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Pharmacology - Fall Semester 2017 > Herbals and Dietary Supplements > Flashcards

Herbals and Dietary Supplements Flashcards

1
Q

When is Echinacea Purpurea used?

A 
Common cold
Infections
Arthritis
Ulcers
Prevent bruising.

Noted to have immune properties.

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2
Q

What are the immune modulations of Echinacea Purpurea?

A 
Increased Interleukins
Increased tumor necrosis factor
Enhanced natural killer cell activity
Enhanced antibody dependent cellular toxicity
Cytokine activation
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3
Q

What are the anti-inflammatory effects of Echinacea Purpurea?

A

Inhibition of cyclooxyrgenase
Inhibits 5-lipoxygenase
Inhibits hyaluronidase

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4
Q

Echinacea Purpurea Drug Interactions

A

Hepatotoxic drugs: Anabolic Steroids and methotrexate

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5
Q

Echinacea Purpurea Side Effects

A

Flu symptoms
Hepatotoxicity
Avoid in autoimmune disorders and AIDS/Cancer
Some forms have large amounts of alcohol
Caution in patients taking immunosuppressants

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6
Q

Echinacea Purpurea Anesthesia Concerns

A

Hepatotoxicity
Interference with immune suppressive therapy in organ transplants
Discontinue at least 2-3 weeks prior

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7
Q

Pharmacologic effects of Garlic (Allium Sativum):
Cardiovascular Effects
Endocrine Effects
Cancer Effects

A

Antiplatelet, antioxidant and anti-thrombolytic

Cardiovascular: helpful in CAD r/t fibrinolytic actions; possible decrease in vascular plaque accumulation. May reduce HTN.

Endocrine: Hypoglycemic effects

Cancer effects: reduction of pro-carcinogens specific for colon, breast, lung and stomach cancer.

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8
Q

Adverse effects of Garlic (Allium Sativum)

A

Increased bleeding time
Hypotension
Interactions: Warfarin, ASA, IBU, due to anti platelet effects.

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9
Q

Garlic (Allium Sativum) Perioperative Concerns

A

Inhibition of platelet aggregation with is irreversible

Discontinue at least 7 days prior to surgery

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10
Q

What is Ginger (Zingiber officinale) used for?

A

To decrease nausea

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11
Q

What are the pharmacologic effects of Ginger (Zingiber official)

A

Inhibits prostaglandin and leukotriene biosynthesis

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12
Q

What are preoperative concerns of Ginger (Zingiber official)?

A 
Augments the action of warfarin
Inhibits platelet aggregation = increased bleeding time.
Discontinue 7-10 days before surgery
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13
Q

Pharmacologic effects of Gingo Biloba (maidenhair tree; fossil tree)

A

It is an antioxidant that decreases red blood cell aggregation and blood viscosity, increasing blood flow.

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14
Q

What are the Cardiovascular effects of Gingo Biloba?

A

Significant reduction in peripheral vascular disease

No difference in blood pressure control

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15
Q

What are the Metabolic effects of Gingo Biloba?

A

Reduced markers of oxidative stress in patients undergoing CABG surgery

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16
Q

What are the CNS effects of Gingo Biloba?

A

Not proven effective in dementia

Animal studies showed increased receptor densities in serotonin and alpha 2 adrenergic receptors and a decrease in beta receptors

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17
Q

Adverse Effects of Gingo Biloba

A

Headache, muscle weakness, restless, mucosal irritation

Bleeding complications with Warfarin

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18
Q

Preoperative Concerns of Gingo Biloba

A

Adverse interactions with ASA, anticoagulants, thrombolytics, NSAIDs, insulin and hypoglycemic agents

Inhibition of platelet activating factor which could result in prolonged bleeding. Also can affect blood sugar levels and metabolism of anesthetic agents. Also increases postoperative sedation.

Discontinue 36 hours prior to surgery

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19
Q

What is Ginseng (Panax Ginseng) used for?

A

To enhance energy, lower blood glucose and as an antioxidant

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20
Q

What are the pharmacological effects of Ginseng (Panax Ginseng)?

