Lecture 21: Herbal medicines/natural treatments Flashcards
1
Q
Dietary Supplement Heath Education Act (DSHEA)
A
passed in 1994; restricted FDA’s ability to control sale and manufacture of herbal products
2
Q
do dietary supplements require FDA approval to enter the market?
A
no
3
Q
what are the conditions for an herbal product labeling itself a supplement?
A
makes no claims to treat, prevent, or cure disease
4
Q
6 popular herbal supplements
A
- st johns wort
- ginkgo
- kava
- ephedrine
- omega 3
- turmeric/curcumin
5
Q
3 uses of st johns wort
A
anxiety, depression, insomnia
6
Q
use of ginkgo
A
dementia
7
Q
2 uses of kava
A
anxiolytic, sedative
8
Q
use of ephedrine
A
psychostimulant
9
Q
active ingredient of st johns wort
A
hypericin or pseudohypericin
10
Q
most SJW labels overstate the amount of hypericin by a factor of __
A
2
11
Q
SJW claims to __
A
promote emotional balance
12
Q
hours to peak blood level of hypericin
A
5h
13
Q
half life of hypericin
A
25h
14
Q
steady state of hypericin
A
4-6 days
15
Q
only __% of hypericin reaches the central circulation
A
15-20%
16
Q
5 MoAs of hypericum extract
A
- reduce reuptake 5HT, NE, DA
- bind to GABA receptors
- bind to benzo receptors
- bind to NMDA recetors
- exert antioxidant action
17
Q
SJW is comparable to ___ for ___ according to a 1996 study
A
TCAs; short term treatment of mild-moderate depression
18
Q
3 study conclusions about SJW
A
- superior to placebo in patients w major depression
- similarly effective as standard ADs
- fewer side effects
19
Q
results of analysis of 37 clinical SJW trials
A
minimal beneficial effects on major depression; may benefit people with minor depression
20
Q
two components of SJW that inhibit drug metabolizing enzymes
A
- hyperforin
2. quercitin
21
Q
hyperforin inhibits (2)
A
CYP-2D6
CYP-2C9
22
Q
quercitin inhibits __
A
CYP-1A2
23
Q
SJW reduces the effectiveness of __ by blocking its conversion to ___ by what enzyme?
A
codeine; morphine; CYP-2D6
24
Q
SJW increases blood levels of (3)
A
- caffeine
- TCAs
- antipsychotics
25
SJW increases activity of __
CYP-3A4
26
SJW reduces concentration of (5)
1. cardiac and anti inflammatory meds
2. oxycodone
3. birth control hormones
4. anticoagulants
5. protease inhibitors
27
5 side effects of SJW
1. sedation/lethargy
2. GI upset
3. photosensitivity
4. hypomania
5. serotonin syndrome
28
what does ginkgo come from?
ginkgo tree; ginkgo biloba
29
ginkgo extract for dementia
EGb-760
30
3 effects US manufacturers claim for ginkgo
1. mental sharpness
2. antioxidant protection
3. maintain healthy circulation
31
standard preparation of ginkgo
1. 24% ginkgo flavonoids
| 2. 6% terpenoids
32
beneficial effects of flavonoids and terpenoids
scavenge free radicals implicated in cell damage in Alzheimers
33
beneficial effects of ginkgolide B (a terpenoid)
inhibits platelet aggregation and slows blood clotting
34
2 adverse reactions to ginkgo
1. increased tendency to bleed and potentiate action of blood thinners
2. flavinoids inhibit CYP-1A2
35
time to peak plasma ginkgo
2-3h
36
half life ginkgo
5h
37
Egb-761 extract may act on processes involved in ___, resulting in (2)
homeostasis of inflammation and oxidative stress
| results in membrane protection and neurotransmission modulation
38
EEG studies show increased __ from ginkgo
increased alpha wave activity
39
according to DeKosky et al, daily doses of ginkgo had what effect on alzheimer's?
