Herbs and toxicities

Question 1

Arnica indications

Answer 1

Bruising and swelling

Question 2

Topical Arnica AEs

Answer 2

Itching
Rash
Petechiae
Dry skin
High dose: vesicles/necrosis

Question 3

PO arnica AEs

Answer 3

Stomach irritation
Dry mouth
HA
Drowsiness
Dore tongue
Lethargy

Question 4

Arnica DDIs

Answer 4

Anticoagulants
Antiplatelets
Antihypertensives

Question 5

What are the CIs of arnica?

Answer 5

PO: pregnancy/lactation
Topical: broken/damaged skin
General: Allergy to asteraceae family

Question 6

Arnica cautions

Answer 6

NSAID
Anticoagulants
Oral corticosteroids
Homeopathic use
Bleeding/bruising disorder
Pregnancy/lactation
Severe liver/kidney disease
Malignancy
Infection
Immunodeficinecy
Metabolic syndrome

Question 7

Arnica active ingredients

Answer 7

Arnica Lactones

Question 8

Arnica MOA

Answer 8

Inhibit NF-kB - reduces synthesis of pro-inflammatory cytokines, COX2, and NO synthesis

Question 9

Butterbur indication

Answer 9

Migraine

Question 10

Butterbur AEs

Answer 10

GI (belching)
Dermal sx
Dizziness
HA
Drowsiness
Fatigue
N/V/D
Stomach pain
Flatulence
Allergic conjunctivitis
Eye/skin discoloration
Sneezing
Mild elevations in liver enz

Question 11

Butterbur DDIs

Answer 11

Use with other herb/supplement that contains pyrrolizidine alkaloids
Use with 3A4 inducers
Anticholinergics

Question 12

Butterbur CIs

Answer 12

Hypersensitivity to asteraceae family

Pregnant/Breasfeeding

Question 13

Butterbur active ingredient

Answer 13

Iso-petasin (inflammation)

Petasin (antispasmodic)

Question 14

Butterbur MOA

Answer 14

Anti-inflammatory - inhibits lipooxygenase pathway and leukotriene synthese
Antispasmodic - cause smooth muscle and vascular wall relaxation
Petasins have high affinity for cerebral blood vessels

Question 15

Fenugreek Indication

Answer 15

DM

Question 16

Fenugreek AEs

Answer 16

Diarrhea
Dyspepsia
Ab distention
Flatulence
May cause hypoglycemia
In healthy males: decrease serum K levels, dizziness, hunger, and increased urination

Question 17

Fenugreek DDIs

Answer 17

Impairs absorption of other PO meds

May enhance hypothrombinemic effect of anticoagulants

Question 18

Fenugreek DDIs

Answer 18

Pregnancy/lactation
Allergy/hypersensitivity to fabaceae family
Allergies to peanuts, chickpeas, and coriander d/t cross reactivity

Question 19

Fenugreek active ingredient

Answer 19

4-hydroxyisoleucine

Question 20

Fenugreek MOA

Answer 20

Stimulate secretion and improve glucose tolerance by direct stimulation of pancreatic beta cells

Question 21

Guggul indication

Answer 21

Hypercholesterolemia

Question 22

Guggul AEs

Answer 22

Rhabdomyolysis
Rash
Ab pain
Diarrhea
HA
Restlessness
Hiccups

Question 23

Guggul DDIs

Answer 23

Decreased bioavailability of propranolol/diltiazem
Anticoagulants
Antiplatelets

Question 24

Guggul CIs

Answer 24

Thyroid disorder
Pregnant patients (stimulates period)

Question 25

Guggul Active ingredient

Answer 25

Guggulsterones E and Z

Question 26

Guggul MOA

Answer 26

May decrease hepatic steroid production, ultimately increasing the catabolism of plasma LDL. Active components may increase hepatic binding sites for LDL thus increasing clearance

Question 27

Melatonin Indication

Answer 27

Managing sleep disorders in children with autism spectrum disorder

Question 28

Melatonin AEs

Answer 28

``` Morning drowsiness Increased enuresis Ha Dizziness Diarrhea Rash Hypothermia ```

Question 29

Melatonin DDIs

Answer 29

Inhibitors of 1A2 (TCAs, fluvoxamine, cimetidine) increase melatonin Pts who take BP/DM meds should be monitored since melatonin may decrease BP or serum glucose

Question 30

Melatonin MOA

Answer 30

Production stimulated by darkness | Biosynthesized from tryptophan which is converted to serotonin and ultimately to melatonin

Question 31

Pycnogenol indication

Answer 31

Chronic venous insufficiency

Question 32

Pycnogenol AEs

Answer 32

``` GI upset (take with food) Dizziness HA N/D Acne and uterine bleeding in women ```

Question 33

Pcynogenol DDIs

Answer 33

Immunosuppresants | Pts w/MS, SLE, RA or autoimmune disorders

Question 34

Pycnogenol CIs

Answer 34

Pregnant/lactating | Children <6 yo

Question 35

Pycnogenol precautions

Answer 35

CV disorders DM Bone/join disorders Confirmed/suspected h/o thrombosis

Question 36

Pycnogenol active ingredient

Answer 36

Procyanidins

Question 37

Pycnogenol MOA

Answer 37

Enhance vascular endothelial function Reduce capillary permeability Improve microcirculation

Question 38

Botanicals that are known to be toxic?

Answer 38

``` Comfrey Sassafras Coltsfoot Pennyroyal oil Germander Chaparral Bayberry Epheda Licorice Wormwood ```

Question 39

Comfrey and Coltsfoot toxic ingredients and toxicity

Answer 39

Pyrrolizidine alkaloids | Hepatotoxic/carcinogenic

Question 40

Sassafras toxic ingredient and toxicity

Answer 40

Safrole | Carcinogenic

Question 41

Pennyroyal toxic ingredient and toxicity

Answer 41

Pulegone | Hepatotoxicity

Question 42

Germander toxic ingredient and toxicity

Answer 42

Furanoditerpenes | Hepatotoxicity

Question 43

Chaparral toxic ingredient and toxicity

Answer 43

Nordihydro-guaiaretic acid | Hepatotoxicity/nephrotoxicity

Question 44

Bayberry toxic ingredient and toxicity

Answer 44

Tannins | Carcinogenic

Question 45

Ephedra toxic ingredient and toxicity

Answer 45

Ephedrine | CV

Question 46

Licorice toxic ingredient and toxicity

Answer 46

Glycyrrhizic acid HTN Na and water retention HF

Question 47

Wormwood toxic ingredient and toxicity

Answer 47

Thujone Convulsions Psychotic effects