Lecture 7 - Herbals

Question 1

Morphine comes from…

Answer 1

Opium poppy

Question 2

Atropine comes from…

Answer 2

Belladonna plant

Question 3

Cocaine comes from…

Answer 3

Coca leaves

Question 4

Nicotine comes from….

Answer 4

Tobacco

Question 5

Penicillin comes from…

Answer 5

Mold

Question 6

Digoxin comes from….

Answer 6

Foxglove plant

Question 7

Where does salicylic acid come from?

Answer 7

Bark of willow tree

However it needs to be acetylated (to become ASPRIN) or else will cause serious GI irritation and bleeds

Question 8

Approximately ___% of Americans regularly take these unofficial and complex herbals

Answer 8

40

Question 9

Dietary supplement

Answer 9

Intended to supplement diet
Contains one or more dietary ingredients
Is inited to be taken by mouth
Is labeled on front panel as dietary supplement
The definition makes the substance FOOD not drugs
FDA is expressly excluded from approval process

Question 10

What is the purpoted use for garlic?

Answer 10

Hypolipidemic

Other:
Lower BP
Reduce platelet aggregation
Antimicrobial

Question 11

What is the purported use of ginkgo?

Answer 11

Improve memory

Free radical scavenger, inhibits platelet aggregation (increased blood flow)

Some(modest) improvement seen only in some clinical trials with Alzheimer’s pts
Large double-blind trial recently completed - no difference from placebo

Alternative: donepezil

Question 12

What is the purported use of st. Johns wort?

Answer 12

Antidepressant

Some components bind to GABA and 5-HT receptors

Results of 2 large clinical trials: no more effective than placebo in treating major depression of moderate severity
Adverse: photosensitivity

Drug interactions: sedation (with SSRIs), increased BP and HR (with MAOI)

Decreased levels of many other drugs, including HIV PIs; OCP; anti-leukemina drug imatinib mesylate (Gleevec)

Alternative: SSRIs, TCA, MAOIs

Question 13

Ginseng

Answer 13

Purported use: “adaptogen” and general cure-all
Proposed to increase steroid production and NO production

Actual data not compelling - adverse effects can include CNS excitation, abnormal menstruation, hypoglycemia

Interaction: interferes with digoxin assays

Question 14

Black Cohosh

Answer 14

Purported use: relief from sxs of menopause (hot flashes), premenstrual syndrome (PMS)
Originally thought to be estrogenic
Some small studies report reduction in sxs in menopause and in PMS

Larger double blind clinical trial showed no difference between Black Cohosh and placebo

Serious liver toxicity, through rare, has been reported. Should not be used if liver disease is present. D/c if sxs such as abdominal pain, dark urine, or jaundice appear

Alternative: estrogen therapy

Question 15

Glucosamine

Answer 15

Major use: improve pain and swelling in OA
Possibly effective: principle component of GAGs that form connective tissue matrix. Has anti-inflammatory properties
Need 2-4 weeks or longer to see effect, relief described as similar to ibuprofen
2006: in NEJM clinical study of glucosamine plus chondroitin sulfate, these substances did not provide any significant relief from OA pain across all participants
A smaller subgroup of study participants with moderate to severe pain showed significant relief with the combined supplements. Need to do a larger study of this subgroup to confirm

Question 16

Fish Oil

Answer 16

Omega 3 fatty acids or cod liver oil

Purported use: hyperlipidemia, high blood pressure, CV disease prevention, macular degeneration, attention deficit disorder (ADD), RA
Evidence supports decrease in triglycerides

Adverse: may increase low-density lipoprotein (bad cholesterol) levels

At high doses (above 3g per day) increased risk of bleeding - caution with blood thinners and NSAIDs

FDA has approved 3 specific formulations (Lovaza, Vascepa, Epanova)