L5: Safety and Contraindications

Question 1

Describe Young Rule’s

Answer 1

A calculation dose used to work out doses for children

Question 2

How is Young’s Rule calculated ?

Answer 2

Child’s dose =
Age of child / (Age of child + 12) x Average adult dose.

eg 6 / (6 +12) = 1/3 of adult dose

Question 3

How is identification of medicinal plants done?

Answer 3

By organoleptic testing
* sight
* smell
* taste

Question 4

What substances can be considered contaminant ?

Answer 4

Chemicals (pesticides/fertiliser)
Insects/parasites
Other plants (mix-up)*

*mix up of SJW with Ragwort

Question 5

Why is it important for herbalists to know about pharmaceutical drugs?

Answer 5

1. To avoid misdiagnosis (drugs can alter symptom picture)
2. To avoid the potential for a negative drug/ herb interaction.

Question 6

What is the protocol for drug-checking?

Answer 6

• Obtain a list of all drugs taken, with doses
• Research effects (side effects) to determine if symptoms coincide
• Research contraindications
• Be aware of possible interactions
• Enquire about symptoms experienced before prescription drugs were taken

Question 7

What are some questions to consider around drugs taken by patient?

Answer 7

• What are the side-effects of the drugs?
• Do any of the symptoms they are presenting with match the side-effects?
• Is there danger to life in withdrawing?
• Is there danger to life in continuing to take them?
• What are the patient’s wishes?
• Would it be safe to withdraw?
• Which herbs might be used instead?

Question 8

What are considerations under Practitioner competance ?

Answer 8

• Knowing limits of competence and scope of practice (when to refer)
• Understanding Biomedical pathologies*
• Understanding plant constituents and potential toxicities
• Understanding safety concerns

*Western model

Question 9

Define the phrase: Limits of Competence

Answer 9

Practicing only what you are trained to practice

Question 10

Define polypharmacy

Answer 10

The use of several ingredients in the same mix

Question 11

What are the two ways that herbs can interact with drugs?

Answer 11

1. Additive : increasing the drug’s action
2. Antagonistic : decreasing the drug’s action

Question 12

What is pharmacokinetics?

Answer 12

The rate at which drugs are metabolised in the body

Question 13

Give examples of herbs that affect the pharmacokinetics of drugs?

Answer 13

Ginger, Tumeric and Garlic reduce pharmacokinetics

St John’s Wort and Ginseng increase pharmacokinetics

Question 14

Name some herbs which may have an additive effect with anti-coagulant drugs

Warfarin, asprin, clopidogrel

Answer 14

Ginkgo, Red Clover, Horse Chestnut

Question 15

Name some herbs which may have an additive effect with hypotensives

Betablockers, ACE inhibitors

Answer 15

Hawthorn*
Motherwort
Limeflower
Mistletoe

Adaptive (dual effect on blood pressure)

Question 16

Which herbs have an antagonistic effect with thyroxine*?

for hypothyroidism

Answer 16

Sedatives
Particulary Lemon balm

Question 17

Name some herbs which may have an additive effect with diuretics

Bendroflumethiazide, furosemide

Answer 17

Dandelion
Buchu
Bearberry

Question 18

What are some drugs that can be less effective if taken alongside St Johns Wort?

because it increases pharmacokinetics

Answer 18

• Anticoagulants
• Digoxin
• OCP
• Statins
• Cyclosporine
• Protease inhibitors

Question 19

What drugs can be affected by additive effects of St John’s Wort

Answer 19

SSRIs
Tricyclic antidepressants
MAOIs
Serotonin supplements

Question 20

What are some examples of herb contra-indications with pathologies?

Answer 20

Licorice - hypertension
Ginseng - hypertension
Cayenne - peptic ulcers
Kelp - hyperthyroidism

Question 21

List THREE safety considerations in herbal medicine.

Answer 21

Hygiene
Plant idenification
Contamination
Toxicity
Practitioner competence

Question 22

What is meant by a “Schedule 20” herb?

Answer 22

A UK legal category for a herb considered too strong to be freely available
Only to be used by qualified practitioners
To be kept locked up
Subject to legal weekly and single dose

Question 23

List THREE things that you might need to check when a patient is taking a pharmaceutical drug.

Answer 23

Whether the symptoms they are experiencing are not caused by the drug
Whether the diagnosis supports the drug
Understand the side-effects
Know the doses

Question 24

What is meant by “Pharmacokinetics”, and what effects may herbs have on this?

Answer 24

The pathway of a drug in the body including the rate it is metabolised by the liver
Herbs can reduce or increase this rate by effecting the liver’s ability to detoxify the drug.

Question 25

Why do we need to be cautious about prescribing St John’s Wort alongside pharmaceutical drugs?

Answer 25

SJW can increase pharmacokinetics of some drugs thereby reducing the effectiveness of the drug - eg digoxin or the OCP

Question 26

What is meant by Simpling in herbal medicine?

Answer 26

The art of identifiying one herb whose range of actions matches the precise picture of a patients symptoms

Question 27

Name some herbs which may have an additive effect with sedatives

Opioids, tranquillizers, sedatives

Answer 27

Valerian
Poppy
Passionflower
Jamaican dogwood