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Tim's Cards > II Pharm V > Flashcards

II Pharm V Flashcards

1
Q

T/F

70% of consumers DON’T report using herbal medicines to healthcare providers

A

True

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2
Q

What is important to determine if you are assessing a pts use of herbal remedies?

A

If using as Replacement or Supplement

instead of or adjunct to

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3
Q

What % of americans have used “natural products” in the last 12 months?

*dietary supplements other than vitamins and minerals

A

17.7%

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4
Q

The 5 most popular products used in the last 30 days (used for health reasons):

A

fish oil (37%)

glucosamine (20%)

echinacea (20%)

flaxseed oils/pills (16%)

ginseng (14%)

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5
Q

What % of americans have used a supplement in the last 30 days?

A

52%

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6
Q

4 most common supplements used in last 30 days:

as opposed to “product”

A

multivitamins/multiminerals (35%)

vitamins E and C (12%)

calcium (10%)

B vitamins (5%)

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7
Q

In the study of 130 participants (mean age 71.4 years) what was the prevalence of polypharmacy?

Polyherbacy?

% at risk for DDI?

***% at risk for drub/herbal supplement interaction?

A
  1. 3%
  2. 2%
  3. 2%

***31.5%

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8
Q

In the study a total of 90 different herbs and supplements were used by participants, the most common of which were:
Glucosamine/chondroitin, Garlic, Echinacea, Ginko, Herbal tea, cod liver oil, st. John’s wort, ginseng, saw palmetto

A

True

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9
Q

The most common reasons people take dietary supplements: Improve general ________

Help manage _______

Help prevent/manage _______

Improve _______

A

Wellness

Arthritis

Colds

Memory

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10
Q

About ___% of cancer pts take anti-oxidants, which counteract cancer fighting drugs

A

50%

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11
Q

What drug causes the MOST interactions with herbs?

A

Coumadin

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12
Q

Systematic lit review identified 1491 pairs of Herbal Drug Supplement - Drug interactions, what 5 herbs/supplements had the most interactions?

A

St. Johns wort

Magnesium

Calcium

Iron

Ginkgo

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13
Q

509 drugs studied for interaction w/ herbs/supplements (100 CNS, 90 CV, 75 systemic anti-infectives) - What were the top 5 Drugs w/ interactions?

A

Warfarin

Insulin

Aspirin

Digoxin (cardiac glycoside)

Ticlopidine (anti-platelet)

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14
Q

Vitamins, minerals, and dietary supplements have more interactions/contraindications with Drugs than Herbs

A

False

*herbs have more

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15
Q

Patients using medications with a _________ have a greater risk for adverse outcomes b/c of HDS-drug interactions

A

Narrow Therapeutic Index

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16
Q

Pts using what class of drugs must be especially careful with Herbal Dietary Supplement products?

A

Anticoagulants

Warfarin

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17
Q

HDS (herbal dietary supplements) are used by what % of cancer pts?

A

50%

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18
Q

Many herbs act as ______ or _______ medications

A

Anti-platelet

Anti-coagulant

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19
Q

The antiplatelet or anticoagulant effects of herbs may be ________ with aspirin, ibuprofen, warfarin, etc.

Pts tend to be ______ of these effects

A

Additive

Unaware

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20
Q

T/F

Many products contain multiple hers and pts often don’t know what is in them

A

True

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21
Q

There is limited evidence supporting bleeding effects of herbal meds, however ginkgo, garlic, ginseng, and ginger antagonize what?

A

Platelet activating factor

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22
Q

Discontinue all herbal meds ______ days before surgery.

A

14 days

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23
Q

For herbs and bleeding, if the “g” is followed by a vowel - what is the rule?

If the “g” is followed by a consonant?

A

g + vowel = bleeding

g + consonant = not a concern

  • ginkgo, ginger, garlic, ginseng - bleeding
  • green tea - no bleeding
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24
Q

4 reasons people take garlic:

A

Anti-lipidemic

Antimicrobial

Anti-asthmatic

Anti-inflammatory

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25
Q

Garlic is associated with what side effect?

A

Bleeding

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26
Q

What are 3 components in Garlic that are implicated in bleeding?

A

Ajoene

Allicin

Sulfur compounds

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27
Q

The Ajoene, Allicin, and Sulfur compounds found in garlic have what kind of effect?

What 2 chemical mediators do these components to Garlic inhibit?

A

Anti-platelet

Platelet activating factor, Adenosine

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28
Q

People take Ginkgo to protect brain function, improve memory/cognition, and ____________

A

Alzheimers/dementia caused peripheral vascular insufficiency

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29
Q

Ginkgo, in 3 randomized controlled studies, doesn’t do anything for the brain, but it does cause _______

A

Bleeding

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30
Q

What component in Ginkgo is implicated in bleeding?

