L5: Safety and Contraindications Flashcards
Describe Young Rule’s
A calculation dose used to work out doses for children
How is Young’s Rule calculated ?
Child’s dose =
Age of child / (Age of child + 12) x Average adult dose.
eg 6 / (6 +12) = 1/3 of adult dose
How is identification of medicinal plants done?
By organoleptic testing
* sight
* smell
* taste
What substances can be considered contaminant ?
Chemicals (pesticides/fertiliser)
Insects/parasites
Other plants (mix-up)*
*mix up of SJW with Ragwort
Why is it important for herbalists to know about pharmaceutical drugs?
- To avoid misdiagnosis (drugs can alter symptom picture)
- To avoid the potential for a negative drug/ herb interaction.
What is the protocol for drug-checking?
- 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
What are some questions to consider around drugs taken by patient?
- 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?
What are considerations under Practitioner competance ?
- 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
Define the phrase: Limits of Competence
Practicing only what you are trained to practice
Define polypharmacy
The use of several ingredients in the same mix
What are the two ways that herbs can interact with drugs?
- Additive : increasing the drug’s action
- Antagonistic : decreasing the drug’s action
What is pharmacokinetics?
The rate at which drugs are metabolised in the body
Give examples of herbs that affect the pharmacokinetics of drugs?
Ginger, Tumeric and Garlic reduce pharmacokinetics
St John’s Wort and Ginseng increase pharmacokinetics
Name some herbs which may have an additive effect with anti-coagulant drugs
Warfarin, asprin, clopidogrel
Ginkgo, Red Clover, Horse Chestnut
Name some herbs which may have an additive effect with hypotensives
Betablockers, ACE inhibitors
Hawthorn*
Motherwort
Limeflower
Mistletoe
Adaptive (dual effect on blood pressure)
Which herbs have an antagonistic effect with thyroxine*?
for hypothyroidism
Sedatives
Particulary Lemon balm
Name some herbs which may have an additive effect with diuretics
Bendroflumethiazide, furosemide
Dandelion
Buchu
Bearberry
What are some drugs that can be less effective if taken alongside St Johns Wort?
because it increases pharmacokinetics
- Anticoagulants
- Digoxin
- OCP
- Statins
- Cyclosporine
- Protease inhibitors
What drugs can be affected by additive effects of St John’s Wort
SSRIs
Tricyclic antidepressants
MAOIs
Serotonin supplements
What are some examples of herb contra-indications with pathologies?
Licorice - hypertension
Ginseng - hypertension
Cayenne - peptic ulcers
Kelp - hyperthyroidism
List THREE safety considerations in herbal medicine.
Hygiene
Plant idenification
Contamination
Toxicity
Practitioner competence
What is meant by a “Schedule 20” herb?
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
List THREE things that you might need to check when a patient is taking a pharmaceutical drug.
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
What is meant by “Pharmacokinetics”, and what effects may herbs have on this?
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 affecting the liver’s ability to detoxify the drug.
Why do we need to be cautious about prescribing St John’s Wort alongside pharmaceutical drugs?
SJW can increase pharmacokinetics of some drugs thereby reducing the effectiveness of the drug - eg digoxin or the OCP
What is meant by Simpling in herbal medicine?
The art of identifiying one herb whose range of actions matches the precise picture of a patients symptoms
Name some herbs which may have an additive effect with sedatives
Opioids, tranquillizers, sedatives
Valerian
Poppy
Passionflower
Jamaican dogwood
