Herbals Uses Flashcards
1
Q
Acai (Uses)
A
Weight loss + Anti Aging
2
Q
Acai (Efficacy)
A
insufficient evidence
3
Q
Acai (Adverse Effects)
A
Generally well tolerated
Changas disease (Parasitic protozoan) from contaminated raw fruit and juice
4
Q
Acai (Important Considerations)
A
Avoid if having MRI, may affect results
5
Q
Bitter orange (Uses)
A
Weight loss
6
Q
Bitter orange (Adverse Effects)
A
Prolong QT interval
Caution anyone with Hypertension or Heart Disease
7
Q
Bitter orange (Important Considerations)
A
Related to ephedrine, banned by many sports
8
Q
Black cohosh (Uses)
A
?able: may reduce hot flash freq compared to baseline but not placebo
9
Q
Black cohosh (Efficacy)
A
Effectiveness can depend on formulation
Not effective for hot flashes related to breast cancer treatment
10
Q
Black cohosh (Adverse Effects)
A
Similar to SSRI
Rash, GI, Tender Boobs, Headache, Weight Gain
11
Q
Black cohosh (Important Considerations)
A
Contraindicated pregnancy due to uterine contractions
MOA more like SSRIs than phytoestrogens
12
Q
Caffeine (Uses)
A
Used in weight loss
13
Q
Caffeine (Efficacy)
A
None really
can give mental acuity but there’s a sweet spot
14
Q
Caffeine (Adverse Effects)
A
increased HR,BP and diuretic effects
15
Q
Caffeine (Important Considerations)
A
High doses increase anxiety and decrease mental acuity
16
Q
Cranberry (Uses)
A
Urinary Tract infections
17
Q
Cranberry (Efficacy)
A
Treatment = not effective Prevention = maybe 1/3 reduce risk
18
Q
Cranberry (Adverse Effects)
A
Stomach upset and Diarrhea in high doses
19
Q
Cranberry MOA
A
prevents bacterial adhesion to urinary tract walls and not due to acidification of urine
20
Q
Echinacea (Uses)
A
Common Cold and Upper respiratory infections
21
Q
Echinacea (Efficacy)
A
may have limited benefit for prevention
does not shorten the length of cold
22
Q
Echinacea (Adverse Effects)
A
GI
Rash (Children)
Allergic reactions
23
Q
Echinacea (Important Considerations)
A
Avoid in patient with autoimmune disorders
Avoid in patients with ragweed allergy, history of asthma,atopy or allergic rhinitis.
Interacts with some CYP but not clinically significant
24
Q
Fish oil (Uses)
A
Hyperlipidemia (High doses are RX)
CVD (reduce BP)
HF (Dietary oil will reduce risk of CHF by 15%)
Mental development in infants (doesn’t do anything to prevent stuff such as dementia)
25
Fish oil (Efficacy)
Hyperlipidemia: Decreases
TG—high doses, Rx
Reduces BP modestly
(2-5 SBP/1-3 DBP)
DIETARY fish oil reduces
risk of CHF by 15%
Mental development
(infants)
26
Fish oil (Adverse Effects)
```
Fishy Burp
Bad Breath (Use EC)
Heartburn
Loose Stools
** Slightly increased LDL**
```
27
Fish oil (Important Considerations)
Take with meals, freeze caps, use enteric coated to
minimize AE
May inhibit platelet aggregation (>3g/day)
AHA recommends 2 servings/week, non-fried fish in
place of other proteins
28
Flaxseed (Uses)
Hot Flashes
29
Flaxseed (Efficacy)
Questionable, need 40Gram/Day and take 1-2 month potentially to work
30
Flaxseed (Adverse Effects)
Bloating
Diarrhea
Flatulence
Abdominal Pain
31
Flaxseed (Important Considerations)
1-2 months to see benefit, amount required is a lot (40Gram). Questionable efficacy
32
Garcinia (Uses)
Weight Loss
33
Garcinia (Efficacy)
Review of 11 studies found no sig effect on weight loss
34
Garcinia (Adverse Effects)
Mild GI
Liver toxicity requiring transplant
*No warfarin interactions*
35
Garcinia (Important Considerations)
Active ingredient is HCA (Hydroxycitric acid)