A

Thought to be an “adaptogen” used to restore homeostasis in the face of stressors

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21
Q

Adverse Effects of Ginseng (Panax Ginseng)

A

Hypertension, tachycardia, headache, anxiety

Also: vaginal bleeding, nostalgia, and insomnia

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22
Q

Ginseng (Panax Ginseng): Drug Interactions

A

ASA, NSAIDs, blood thinners, MAOI’s, diuretics

Psych pt’s taking lithium, neuroleptics and phenelzine

Caution when use with psychiatric, estrogenic or diabetes drugs, hypoglycemic medications

May increase effectiveness of warfarin

Caution in immunocompromised and autoimmune patients due to increase in natural killer cells

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23
Q

Ginseng Preoperative Concerns

A

May exacerbate hypertension and tachycardia during surgery when combined with adrenergic agonists

Hypoglycemia; inhibits platelet aggregation and coagulation cascade

Discontinue at least 7-10 days prior to surgery

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24
Q

Pharmacologic effects of St John’s Wort (Hypericum Perforatum)

A
  • Has antidepressant effects: works in same way as MAO-A and MAO-B inhibitors.
    • Inhibits reuptake of serotonin, NE and Dopa
    • Equivalent to SSRI in mild/moderate depression
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25
Q

Adverse Effects of St Johns Wort

A

GI distress, dry mouth, fatigue, dizziness, confusion and anxiety

Photosensitization, Hypomania, mania, and AUTONOMIC AROUSAL

“St John is AUTOmatically AROUSed.”

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26
Q

Drug Interactions of St Johns Wort

A

Induces CYP enzymes interfering with drug metabolism = Increased drug levels short-term, decreased drug levels long-term

  • Carbamazepine, lidocaine, midazolam, nifedipine, simvastatin, theophylline
  • Digoxin
  • Birth control drugs
  • Cyclosporine
  • HIV protease and reverse transcriptase inhibitors, warfarin, theophylline and anticonvulsants

Inhibits re-uptake of amine transmitters: antidepressants and stimulants should be avoided due to the risk of serotonin syndrome.

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27
Q

Perioperative Effects of St Johns Wort

A

Inhibits serotonin, NE and Dopa reuptake by neurons; increases drug metabolism by induction of CYP 450

EFFECT ABILITY TO INDUCE ANESTHESIA with LIDOCAINE or promote relaxation with MIDAZOLAM

PROLONGED EFFECT OF ANESTHETIC AGENT

Discontinue at least 5 days prior to surgery

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28
Q

Why is Saw Palmetto (Seronoa repens) taken?

A

Decrease anxiety and as an anti-inflammatory

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29
Q

What are the pharmacologic effects of Saw Palmetto (Seronoa repens)

A

Treatment of benign prostatic hyperplasia (BPH)

- Inhibits conversion of dihydrotestosterone by 5A reductase

30
Q

Adverse Effects of Saw Palmetto (Seronoa repens)

A

Abdominal pain, nausea, fatigue, headache, decreased libido, rhinitis

31
Q

Drug interactions with Saw Palmetto (Seronoa repens)

A

ASA, anticoagulants; anti-platelet drugs; NSAIDs; Androgens such as finasteride or flutamide

32
Q

Anesthesia concerns with Saw Palmetto (Seronoa repens)

A

Preoperative bleeding

Stop 2-3 weeks before surgery

33
Q

What is the pharmacology of Coenzyme Q10

A

Potent antioxidant found in mitochondria of many organs including the heart, kidney, liver, and skeletal muscle

Potent antioxidant and has a role in maintaining healthy muscles

34
Q

What is Co Q10 used for?

A

HTN, Heart Failure (improves EF), Ischemic heart disease, prevention of statin induced myopathy.

35
Q

What are side effects and drug interactions with Co Q10?

A

Interactions: May decrease effects of Warfarin

SE’s: Gastric upset, nausea, heartburn, anorexia

36
Q

What is the purpose of Glucosamine sulfate?

A

Act as substrate for production of glycosaminoglycans and proteoglycans (cartilage) in joints and also serves as a cartilage nutrient.

Thought to benefit patients with arthritis

37
Q

What are the adverse effects of Glucosamine sulfate?

A

No real adverse effects

38
Q

Drug interactions/anesthesia concerns with Glucosamine sulfate?

A

May increase INR in patient taking Warfarin
Interacts with diuretics and insulin
Recommend discontinuation 2-3 weeks before surgery

39
Q

What is Melatonin

A

A serotonin derivative important in regulating sleep/wake cycle.

40
Q

Pharmacologic Effects and clinical uses for Melatonin

A

Insomnia

Jet lag

41
Q

Adverse Effects of Melatoinin

A

Hypo- or Hypertension
Dizziness, fatigue headache and irritability
SHOULD NOT BE TAKEN BY PREGNANT WOMEN OR THOSE ATTEMPTING TO CONCEIVE.
SHOULD NOT BE USED WHILE BREAST FEEDING
Reduces prolactin release
May decrease sperm quality

42
Q

Drug Interactions with Melatonin

A

NSAIDs
Antidepressants
B Aderenoceptor agonists and antagonists
Scopalomine
May decrease prothrombin time and decrease effects of warfarin
May interact with nifedipine: increases heart rate and blood pressure

43
Q

What is Vitamin E used for?