This component is a potent antagonist of what?

A

Terpenoids

Platelet activating factor

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31
Q

Terpenoids acting as an antagonist to Platelet Activating Factor causing bleeding in Ginkgo has what effect?

There is a risk for spontaneous bleeding with Ginkgo and concurrent use of what 2 drugs?

A

Antiplatelet

Aspirin

Warfarin

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32
Q

People take Ginseng for the following reasons: Anti-cancer, slows aging, prevents heart attack, improves digestion, reduces HTN, strengthen immunity, and CNS stimulant

A

True

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33
Q

What components of Ginseng are implicated in bleeding effects?

The antiplatelet effect inhibits ______, platelet aggregation, ______ and ______

A

Gensenosides

PAF, thrombin, thromboplastin

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34
Q

Ginseng antagonizes the effect of what?

A

Warfarin

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35
Q

Ginseng Potentiates bleeding with what 4 drugs?

A

Aspirin

NSAIDS

warfarin

heparin

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36
Q

People take ginger to relieve motion sickness, morning sickness, decrease arthritis pain/inflammation, and relieve upset stomach.

A

True

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37
Q

3 components implicated in Ginger’s antiplatelet effect?

A

Pungent principles

Volatile Oils

Proteolytic enzymes

38
Q

Pungent principles, Volatile Oils, and Proteolytic enzymes of Ginger reduce platelet _____ and inhibits _______

A

thromboxane

platelet aggregation

39
Q

T/F

Literature on ginger is mixed and the most significant effects are if ginger is cooked

A

False

***raw

40
Q

3 effects of Feverfew

or why people take it

A

Anti-inflammatory (RA)

Preventive for Migraine Headache

Muscle soreness

41
Q

The net effect of Feverfew is that it inhibits _______

What are the 2 active chemicals in Feverfew?

A

Platelet Aggregation

Sesquiterpene lactone, parthenolide

42
Q

What dental consequence is there to taking Feverfew?

remember, it inhibits platelet aggregation

A

Irritation of Oral mucosa and tongue

43
Q

Feverfew also increases the risk for what?

A

photosensitivity

44
Q

Fish oils are used for skin disorders, cardioprotection, diabetes, headache, immune support, memory, PMS, ulcerative colitis, and many others….

A

True

45
Q

What is the main side effect of Fish Oil

has many mechanisms

A

Bleeding complications

46
Q

Taking more than how many grams of fish oil/day increases the chance of bleeding?

A

3 grams

47
Q

Very larg intakes of Fish Oil increases the chance of what?

A

hemmorrhagic stroke

48
Q

High doses of Fish Oil have been associated with _____ and _____

A

nosebleed

blood in urine

49
Q

What weed-like plant is the most widely studied herb with demonstrated efficacy to reduce mild to moderate depression?

A

St Johns Wort

50
Q

T/F

The exact mechanism of St Johns Wort is unclear

A

True

51
Q

St. Johns Wort may work by inhibiting the reuptake of what?

A

Serotonin (5-HT)

52
Q

What are the 2 major antidepressive components of St Johns Wort

(or what they’re thought to be)

What are 2 other biologically active constituents to this weed?

A

Hyperforin, Hypericin

Flavonoids, tannins

53
Q

What is the major biologically active constituent of St Johns Wort?

A

Hyperforin

54
Q

Hyperforin (in St Johns Wort) has been shown to inhibit the uptake of what 5 neurotransmitters?

A

5-HT

dopamine

norepinepherine

GABA

glutamate

55
Q

What is the main component in St Johns Wort implicated in bleeding?

Works how?

A

Hypericin

induces cytochrome P450 liver enzymes

56
Q

St Johns Wort is a classic ______, which means it breaks down drugs faster b/c it kickstarts certain enzyme pathways.

A

Inducer

57
Q

Even though the Hypericin in St Johns Wort is implicated in bleeding, it has what effect on Warfarin?

This does what to the INR?

A

Reduces anticoagulant effect (increases clotting)

Lowers INR

58
Q

A high INR means what?

Low INR?

A

No clotting

clotting

59
Q

T/F
When used in combo w/ other antidepressants, St Johns Wort can produce Serotonin Syndrome - and the pt looks like they’re having an MI or a seizure

A

True

60
Q

St John’s Wort is equal to Zoloft in the treatment of what?

A

Mild to Moderate depression

61
Q

St. Johns Wort has many DI’s - 5 major ones:

A

Oral contraception doesn’t work (some people)

Pt difficult to awaken from general aneshtesia

Photosensitivity of Tetracyclines increased

Glucocorticoid effects decreased

Anticoagulant efficacy decreased

62
Q

You should discontinue all herbs (esp St Johns Wort) how many days prior to surgery?

