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NURA-671-01 Advanced Pharmacology > Lecture 1: Herbal Medications & Anesthesia JL > Flashcards

Lecture 1: Herbal Medications & Anesthesia JL Flashcards

1
Q

Complementary & Alternative Medicine

CAM Therapy

A

A broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs other than those intrinsic to the politically dominant health system of a particular society or culture.

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2
Q

CAM Therapies: Use
Adult = X%
Children = X%

A

Adult – 38.3%

Children – 11.8%

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3
Q 
CAM Therapies: Most Common
? - 17.7% 
? - 12.7% 
? - 9.4% 
? - 8.6% 
? - 8.3%
A 
Natural products - 17.7% 
Deep breathing – 12.7% 
Meditation – 9.4% 
Chiropractic -8.6% 
Massage -8.3%
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4
Q

CAM Therapies = __ billion/yr

Herbals = __ billion/yr

A

80

8-10

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5
Q

Herbal medicine

A
  • Plants, seeds, berries, roots, bark, and flowers***
  • Used long before recorded history
  • Traditional Chinese Medicine
  • Ayurveda
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6
Q

Bark of the Willow Tree ?
Papaver Somniferous ?
Penicillium ?

A

Bark of the Willow Tree - aspirin
Papaver Somniferous - opium
Penicillium – antibiotics

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7
Q

19th & 20th Centuries……

21st Century…….

A

19th & 20th Centuries……
• Scientists figured out the active compounds from plants
• Chemists manufactured them in the lab

21st Century…….
• Genomic era
• Automated assays enabling mass screening of compounds
• Gene manipulation
• Mixing or re-arranging of terminal groups

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8
Q

FDA Dietary Supplement Health and Education Act (1994)

A
  • Defines and regulates dietary supplements
  • A dietary supplement must contain one or more dietary ingredients including vitamins, minerals, herbs, amino acids, dietary substance, metabolite, constituent, extract, or combination of above.
  • Must be labeled as dietary supplement
  • Cannot be approved or authorized for investigation as new drug, antibiotic, or biologic unless labeled before investigation
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9
Q

Labeled as dietary supplement =

A

dont have to do anything

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10
Q 
Dietary Supplements:
• Manufacturers are not required to prove ?
• Not required to report ?
• Manufactured before 1994 = ? 
• After 1994 = ?
A
  • Manufacturers are not required to prove efficacy, safety, or quality of their products.
  • Not required to report any post-marketing adverse events to central agency.
  • Manufactured before 1994 = Grandfathered in
  • After 1994 = Reasonable evidence of their safety or reasonable expectations of their safety must be reviewed not approved.
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11
Q

FDA Good Manufacturing Practices (2007):

A
  • Tries to regulate production and manufacturing
  • NO real oversight
  • Variations in quality, harvesting, storage conditions, processing, purity, and efficacy of herbal
  • Herbal medications are not what they seem.
  • (2013) New York Times Article - 1/3 had outright substitutions - St. John’s Wort Product contained… ..- Rice - Alexandria senna (laxative)
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12
Q

National Institute of Health:

Office of Alternative Medicine (1988)

A

• Study and evaluation of complementary and alternative medicine practices to disseminate the results.

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13
Q

National Institute of Health:

National Center for Complementary & Alternative Medicine (1992)

A
  • Define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and the role in improving health and health care.
  • To produce scientific evidence to inform decision making by the public, health care professionals, and policy makers.
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14
Q

AANA/ASA Pre op Recommendations (for all) =

A

Discontinue 2 weeks before surgery (testing answer)….see slides for Hopkins clinical/practice recommendations!

