for bleeding, anticoagulant, neuraxial techniques (consider risk/benefit analysis)

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8
Q

Ginger: details, use

A

Use: arthritis, sprains, muscular aches, pain, sore throat, antiemetic

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9
Q

Ginger: concerns

A

concerns:
1. inhibit arachidonic acid - induced human platelet serotonin release and aggregation
2. increased INR and epistaxis

potency similar to that of aspirin with antiplatelet activity

may warrant d/c at least 2 wks prior to sx

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10
Q

Gingko: details, use, actions

A

use: cognitive disorders, PVD, macular degeneration, vertigo, tinnitus, erectile dysfunction, altitude sickness, cognitive performance (alzheimers or dementia)
actions: terpenoids and flavonoids

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11
Q

Gingko: concerns

A
  1. alters vasoregulation
  2. modulates neurotransmitter and receptor activity
  3. inhibits platelet activating factor
  4. potential drug interactions with warfarin, MAOIs, amlodipine, prochlorperazine
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12
Q

Gingko: pharmacokinetics

A

E1/2 life: 3-10 hours

stop 2 wks prior

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13
Q

Ginseng: details, actions

A

actions: protects against stress and restores homeostasis

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14
Q

Ginseng: concerns

A
  1. hypoglycemia –> also consider NPO status for sx
  2. alters coag pathways - inhibit platelet aggregation, prolong thrombin time and APTT
  3. warfarin interference
  4. side effects: transient nervousness, excitation, tachycardia, insomnia, headache, HTN, epistaxis, water/electrolyte disturbances
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15
Q

Ginseng: pharmacokinetics

A

stop 48 hours to 2 weeks prior

platelet inhibition may be irreversible so maybe want to consider stopping 2 weeks prior

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16
Q

Green tea: use

A

use: improve brain function, fat loss, protection against CA, lowering risk of heart disease

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17
Q

Green tea: concerns

A
  1. antiplatelet activity (inhibit thromboxin a2?/prolong bleeding)
  2. antagonize warfarin (vitamin K)
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18
Q

Green tea: pharmacokinetics

A

half life: 1.9-4.6 hrs/2.2 -3.4 hrs

stop 7 days prior

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19
Q

Kava: actions

A

anxiolytic and sedative effects

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20
Q

Kava: concerns

A
  1. CNS - antiepileptic, neuroprotective, LA properties
  2. sedative hypnotic (potentiate GABA)
  3. increased barb sleep time
  4. abuse potential
  5. hepatotoxicity
  6. kava dermopathy
  7. inhibition of platelet aggregation
  8. CV effects
21
Q

Kava: pharmacokinetics

A

peak plasma: 1.8 hours
E1/2 life: 9 hours
renal and fecal elimination

d/c 24 hours prior (consider that it will effective sedatives)
earlier if potential to compromise hepatic function

22
Q

Saw Palmetto: details, use, actions

A

Use: BPH

Actions:

  1. inhibition of estrogen and androgen receptors
  2. binding of autonomic recptors
  3. blocking prolactin receptor signal transduction
  4. interference with fibroblast proliferation
  5. induction of apoptosis
  6. inhibition of alpha 1 adrenergic receptors
  7. anti inflammatory effects
23
Q

Saw Palmetto: concerns

A
  1. bleeding/coagulopathy
  2. inhibition of COX
  3. platelet dysfunction
24
Q