A

as an anti-oxidant, anti-aging, prevention of atherosclerosis, stroke and prophylactically to prevent cancer in fibrocystic breast disease

44
Q

Drug Interactions with Vitamin E?

A

Interacts with Anticoagulants

45
Q

Preoperative concerns with Vitamin E?

A

May increase bleeding when used with anticoagulants
May effect thyroid funciton
May raise blood pressure in hypertensive patients
RECOMMEND STOPPING 2-3 WEEKS BEFORE SURGERY

46
Q

What is Valerian used for?

A

Mild sedative, mild anxiolytic

47
Q

What are drug interaction concerns with Valerian?

A

Increases activity at Gamma-aminobutyric acid receptors and inhibits P450 enzymes

48
Q

Anesthesia concerns for Valerian?

A

GABA mediated hypnotic effects may DECREASE MAC; benzodiazepine like withdrawal syndrome may occur. Tapper dose several weeks before surgery; treat withdrawal with benzodiazepines

Discontinue at least 1 week prior to surgery

49
Q

What is Milk Thistle (Silybum marianum) used for?

A

Treatment of liver cirrhosis, hepatitis and gallbladder disease

50
Q

Side Effects of Milk Thistle (Silybum marianum)?

A

Laxative effect on GI system

51
Q

Preoperative Concerns with Milk Thistle (Silybum marianum)?

A

Volume depletion. Should discontinue 2-3 weeks prior to surgery.

52
Q

What is Goldenseal (Hydrastis canadensis) used for?

A

Laxative; anti-inflammatory; postpartum hemorrhage

53
Q

How does Goldenseal (Hydrastis canadensis) function pharmacologically?

A

As an oxytocic

54
Q

Drug interactions with Goldenseal (Hydrastis canadensis)?

A

DO NOT USE WITH:
Anticoagulants: Decreases effectiveness
Antihypertensive: May increase hypotensive effects or interfere with effects.
Beta Blockers
Calcium channel blockers
Digoxin
CNS depressants: May increase sedative effects.

55
Q

Preoperative concerns with Goldenseal (Hydrastis canadensis)?

A 
Volume Depletion
Post-operative sedation
Increased hypertension
Increased edema
Increased electrolyte imbalance

Discontinue 2-3 weeks before surgery

56
Q

Uses for KAVA (Piper methysticum)?

A

Anxiolytic and muscle relaxant

57
Q

Pharmacological effect of KAVA (Piper methysticum)?

A

Acts on GABA in the amygdala; has direct effect on benzodiazepine receptors

58
Q

Drug interactions with KAVA (Piper methysticum)?

A

Benzo’s, barbituates, alcohol and levodopa

59
Q

Preoperative concerns with KAVA (Piper methysticum)?

A

GABA mediated hypnotic effects may decrease MAC; possible acute withdrawal. May cause serious hepatotoxicity.

Discontinue 24 hours before sugery

60
Q

Common uses for Feverfew (Tancetum parthenium)

A

Migrane headaches, anti-inflammatory and fever reduction

61
Q

Pharmacologic effects of Feverfew (Tancetum parthenium)

A

Inhibits serotonin release from platelet and platelet aggregation.

62
Q

Side effects of Feverfew (Tancetum parthenium)

A

Mouth ulcers, withdrawal, insomnia, myalgia, tension headaches and muscle stiffness.

63
Q

Drug interactions of Feverfew (Tancetum parthenium)

A

Interferes with the action of warfarin

64
Q

Preoperative concerns of Feverfew (Tancetum parthenium)

A

Prolonged bleeding time
Discontinue 7-10 days prior to surgery
Contraindicated in pregnancy

65
Q

Common uses of Fish Oils (Eicosapentaenoic Acid)

A

Prevent arteriosclerotic disease, hypertriglyceridemia and prevent MI

66
Q

What are drug interactions and preoperative concerns with Fish Oils?

A

Possible interaction with warfarin
Preoperative concern with bleeding.
Recommend discontinue 2-3 weeks prior to surgery.

67
Q

Popular uses for Ephedra?

A

Appetite suppressant and treatment of asthma

68
Q

Pharmacologic action of Ephedra?

A

Ephedrine like sympathetic stimulation of CNS

69
Q

Side effects of Ephedra?

A

Tachycarida, hypertension, arrhythmias, seizures, headache, anxiety. Possible MI or Stroke

70
Q

Drug interaction with Ephedra?

A

MAOI, glycosides, halothane, oxytocin, stimulants, bronchodilators

hALOThane!!

“i say “EPH” ALOT”

71
Q

Anesthesia concerns with Ephedra

A

Discontinue at least 24 hours prior to surgery and avoid use of MAOI.

Can cause hypertension and arrhythmias with anesthetics

Pharmacology - Fall Semester 2017 (2 decks)

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