Herbals / OTC Flashcards
DHEA
What is it?
Why is it used?
Naturally occuring steroid hormone
Raw material to make estrogen, progesterone, testosteron and cortisol
Lysine
Use?
Counseling
For cold sores and is recommended for those with HSV
Give on empty stomach
Lutein
Use?
Eye health
St.John’s wort
Use
ADE
Interactions
Depression
GI, dizzy, tired, dry mouth
450 inducer - can decrease birth control, decrease INR and cyclosporine levels
Can increase risk of serotonin syndrome because STW is a serotonin agent
SAM-e (s-adenosyl-L-methionin)
Use?
Caution?
Depression/osteoarthritis
May increase serotonin levels
Lithium oraotate
Brand
Use
ADE
OTC drug interaction
Symmetry, Serenity
Used for addiction, insomnia, mood swings, stress
Cognitive, weight gain, hypothyroidism, polyuria
NSAID’s increase lithium levels
Glucosamine sulfate
Use
Allergies
Caution
Osteoarthritis
May contain shellfish
Caution with diabetic patients
Chondroitin
Use
Caution
Time to effects
Drug interaction
Osteoarthritis
Caution with diabetic patients
2-3 months
May increase INR
Kava Kava
Use
ADE
Interaction
Anxiety, stress, insomnia
Hepatotox
Can cause CNS depression when mixed with alcohol
Valerian
Use
Insomnia
Chamomile
Use
Caution
Anxiety and as a bedtime tea
Anaphylaxis
Saw palmetto
Use
MOA
BPH
Noncompetitivley inhibits 5AR
Ma Huang (ephedra)
Use
ADE
Increase energy and for weight loss
Agitation, tremor, seizures, increase HR/BP
Ginseng
Use
Drug Interaction
Fatigue
Improve athletic performance , cognitive function, and immune function
May decrease blood glucose
Can induce 2C9 causing a decrease in INR
Ginkgo
Use
ADE
Drug interaction
Dementia, AD, asthma
GI, dizzy , may increase chance of stroke
Can inhibit platelet aggregation = increased bleeding
Prevagen
Use
ADE
Improve memory
CV events, seizures
Garlic (allium sativum)
Use
Drug interaction
Pgx
Prevention of atherosclerosis
High BP - weak evidence
Immune system - weak evidence
HLD - no evidence
May increase INR
450 inducer
Echinacea
Use
MOA
Respiratory tract infection and general immune system stimulation
May increase phagocytosis and promote lymphocyte activity
Goldenseal
Use
Drug interaction
Antimicrobial
Anti-inflammatory
Laxative
May induce contraction so never for pregnancy
May decrease INR
Fever few use
Butter bur use
Both used for migraine prophalaxis (NEVER treatment)
SOY
Use
Decrease hot flashes and other postmenopausal symptoms
Yohimbe
Found where?
Use
Caution
Found in bark western to Africa
Impotence
Aphrodisiac
Body building
Heart attacks, seizures, GI problems, tachycardia
Evening primrose oil
Use
Drug Interaction
Eczema
Inflammation such as RA
Breast pain
May increase INR
Borage seed oil
Use
Caution
Skin conditions
Joint pain
Menopausal disorders
Liver damage and increased bleeding
Cranberry
Use
Counseling
Prevention of recurring UTI’s
Don’t drink large amounts because it can increase risk of kidney stones
Dong Quai
Use
ADE
Regulate menstrual cycles
Help with menopausal difficulties
Has anticoagulant activity
Photosensitivity , diarrhea
Black cohosh
Use
ADE
Time to effect
Caution
Menopausal symptoms
Liver failure
4-5 weeks
May induce labor/miscarriage
CoQ10
Use
MOA
Drug interaction
Migraine PPX, decrease complications of heart surgery, statin myalgia,
Produced by human body and is important for basic functioning of cells
May decrease INR
Milk thistle
Use
Cautio
Used for liver problems, and gall bladder
May lower blood sugar
Red Yeast Rice
Use
ADE
Lower cholesterol
Statin ADE - when fermented it becomes lovastatin
Honey
Use
Age restriction?