36
Garlic (Uses)
Not significant Cholesterol
| Hypertension
37
Garlic (Efficacy)
HTN: Limited (decreases
SBP 7-8%)
Lipids: None (recent
studies)
38
Garlic (Adverse Effects)
Heartburn
Flatulence
Nausea/Vomiting
Contact Dermatitis
39
Garlic (Important Considerations)
Must take daily for >2 months to see clinical benefit
odorless garlic won't work too well
40
Ginkgo (Uses)
Dementia
| Peripheral Arterial Disease (Blood clot risk)
41
Ginkgo (Efficacy)
May improve cognitive symptoms in patients with dementia
No benefit in slowing or preventing dementia
42
Ginkgo (Adverse Effects)
Allergic reactions (Poison oak, ivy and mango tin)
Bleeding
43
Ginkgo (Important Considerations)
Decreases Blood viscosity = bleeding risk
Need 2-3 weeks for initial effect
44
Ginseng (Uses)
general wellbeing
Immune Stimulant
Sexual Dysfunction
45
Ginseng (Efficacy)
Minimal; depends on
| indication
46
Ginseng (Adverse Effects)
Insomnia (Take in AM)
Headache
Estrogenic effects (Rare, high dose)
47
Ginseng (Important Considerations)
We focus on Panax Ginseng
```
Increased risk of bleeding (Antiplatelet agents = Anticoagulants)
Hypoglycemia w/ Diabetes medications
```
48
Glucosamine (Uses)
Osteoarthritis but not Rheumatoid Arthritis
49
Glucosamine (Efficacy)
Sulfate: Improves pain and functionality for osteoarthritis of the knee when used for >4 Weeks
No improvement in osteoarthritis of the hip
Dependent on formulation
50
Glucosamine (Adverse Effects)
Mild GI complains
51
Glucosamine (Important Considerations)
Warfarin: increased INR
Shellfish allergy....Naturally derived = bad but synthetic would most likely be Safe
52
Melatonin (Uses)
Jetlag and Insomnia
53
Melatonin (Efficacy)
Best evidence for improving insomnia in elderly
54
Melatonin (Adverse Effects)
if dose too high it can cause insomnia so lower dose should you tried
Dose: 2-3mg QHS, can go up to 10
55
Melatonin (Important Considerations)
Mechanism: It regulates circadian rhythm's and is a natural hormone secreted from pineal gland
Don't use natural, only synthetic derived
56
Red clover (Uses)
Hot flashes
57
Red clover (Efficacy)
mixed evidence shows no benefit over placebo
58
Red clover (Adverse Effects)
Nausea, Vomiting, Vag Spotting
59
Red clover (Important Considerations)
Avoid if taking tamoxifen
Avoid in women with estrogen-dependent cancers
May increase risk of bleeding with anti-platelet agents or anticoagulants
60
SAMe (Uses)
increases Serotonin, NE and Dopamine levels
61
SAMe (Efficacy)
Insufficient evidence
62
SAMe (Adverse Effects)
Headache
Dry mouth
Insomnia
Nausea,vomiting, diarrhea
63
SAMe (Important Considerations)
Concerns: Product quality and Cost
64
Saw palmetto (Uses)
BPH
65
Saw palmetto (Efficacy)
Likely ineffective for BPH
5a-reductase inhibitors = similar in relieving BPH symptoms
A1-blockers= Palmetto less effective for Urinary symptoms and reducing prostate volume
66
Saw palmetto (Adverse Effects)
```
Dizziness
Headache
Decreased Libido
GI Complaints
Bleeding
```
67
Saw palmetto (Important Considerations)
Prolonged Bleeding time
68
Soy (Uses)
Hot flashes
Takes up to 2 months
Always choose Protein (Food) over Soy supplement
** Protein can reduce LDL by 10% and BP **
69
Soy (Efficacy)
Soy PROTEIN may modestly decrease severity/freq of hot flashes
take up to 2 months to work
70
Soy (Adverse Effects)
Generally well tolerated
** Avoid Supplements**
71
Soy (Important Considerations)
PROTEIN >> Supplements
Takes 2 months to work
72
