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S2 Pharmacology > Nutritional and Herbal Supplements > Flashcards

Nutritional and Herbal Supplements Flashcards

1
Q

why do I need to be aware of studies on supplements?

A 
many performed outside US
-flaws (not RDBPCT)
-limitations (small)
-unable to interpret results
-different population
not regulated by any governing body
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2
Q

St. John’s Wort

-mechanism

A

inhibits metabolism and reuptake of serotonin, dopamine, and epinephrine

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3
Q

St. John’s Wort

  • purpose
  • study results
A

depression
no more effective than placebo for mild to moderate depression (similar to Rx agents) with fewer side effects
not effective for major depression

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4
Q

St. John’s Wort

  • recommendations
  • side effects
A

more rigorous studies needed - they always say this
associated with allergic reactions and photosensitization
relatively inexpensive
patient should not self-treat depression

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5
Q

Echinacea

  • MOA
  • function
A

enhances phagocytosis, stimulates certain cytokines

anti-inflammatory actions

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6
Q

Echinacea

-study results

A

may be beneficial for early treatment of URTI (upper resp tract infection), though larger, properly designed trials show no beneefit over placebo

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7
Q

Echinacea recommendations

  • may be effective for…
  • side effects
  • long-term use?
A

may be effective in reducing a cold’s severity and duration if taken early
probably safe for short term use
allergies and GI pain are commonly reported
long-term use should possibly be avoid due to immunosuppression, though evidence for this is scarce

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8
Q

Ginkgo Biloba

-MOA

A

free radical scavengers (antioxidant)
inhibits platelet activating factor
increases GABA

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9
Q

Ginkgo Biloba

-study results

A

potentially increases memory and attention

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10
Q

Ginkgo Biloba

-side effects

A

drug interactions max exist

may increase risk of bleeding

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11
Q

Saw Palmetto

-MOA

A

inhibit 5-alpha-reductase
blocks testosterone and dihydrotestosterone uptake by the prostate
anti-inflammatory activity

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12
Q

Saw Palmetto

-study results

A

improved urologic symptoms and flow when compared to finasteride with fewer side effects

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13
Q

Saw Palmetto

  • recommendations
  • safety
  • drug interactions
A

may decrease BPH symptoms
probably safe
limited (known) drug interactions

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14
Q

garlic

-MOA

A

potentially inhibits cholesterol synthesis

also has effects on plasma protein and cell membrane remodeling

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15
Q

garlic

-study results

A

mixed results on lipid-lowering ability
potentially has modest ability to lower LDL
possible antihypertensive effect
antiplatelet, antithrombotic and fibrinolytic activity seen

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16
Q

garlic

-recommendations

A

well tolerate with few side effects
drug interactions exist, must use carefully
must use high doses to see any effect

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17
Q

ginger

-function

A

potentially affects GI motility

some evidence for use as an antiemetic

18
Q

ginger

-study results

A 
hyperemesis gravidarum (severe morning sickness)
results are mixed for treating motion sickness and nausea associated with surgery or chemotherapy
19
Q

ginger

-drug interactions

A

drug interactions may exist, must use carefully

20
Q

ginseng

  • MOA
  • function
A

proposed: central cholinergic and dopamingeric effects and stimulation if the HPA axis
claims to increase energy and improve mental abilities

21
Q

ginseng

-study results

A

multiple studies have shown no effects on exercise performance, mood, memory or concentration

22
Q

herbal agents used for pain relief

A 
arnica montana
black cohosh
chamomile
Boswellia Serrata
evening primrose oil
kava
peppermint
piscidia-Jamaican Dogwood
SAM-e
St. Johns Wort
Willow Bark
Wintergreen Oil
23
Q

arnica montana

-how is it used

A

used externally for muscle pain increased by movement

24
Q

black cohosh

  • don’t confuse with…
  • used for…
A

don’t confuse with blue cohosh

generally used to treat Sx of menopause, though high quality trials show no effect

25
Q

chamomile

  • purpose
  • evidence
A

used for stomach and GI pain, cramps, rheumatism, neuralgia, inflammation, ulcers
no robust evidence

26
Q

boswellia serrata

  • aka
  • purpose
  • evicence
A

frankincense
believe to disrupt the enzymes which cuase inflammatory pain
robust evidence of efficacy is lacking

27
Q

evening primrose oil

  • evidence
  • purpose
A

no robust evidence

proposed anti-inflammatory actions –> arthritis, joint and back pain

28
Q

kava

  • linked to…
  • function
  • may be useful for…
A

linked to liver damage/failure
mild CNS depressant
may be useful in the Tx of anxiety

29
Q

chondroprotective agents

-how do they work?

A

increase proteoglycan synthesis
decrease collagenolytic activity
increase in hyaluronic acid production
inhibit lysosomal enzyme release

30
Q

oral bioavailability of

  • glucosamine
  • chondroitin
A 
glucosaming
-26%
-87% absorbed from GI tract (first-pass metabolism accounts for the difference)
chondroitin
-12%
31
Q

glucosamine and chondroitin

-MOA

A

exact machanism not known

32
Q

glucosamine and chondroitin

-in vitro anti-inflammatory activity

A

proposed to prevent breakdown of synovial sturctures

33
Q

glucosamine and chondroitin

  • exogenous glucosamine has been shown to…
  • -unclear if…
A

distribute to joints (knees) and increase the synthesis of hyaluronic acid
-unclear if this occurs at synovial concentrations that can be achieved through supplements (5 uM vs. 500 uM)

34
Q

glucosamine and chondroitin

-trial results

A

no benefit vs. placebo in short-term studies
long-term (2 years) trials show no benefit over placebo
small sample size in a lot of studies

35
Q

glucosamine drug interactions

A

ACE inhibitors
K sparing diuretics
diabetic medications

36
Q

chondroitin drug interactions

A

none reported

37
Q

glucosamine adverse effects and cautions/contras

A 
heartburn
moderate constipation
diarrhea
avoid in/with
-pregnancy
-shellfish allergy
-diabetics/glucose intolerance
-CHF/renal impairment
38
Q

chondroitin adverse effects and cautions/contras

A 
moderate constipation
diarrhea
nausea/epigastric pain
hypersensitivity
avoid in pregnancy
39
Q

supplement concerns

A 
not FDA regulated
allergic reactions can still occur
-can be serious such as anaphylactic shock
toxities
-direct
-unlisted poisonous ingredients
-excessive pharmacologic activity
adulteration/contamination
misidentification/mislabeling
40
Q

patients should never…

A

use herbal products in lieu of seeking medical treatment
-use of herbals may delay Tx
patients should never stop taking their proven conventional therapies to use an unstudied, unproved regimen

41
Q

use extreme caution around _____ when taking herbal agents

A

surgery

S2 Pharmacology (7 decks)

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