Wound healing - As a moisture barrier
Some antibacterial and antifungal activity
Don’t give to <1y.o
Cinnamon
Use
Used for T2DM
Kratom
Use
Has opioid-like effects - low doses are stimulant but high doses are a sedative
Prohibited in some states
ADEK
Uses
A - vision
D- bones
E- antioxidant
K = clotting factor
Vitamin B’s other names
B1- B12
B1 = Thiamine
B2 = riboflavin
B3 = niacin
B5 = Pantothenate
B6 = Pyridoxine
B7 = Biotin
B9 - Folate
B12- cyancobalamin
What is a B3 deficiency called? What are the symptoms?
Pellagra
Marked by 3 D’s - dementia, diarrhea, dermatitis
What labs are affected with B7?
Falsely Low tropnin and low TSH
Os- cal
Generic
Counseling
Calcium carbonate and Vitamin D3
Give with fod
What are the recommended daily calcium limits?
19-50 or 51-70M - 1G
>51 F or >70 M - 1.2G
List elemental iron amount of…
- Ferrous gluconate
- Sulfate
- Fumarate
How can iron absorption be enhanced?
- 12%
- 20%
- 33%
Give with vitamin C
When do you start iron supplements in babies?
What is the dose?
After 4 months and if they are breast-fed. If they are formula fed, they get enough iron.
4-6 months - 1mg/kg/d
6-12 months - 11mg/day
1-3 years - 7mg/day
Tylenol dosing for kids
15mg/kg Q4-6H
MAX 75mg/kg/day
Max OTC tylenol dosing for adults
Reg strength - 3250mg/d
Extra strength - 3g/d
Arthritis - 3.9g/day
How is N-acetylcysteine supplied?
Inhalation
Oral solution
Effervescent tablet
IV
What is the max dose of aspirin when on ticagrelor?
What is the max dose in general?
81mg/d
4g/day
Aspirin ADE
Contraindications
Drug interaction
Antidote for overdose
GI - PUD, bleed
CNS - tinnitus
Increase uric acid - so never give in gout patients
Kids with viral illness, gout, active PUD
Ibuprofen/naproxen can decrease aspirin effects so separate by >2 hours
Give activated charcoal, IV dextrose, and/or sodium bicarb
Where do NSAID’s work?
What is the BBW?
Afferent arteries
GI events (ulceration, bleeding). and CV events (edema and increase BP)
Diclofenac
Brand/ROA/indication
Cambia packets for acute migraine attach
Zorvolex tablets
Arthrotec tablets with misoprostel
Voltaren gel for pain
Flector patch BID
What are two long acting NSAID’s?
Meloxicam
Piroxicam (feldene)
OTC max dose vs RX of ibuprofen
1200mg/day
RX - 3200mg/day
Naproxen max dose OTC and RX
OTC - 600mg/day
RX- 1500mg/day
Ketorolac
Brand/ROA
Max duration
Toradol tablets
Acuvail eye drop
Sprix nasal spray
also IV/IM
5 days
Celecoxib
Allergy
Combo
Sulfa allergy
Consensi - amlodipine + celecoxib
Capsaicin
Brand
Indication
ROA
Zostrix
Muscle/joint pain, neuropathic pain, post-herpetic neuralgia, diabetic neuropathy
Topical
Patch 0.025-0.05% (max 4/day) - can be cut
Fexofenadine
Brand
Counseling
Allegra
Take on empty stomach and separate from orange/apple/grapefruit juice by 4 hours
Desloratadine
Brand
Clarinex
What are 3 OTC decongestants?
Pseudeoephedrine
Phenylephrine
Oxymetazoline (afrin)