Saw Palmetto: pharmacokinetics

A

No clinical data

No specific recs to stop

25
St Johns Wart: use, actions
Use: mental health, clinical depression (Major) Actions: inhibits reuptake of serotonin, norepi, dopamine syndrome of central serotonin excess?
26
St Johns Wart: concerns
1. increase metabolism of many drugs --> indinavir sulfate (HIV med), ethinylestradiol (birth control), cyclosporine as well as alfentanil, midazolam, lidocaine, ca channel blockers, 5HT 2. decreased anticoagulant effect of warfarin, NSAIDs 3. changes digoxin pharmacokinetics
27
St Johns Wart: pharmacokinetics
Stop 5 days prior and avoid post op important in transplant/those requiring anticoagulation
28
Valerian: use, actions
Use: sedative, treatment for insomnia Actions: dose dependent sedation/hypnosis (GABA)
29
Valerian: concerns
1. Withdrawal (with abrupt d/c) 2. cardiac complications 3. attenuation of symptoms with benzos 4. potentiate sedative effects of anesthetics
30
Valerian: pharmacokinetics
not studied withdrawal - dose gradually decreased close supervision over several weeks if possible (if unable to do so, consider having patient take up until day of surgery) consider benzos for withdrawal symptoms
31
Coenzyme Q: details, use, actions
dietary supplement antioxidant compound - structurally related to Vit K Use: cancer Actions: counteract apoptotic events (DNA fragmentation, cyctochrome C release, membrane potential depolarization)
32
Coenzyme Q: concerns, when to stop
Concerns: 1. warfarin --> decrease effects 2. increase risk of bleeding **conflicting evidence** stop 2 weeks prior
33
Glucosamine and Chondroitin: details, use
dietary supplement Use: joint disorders, management of OA
34
Glucosamine and Chondroitin: concerns
1. worsen diabetes (animal) | 2. warfarin
35
Glucosamine and Chondroitin: pharmacokinetics, when to stop
90% absorbed (oral) extensive first pass metabolism peak plasma - 4 hours stop 2 weeks prior
36
Fish oil: details, use
dietary supplement Use: reduce incidence of chronic dx involving inflammatory processes, CV dx, bowel dx, RA, neurodegenerative illnesses
37
Fish oil: concerns, when to stop
Concerns 1. inhibit platelet aggregation 2. warfarin stop 2 weeks prior
38
prolonged sedative effects of anesthetic agents
kava - anxiolytic and sedative effects | valerian - potentiate sedative effects of anesthetics
39
increased risk of bleeding
garlic - inhibits platelet aggregation ginger - increased INR, potency similar to aspirin ginkgo - inhibits platelet activating factor ginseng - alters coag pathways, prolongs PT/PTT (platelet inhibition may be irreversible) green tea - antiplatelet Kava - inhibition of platelet aggregation saw palmetto - bleeding, inhibition of COX, platelet dysfunction coenzyme Q - increased risk of bleeding? (unclear) glucosamine/chondroitin - increased risk of bruising and bleeding (with warfarin) fish oil - inhibit platelet aggregation (warfarin int also)
40
coagulopathy
green tea - antiplatelet activity/antagonizes warfarin | saw palmetto - coagulopathy, platelet dysfunction
41
CV instability
``` ephedra - sympathomimetic effects garlic - hypotension ginseng - tachycardia, HTN kava - CV effects valerian - cardiac complications? ```
42
hypoglycemia
echinacea | ginseng
43
hepatotoxicity
echinacea | kava
44
interactions with other meds
ephedra - MAOIs garlic - warfarin - tend to see increase INR ginkgo - warfarin, MAOIs, amlodipine, prochlorperazine ginseng - warfarin interference green tea - antagonizes warfarin kava - sedatives, barbs, LA st johns wart - increase metabolism of many drugs --induction of CYP450 3A4 - indinavir, ethinylestradiol, cyclosporine, alfentanil, midazolam, lidocaine, CCB, 5HT --CYP450 2C9 - decreased anticoag effect of warfarin, NSAIDs --digoxin coenzyme Q - warfarin (decrease effects, structurally similar to vitamin K) (unclear effect) glucosamine/chondroitin - warfarin (increases effects) fish oil - warfarin (may see increased INR, especially with larger doses)
45
Withdrawal symptoms if stopped abruptly
valerian - benzos for withdrawal symptoms
46
stop at least 24 hours prior
ephedra | kava - potential enhancement of sedative (earlier if potential to compromise hepatic function)
47
stop 7 days prior
garlic | green tea
48
stop at least 2 weeks before surgery
``` ginger ginkgo ginseng - 48 hrs - 2 wks coenzyme Q glucosamine/chondroitin fish oil ```
49
If they can't taper, advise them to take up until day of surgery.
valerian

NURA 671 Advanced Pharmacology (9 decks)

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