none; no reduced incidence
40
findings of yancheva et al rel to ginkgo, ACHE inhibit
all three treatments resulted in improved intellectual functioning and emotional states
41
conclusion of ginkgo studies
modestly improved cognitive functioning associated with cerebrovascular impairments, but does not prevent incidence of alzheimer's
42
improvement in cog functioning with ginkgo accounted by __
ability to reduce 'stickiness' of blood platelets
43
3 ginkgo side effects
1. mild GI upset
2. mild headaches
3. exacerbate bleeding problems (spontaneous intracranial hemorrhage)
44
ginkgo pregnancy effects
antiplatelet function may put fetus at risk for hemorrhage
45
most interesting agent in kava; where is it found?
kava lactones; fat soluble portions of kava root
46
lactone is a __
cyclic ester
47
kava inhibits what enzyme?
CYP450
48
the action of kava is similar to __
alcohol
49
kava pyrones may bind to (2)
1. GABA receptors
| 2. benzodiazepine binding site
50
kava lactones block ___, causing an anesthetic like effect
sodium channels
51
kava lactones block sodium channels, causing an ___
anesthetic like effect
52
in animals, kava acts like a __
anti convulsant
53
low dose kava effect
anxiolytic
54
high dose kava effects (3)
drowsiness, sedation, intoxication
55
5 kava side effects
1. drowsiness
2. nausea
3. muscle weakness
4. blurred vision
5. yellow skin
56
hepatoxicity
liver failure
57
what 3 NTs does ephedrine release?
epinephrine, NE, DA
58
ephedrine is pharmacologically similar to ___
amphetamine
59
ephedrine shorter or longer action than amphetamine?
shorter
60
2 benefits of ephedrine
1. reduces appetite
| 2. stimulates cardiac function
61
3 adverse effects of ephedrine
1. increase BP
2. increase HR
3. cardiac contraction (fatal arrhythmias)
62
what does mixing ephedrine with caffeine do?
increases cardiovascular toxicity
63
why did the FDA ban ephedrine?
155 deaths, heart attacks and strokes
64
pseudoephedrine
in decongestants
65
2 major omega 3s
1. eicosapentaenoic acid (EPA)
| 2. docosahexaenoic acid (DHA)
66
omega 3s are found in (5)
1. wild ocean fish
2. flax seeds
3. olive oil
4. walnuts
5. dark leafy veg
67
EPA and DHA are generally deficient in (3)
1. western diets
2. during pregnancy
3. normal brain maturation in children/adolescents
68
EPA/DHA deficiencies linked to (2)
1. mood disorders
| 2. chronic pain syndromes
69
negative effect of O3
GI symptoms
70
because O3s are involved in neural development, there is some efficacy in (3)
1. autism spectrum
2. reduction of allergy
3. reduction of developmental behaviors
71
children with ADHD consume __% less omega3 rich foods
50%
72
effects of O3 on adolescents with sub threshold psychosis
reduced rate of transition to psychotic disorder
73
why are O3s beneficial for inflammation and neuropathic pain?
omega 6 acids promote production of inflammatory mediators; O3 inhibits production
74
O3s specifically block ___
arachidonic acid; so do NSAIDs
75
what 2 things are produced by O3 that stop inflammatory mediators?
resolvins, protectins
76
ideal ratio of O3 to O6
1:1
77
most western diets have ratio of ___ O3:O6
1:8
78
up to __% of american adult population experiences chronic pain
28%
79
O3, esp __, has what 4 beneficial cognitive effects?
DHA
1. reduces incidence of dementia/cog decline
2. improves synaptic and NT function
3. enhances learning/memory
4. has neuroprotective properties
80
healthy daily intake of O3
500 mg/day
81
adding O3 to low dose aspirin reduces ___
platelet adhesion to diseased coronary arteries
82
low O3 index may be risk factor for ___
sudden cardiac death
83
3 beneficial effects of O3 in pregnancy
1. development of neural and retinal tissues
2. reduce susceptibility to allergies
3. prevents depressive symptoms
84
recommended O3 pregnancy dose
200mg/day
85
6 conditions turmeric and curcumin help with
1. inflammation
2. cardiovascular
3. cancer
4. digestive system
5. antibacterial/antifungal
6. alzheimers
7. memory
