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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
Q

St Johns Wart: use, actions

A

Use: mental health, clinical depression (Major)

Actions: inhibits reuptake of serotonin, norepi, dopamine

syndrome of central serotonin excess?

26
Q

St Johns Wart: concerns

A
  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
Q

St Johns Wart: pharmacokinetics

A

Stop 5 days prior and avoid post op

important in transplant/those requiring anticoagulation

28
Q

Valerian: use, actions

A

Use: sedative, treatment for insomnia

Actions: dose dependent sedation/hypnosis (GABA)

29
Q

Valerian: concerns

A
  1. Withdrawal (with abrupt d/c)
  2. cardiac complications
  3. attenuation of symptoms with benzos
  4. potentiate sedative effects of anesthetics
30
Q

Valerian: pharmacokinetics

A

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
Q

Coenzyme Q: details, use, actions

A

dietary supplement

antioxidant compound - structurally related to Vit K

Use: cancer

Actions: counteract apoptotic events (DNA fragmentation, cyctochrome C release, membrane potential depolarization)

32
Q

Coenzyme Q: concerns, when to stop

A

Concerns:

  1. warfarin –> decrease effects
  2. increase risk of bleeding

conflicting evidence

stop 2 weeks prior

33
Q

Glucosamine and Chondroitin: details, use

A

dietary supplement

Use: joint disorders, management of OA

34
Q

Glucosamine and Chondroitin: concerns

A
  1. worsen diabetes (animal)

2. warfarin

35
Q

Glucosamine and Chondroitin: pharmacokinetics, when to stop

A

90% absorbed (oral)
extensive first pass metabolism
peak plasma - 4 hours

stop 2 weeks prior

36
Q

Fish oil: details, use

A

dietary supplement

Use: reduce incidence of chronic dx involving inflammatory processes, CV dx, bowel dx, RA, neurodegenerative illnesses

37
Q

Fish oil: concerns, when to stop

A

Concerns

  1. inhibit platelet aggregation
  2. warfarin

stop 2 weeks prior

38
Q

prolonged sedative effects of anesthetic agents

A

kava - anxiolytic and sedative effects

valerian - potentiate sedative effects of anesthetics

39
Q

increased risk of bleeding

A

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
Q

coagulopathy

A

green tea - antiplatelet activity/antagonizes warfarin

saw palmetto - coagulopathy, platelet dysfunction

41
Q

CV instability

A 
ephedra - sympathomimetic effects
garlic - hypotension
ginseng - tachycardia, HTN
kava - CV effects
valerian - cardiac complications?
42
Q

hypoglycemia

A

echinacea

ginseng

43
Q

hepatotoxicity

A

echinacea

kava

44
Q

interactions with other meds

A

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
Q

Withdrawal symptoms if stopped abruptly

A

valerian - benzos for withdrawal symptoms

46
Q

stop at least 24 hours prior

A

ephedra

kava - potential enhancement of sedative (earlier if potential to compromise hepatic function)

47
Q

stop 7 days prior

A

garlic

green tea

48
Q

stop at least 2 weeks before surgery

A 
ginger
ginkgo
ginseng - 48 hrs - 2 wks
coenzyme Q 
glucosamine/chondroitin
fish oil
49
Q

If they can’t taper, advise them to take up until day of surgery.

A

valerian

NURA 671 Advanced Pharmacology (9 decks)

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