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15
Q

Echinacea: Chemistry (just review)

A
  • Not a single compound

* Volatile oils, alkamides, polyalkenes, & caffeic acid derivatives

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16
Q

Echinacea: Pharmacology & Clinical Effects

A
  • Anti-inflammatory
  • Cancer
  • Immune modulation
  • URI Treatment
  • Recurrent URI preventions
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17
Q

Echinacea: Adverse Effects

A
  • Allergic reactions (1 case of anaphylaxis)
  • Caution in patients with liver dysfunction
  • Caution in antipsychotic and antidepressants
  • Poor wound healing
  • Decrease the effectiveness of exogenous steroids
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18
Q

Ephedra: Chemistry (just review)

A

• Alkaloids ephedrine, pseudoephedrine & methylephedrine

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19
Q

Ephedra: Pharmacology & Clinical Effects

A
  • Has both direct and indirect effects on α and β adrenergic receptors
  • CNS Stimulant
  • Weight loss supplement
  • Treatment of asthma
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20
Q

Ephedra: Adverse Effects

A
  • CV: palpitation, tachycardia, hypertension, & cardiomyopathy (chronic use)
  • Fatal arrhythmias & MI
  • Hemodynamic instability intraop
  • CNS: Seizure, stroke, psychosis
  • Other: Hepatitis
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21
Q

Ginseng: Chemistry (just review)

A
  • Ginsenosides (steroidal saponins)

* Like steroids

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22
Q

Ginseng: Pharmacology & Clinical Effects

A
  • Memory enhancement
  • Physical enhancement
  • Lower blood sugar
  • Alter coagulation pathway/inhibits platelet aggregation
  • Immunomodulation
  • Aphrodisiac
23
Q

Ginseng: Adverse Effects

A
  • Increased bleeding
  • Inhibit platelet (irreversible)
  • Hypoglycemia
  • Interacts adversely with monoamine oxidase inhibitors
24
Q

Ginger: Chemistry

A

• Shogaol, gingerol, and galanolactone (just review)

  • • Antagonizes serotonin (5HT3 receptors) = ?
  • • Inhibits prostaglandin = inhibit vasodilation, platelet aggregation and inflammation
  • • Inhibits thromboxane synthetase = inhibits clot formation
25
Q

Ginger: Pharmacology & Clinical Application

A
  • GI discomfort
  • Anti-inflammatory
  • Nausea/motion
  • Respiratory problems
  • Sore throat
  • Increased bleeding time
26
Q

Ginger: Adverse Effects

A
  • Increased bleeding
  • Hyperglycemia
  • Pregnancy – possibly safe?
  • Large doses may alter fetal sex hormones
27
Q

Garlic: Chemistry

A

Sulfur containing compounds – alliin or ajoene
• Potent antibiotic properties
• HMG-CoA reductase
Cysteine
• Alters arachidonic acid metabolism

28
Q

Garlic: Pharmacology & Clinical Application

A
  • Decrease blood pressure
  • Decrease atherosclerosis (Decrease lipids/cholesterol)
  • Inhibits platelet aggregation
  • Anti-tussive/expectorant
29
Q

Garlic :Adverse Effects

A
  • Bleeding – 1 case report of spontaneous epidural hematoma
  • Smell-bad breath
  • GI upset (N/V/D)
30
Q

Kava: Chemistry

A

• Kavalactones (May potentiate GABA) -> increased inhibition of NTs = higher affinity to receptors….sedation!

31
Q

Kava: Pharmacology & Clinical Applications

A
  • Anxiolytic
  • Sedative…… Addiction/tolerance
  • Antiepileptic
  • Neuroprotective
32
Q

Kava: Adverse Effects

A
  • Addiction/tolerance
  • Withdrawal
  • Inhibits cytochrome P450 and 2E1
  • Glutathione depletion – acetaminophen induced cytotoxicity
33
Q

Valerian: Chemistry

A

Sesquiterpines
• Modulation of GABA neurotransmitters
• Inhibit GABA breakdown or re-uptake = longer effect