A

14

63
Q

Vitamin E is a fat soluble vitamin that most people use as what?

A

Antioxidant

64
Q

What are 3 antioxidant effects of Vitamin E?

A

Prevents oxidation of Vitamins A and C

Protects polyunsaturated FA’s in membranes

Protects RBC’s against hemolysis

65
Q

Vitamin E may alter the effect of what on clotting factors?

A

Vitamin K

66
Q

Vitamin K + Warfarin =

A

hypoprothrombinemia

*delays clotting further (increases INR)

**increases risk for spontaneous hemorrhage

67
Q

Echinacea is used for the common cold, cough, and bronchitis, and must be limited to 10 days use why?

A

Hepatotoxicity

*esp with other hepatotoxic meds

68
Q

Echinacea is definitely hepatotoxic, and probably decreases the effectiveness of what?

A

Corticosteroids

69
Q

Abrupt discontinuation of taking Feverfew will have what 4 consequences?

A

rebound headaches

joint pain

stiffness

anxiety

70
Q

Feverfew inhibits what?

Up to ___% of users develop _____

Causes irritation of what?

Contraindication?

A

platelet activity

15%, aphthous ulcers

Oral mucosa/tongue

Pregnancy

71
Q

Kava Kava acts like what class of drugs?

is on watchlists

A

BDZ

*anxiety, muscle relaxant, additive for other depressants

72
Q

Kava Kava is used for what?

A

anxiety, stress

minor tranquilizer, skeletal muscle relaxant

73
Q

Kava Kava potentiates what?

For this reason must use with caution if doing what in dentistry?

A

CNS effects of other depressants

sedation

74
Q

FDA is monitoring Kava Kava for what?

A

hepatotoxicity

*europe - cirrhosis, hepatitis, liver failure)

75
Q

3 contraindications for Kava Kava:

A

pregnancy

lactation

Parkinson’s

76
Q

Licorice is used for GI, antitussive, aphthous ulcers, and herpes, but may cause what?

May alter…

3 contraindications:

A

HTN

platelet aggregation

pregnancy, lactation, liver/renal impairment

77
Q

Valerian acts like what?

A

BDZ

*mild sedative

78
Q

Valerian ______ the effects of CNS ______

A

potentiates

depressants

(barbiturates, etc)

79
Q

A lot of these herbs have synergistic effects with aspirin and NSAIDS, what should be done?

A

alternative analgesics

80
Q

Monitor pts on _____ for herbal use and counsel appropriately

A

warfarin

81
Q

Cross reference all herbal and prescription meds prior to prescribing to ensure _____

A

compatibility

82
Q

The 7 Level 1 drugs (basic critical)

A

Endogenous catecholamine (epi 1:1000)

Histamine blocker (diphenhydramine, chloropheniramine)

Oxygen

Vasodilator (nitro)

Bronchodilator (albuterol)

anti-hypoglycemic

fibrinolytic (chewable aspirin)

83
Q

2 histamine blockers used as a Level 1 drug (basic critical)

A

diphenhydramine (Benadryl)

choropheniramine (Chlor-Trimeton)

84
Q

9 Level 2 rescue drugs:

A

Respiratory stimulant (aromatic ammonia)

Histamine blocker (diphenhydramine)

Analgesic (morphine sulfate)

Anticonvulsant (diazepam/Valium)

Anti-hypertensive (beta blockers)

Anti-hypoglycemic

Glucocorticoid (hydrocortisone)

Vasoconstrictor (methoxamine)

Anticholinergic (atropine)

85
Q

Level 3 rescue drugs:

A

Advanced cardiac life-support drugs

86
Q

6 level 3 drugs (advanced cardiac life-support)

A

Alkalinizing agent (sodium bicarbonate - not used much)

Analgesic (morphine sulfate)

Anti-dysrhythmic

Anti-cholinergic/anti-dysrhythmic

Calcium salt

Endogenous catecholamine

87
Q

An Anti-dysrhythmics used for advanced cardiac life-support (Level 3)

***the drug of shoice for suppression of ventricular tachycardia and ventricular fibrillation

A

lidocaine (Xylocaine)

88
Q

What is the Level 3 anti-cholinergic/anti-dysrhythmic?

A

atropine

89
Q

Two types of Antidotes (Level 4):

What are they?

A

Benzodiazepine antagonist, flumazenil

Opioid antagonist, naloxone (Narcan), naltrexone

90
Q

What level 2 drug is used to restore heart rate and arterial pressure when vagal stimulation causes sudden decrease in pulse rate and cardiac action (this overcomes severe bradycardia/syncope)

A

atropine

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