St. John's Wort (Uses)
Effective for mild-moderate depression
73
St. John's Wort (Efficacy)
effective, high placebo effect
74
St. John's Wort (Adverse Effects)
** Shit Load**
```
** Photosensitivity (5-10mg Hypericin)
Dry mouth
Fatigue
Restlessness
Vivid dreams
Dizziness
Insomnia
```
75
St. John's Wort (Important Considerations)
Potent inducer of CYP3A4, P-gp....will decrease effectiveness of drugs related to those
Midl inducer: 1A2, 2C9, 2C19
76
Valerian (Uses)
Insomnia
77
Valerian (Dosing)
May take a few days to weeks for full effect
Taper when discontinuing
78
Valerian (Adverse Effects)
Headache
Nervousness
Excitability
Hepatotoxicity (Rare)
79
Valerian (Important Considerations)
Not as fast as benzo, shouldn't be used with them because similar MOA
80
Reasons to re-evaluate herbal use? (Counseling points)
```
Plan on becoming pregnant
Breastfeeding
Need surgery/invasive procedures (Due to bleeding)
Have cancer or starting chemo
Change in medical condition
Starting or stoping medications
```
81
Drugs used for menopause?
Soy
Black cohosh
Red clover
Flaxseed
82
What makes Menopause herbals "work"
Phytoestrogens "plant estrogens" = what make them work
Isoflavones = most potent of these/ most studied
83
Is soy effective for women who have hot flashes related to breast cancer?
No
84
Who should avoid Soy supplements?
if taking tamoxifen
Women with estrogen-dependent cancers
** In general Soy protein is the better choice, answer is never Soy Supplements **
85
Black Cohosh MOA?
thought to be similar to SSRIs
86
Black Cohosh Contraindications
Pregnancy: increased risk of miscarriage
87
How often should you get LFTs on Black Cohosh?
every 6 mo - 1yr
88
Why is Caffeine given combo with Ephedrine?
Caffeine decreases breakdown of NE in synaptic cleft
Ephedrine increase release of NE
Combo gives sustained effect
89
Ephedra Adverse effects
```
Heart Attack
Arrhythmia
Stroke
Psychosis
Death
Seizures
```
90
Is ephedrine and derivates allowed to be used by athletes?
No, banned by every organization
91
Who should avoid immunostimulants?
Those with allergies, autoimmune disorders and those on immunosuppressive therapies
92
Fish Oil interactions?
Over 3g can inhibit platelet aggregation
93
Garlic Interactions
Antiplatelet agens and anticoagulants
induces P-gp efflux pump (decrease serum conc of P-GP substrates)
94
Soy Health Claim
Consuming 25 grams of soy protein per day reduces the risk of heart disease
95
St. John's Wort Dosing
May take 3-4 weeks to see maximal effects
Taper when discontinuing to avoid withdrawal effects
96
St. Johns Wort MOA
Inhibits reuptake of serotonin, NE and Dopamine
Gaba effects
97
Ginkgo Interactions
Antiplatelet agents or anticoagulants (Stop 2 week before surgery)
```
Induce CYP2C19 (moderate)
Medications that can lower seizure threshold
```
98
Ginkgo toxin from seeds can cause...
seizures
99
Valerian MOA
May increase GABA activity in CNS by inhibiting enzyme that metabolizes GABA
Benzo like effects
100
What is Glucosamine derived from?
Exoskeletons of shrimp, lobster, and crabs or made synthetically
101
Saw Palmetto MOA
Antiandrogenic
Antiproliferative
Anti-inflammatory
5-Alpha reductase activity
102
Cranberry Interactions
Warfarin: increases INR
| May inhibit CYP3A4
103
What does Fish oil contain, and differences between Plant based Fatty Acid and ones from fish.
Contains EPA and DHA...... plant based Fatty Acid are not as effective because the ALA gets converted to EPA/DHA in small amounts