34
Q

Valerian: Pharmacology & Clinical Applications

A
  • Insomnia
  • Sedation
  • Anxiety
35
Q

Valerian

• Adverse Effects

A
  • Stopping after long term use may result in withdrawal
  • Interactions with alcohol and sedatives
  • Hepatotoxicity with long term use
  • *Abuse
36
Q

Ginkgo biloba: Chemistry

A

Flavonids, terpenoids, & organic acids
• Free radical scavenger
• Modulation of neurotransmitters
• Inhibits platelet activating factor

37
Q

Ginkgo biloba: Pharmacology & Clinical Applications

A
  • Dementia – Alzheimer’s
  • Age related macular degeneration
  • Peripheral vascular disease
  • Vertigo
38
Q

Ginkgo biloba: Adverse reactions

A
  • Spontaneous intracranial bleeding
  • Postoperative bleeding risk
  • Nausea/vomiting
  • Stomach pain
  • Interactions with SSRI or MAOI’s
39
Q

St. John’s Wort (Hypericum perforatum): Chemistry (just review)

A

Hypericin and hyperforin

• Inhibits re-uptake of serotonin, norepinephrine, and dopamine

40
Q

St. John’s Wort (Hypericum perforatum): Pharmacology & Clinical Applications

A
  • Mild to moderate depression
  • Insomnia
  • OCD
  • ADHD
41
Q

St. John’s Wort (Hypericum perforatum): Adverse Reactions

A

Induces cytochrome P450 enzymes (3A4 & 2C9) = LIVER
• Alfenta, midazolam, lidocaine, CCB, serotonin receptor antagonists
• Warfarin and NSAIDS
• Cyclosporin (49% reduction)
Serotonin syndrome
Fatigue
Sedation

42
Q

Hoodia gordonii: Chemistry

A
  • Molecule P57 – neuroactive steroid
  • Has effect on hypothalamus (May look like glucose and trick brain into thinking your full)
  • Multiple companies have tried to bring to market without success
43
Q

Hoodia gordonii: Pharmacology & Clinical Application

A

Appetite suppressant

• Used in Africa for thousands of years

44
Q

Hoodia gordonii: Adverse Reactions

A
  • Nausea & vomiting
  • Dizziness
  • Increased blood pressure and heart rate
  • Altered skin sensations
  • Abuse potential
45
Q

Feverfew: Chemistry

A

Parthedolide
• Inhibits Nf-KB –> anti-inflammatory
• Inhibits prostaglandin synthetase

46
Q

Feverfew: Pharmacology & Clinical Application

A
  • Prevent migraines
  • Reducing headache symptoms (pain & sensitivity to light)
  • Rheumatoid arthritis
47
Q

Feverfew: Adverse Reactions

A
  • Nausea, vomiting, & diarrhea
  • Nervousness & dizziness
  • ***Pregnancy - potential abortifacient, d/t increase blood flow
  • ***Induce liver enzymes – altering drug metabolism
  • ***Increase risk of bleeding (Especially if already on platelet altering medications)
48
Q 
Summary:
Herbal Products 
FDA 
NIH 
AANA/ASA
A

Herbal Products
• Commonly used
• Always ask about use

FDA
• Dietary Supplement Health and Education Act (1994)
• Good Manufacturing Practices (2007)
• “Relative” efficacy & safety

NIH
• Study efficacy of products

AANA/ASA
• Both recommend holding medications for up to two weeks
• No specific guidelines…..

49
Q

Bleeding

A
  • Ginseng
  • Ginger
  • Garlic
  • Ginkgo
  • Feverfew
50
Q

Sedation (gaba)

A
  • Kava
  • Valerian
  • St. John’s Wort
51
Q

Sympathetic stimulation (dietary)

A
  • Ephedra

* Hoodia?

52
Q

Liver

A
  • Echinacea
  • St. John’s Wort
  • Feverfew
53
Q

Pregnancy

A
  • Feverfew

* Ginger?

NURA-671-01 Advanced Pharmacology (18 decks)

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