OTC's herbals And Supplements Flashcards
Classification of an OTC
Safe, low potential for misuse, pt can self administer and diagnose w/o supervision
Hazards of OTC
Acetaminophen toxcity
Do not give infants or anyone under 4 decongestants
May be masking a serious illness
Adverse effects of OTC
GI upset, GI bleeding
Sedation with antihistamines
Impaired driving
Pharm tx for URI
Treat based on TYPE of symptoms and FREQ of symptoms
URI ( how to treat)
Mild and intermittent = antihistamine or decongestant
Moderate and freq and persistent = intranasal corticosteroid ( with or without antihistamine or decongestant)
Severe: intranasal corticosteroid with a antihistamine or decongestion ( consider oral steroid x 5)
Nasal decongestants : class, MOA, benefits, adverse, precautions, contraindication, preg
Sympathomimetic amine ( class)
MOA: stimulates beta receptors of smooth muscle and stimulates alpha receptors causing vasoconstriction
Benefits: reduces tissue edema and nasal congestion, promotes sinus drainage, opens Eustachian tubes
Adverse effects: tachy, increases IOP, urinary retention
Precaution: peripheral HTN, CVD, prostatic hypertrophy
Contraindications: mitral value prolapse, cardiac palpitations , severe HTN, severe CAD
Preg: C, not for nursing mothers
Types of nasal decongestants
Phenylinephrine ( Sudafed PÉ)
Pseudoephedrine ( Sudafed 12 hours)
Oxymetazoline ( Afrin)
Antihistamine + D ( AKA Allerga D, Claritin D)
Oral Antihistamines
1st generation : Tavist, Chlor-Trimetor, Benadryl ( more side effects)
2nd generation: Zyrtec, Claritin, Allegra ( less sedative s/e)
MOA: compete for histamine receptor ( H1) site, antagonize effects of histamine
Benefits: treats rhinorrhea, watery eyes, postnasal drip, sneezing
Adverse effects: dizziness , confusion, dry mouth , constipation
Precautions: lower resp disease, sleep apnea, bladder neck obstruction, elderly , pedi
Preg: B or C , not for nursing mothers
Intranasal corticosteroid
Examples: Flonase, Nasacort, Nasonex, Veramyst
No systemic side effects
Good for people who have had “ 6 weeks of hell”
Intranasal Mast Cell stabilizers
Cromolyn *
MOA: preventative agent, inhibits sensitized and mast cell degranulation that occurs after exposure to specific antigens
Drawbacks: must be nebulized ( may take months to see effects) 4-6 times a day
Adverse effects: nasal irritation, stinging, sneezing
Preg: B, lactation unknown
Antitussives ( Belsym)
Dextromethorphan
DO not supresses the cough during the day
MOA: centrally acting in medulla to elevate threshold for cough
Adverse: n/v dizziness
Precautions: pedi < 6
Contraindication: MAOI with 14 days
Preg: C
Expectorants
Guaifenasin
MOA: increases resp tract fluid secretions, reduces surface tension, loosens bronchial secretion
Benefits: used in the presence of mucus and congestion
Precaution : not use in children less than 12
Preg: C
Tylenol
MOA: no anti inflammatory activity , central inhibition of PG synthesis
Max dose of 4 g per day
Can use in pregnancy
Sleep aids
Sominex and Unisom
MOA: same as antihistamine
Adverse: sedation, dry mouth, constipation, blurred vision
Preg: B not recommended in lactation
Black Cohosh
Hot flashes and menopausal symptoms
Adverse: increased menstrual flow, GI upset, dizziness
Interaction: fertility agents, estrogens, oral contraceptives, progestin
Contraindication: abnormal fetal positioning, eclampsia
Preg: X
Coenzyme Q10
Acute MI, chronic systolic heart failure, mitochondrial disease
Adverse: well-tolerated,
Interactions: antihypertensives, warfarin
Preg: unknown
Cranberry
Recurrent UTI
Adverse : well tolerated
Preg: unknown
Creatine
Non-hormonal performance enhancement
Adverse: weight gain from urinary retention
Interaction: cyclosporine
Contraindication: renal impairment
Echinacea
Common cold or mild flu
Adverse: allergic reaction to plants ( sunflowers, daisies)
interactions: AID’s drugs, corticosteroids
Preg: unknown
Garlic
Hypercholesterolemia
Adverse: GI
Preg: safe but data lacking
Gingko Biloba
Dementia, memory impairment
Adverse: inhibits platelet aggregation
Interaction: anticoagulants
Preg: not reccomended
Ginseng
Immune system enhancement, mental performace
Adverse: mild overdose : excitation, fidgeting, headache, inhibits platelet aggregation
Interactions: anticoagulants , anti-platelets
Preg:avoid
Melatonin
Mild insomnia, jet lag
Adverse: headache, depression, tachy
Preg: should be avoided
Saw Palmetto
Adjunct for BPH
well tolerated
Interactions: androgens, 5-alpha reductase
Contra: UTI, prostate CA
Preg: avoid in preg
St. John’s Wort
Adjunct for depression and seasonal affective disorder
Adverse: GI irritation, sexual dysfunction
Interaction: induces CYP34A, MAOI, warfarin, SSRI;s
Contra: AIDS/HIV, MAOI, SI
Preg: not reccomended
Valerian
Occasional treatment mild insomnia or anxiety die to restlessness or nervousness of non-psychotic origin
Adverse: paradoxical reaction (agitation)
Interaction: sedatives, hypnotics, ethanol, anxiolytics
Nutrient - Drug interactions
Food may effect
- drug absorption, metabolism, excretion,
Drug may affect nutrient status
Influence of Diet on Drug Absorption
Drug absorption can be decreased, delayed, accelerated or increased by food
Food changes gastric ph
Food may bind with medication, decreasing absorption
Influence of diet on drug metabolism
The rate of the drug metabolism is affected by nutrient intake
- low carb high protein diet may increase drug -metabolizing enzymes
- antioxidant vegetables may increase the activity of drug - metabolizing enzymes
Grapefruit and P450
- inhibits CYP 3A4
- increases levels of ccb, statins, tacrolimus
Food and P450:
- Veggies, caffeine, charcoal broiling may lead to therapeutic failure
Influence of Diet on Drug Excretion
Some food can change urinary PH
Foods that alkalinize the urine
- milk, veggies, citrus fruits
Foods that Acidify the urine
- meat, fish, cheese, eggs
Drug - food incompatibilities
Warfarin - Vit K containing foods
MAOI- tyramine-containing foods ( fermented pickles)
Metronidazole: alcohol
Caffeine : accelerates absorption up to 20X
Alcohol: enhances drug solubility
Influence of drugs on nutrients
Drug induced nutrient depletion
- antacid therapy or potassium therapy can decrease folic acid, iron, vit B
Phenytoin reduces folic acid
Loop diuretics affect sodium, calcium, potassium
Fiber
Decreased constipation, CAD, better glucose control , improved lipid levels
Vitamins A, C, D, K
A= vision, bone growth, immune, reproduction
C ( ascorbic acid) = humans cant synthesize vitamin C, inadequate intake may lead to scurvy , smokers are at risk, does not decrease URI’s,
D = Bone health , need 400 IU day
K= need for blood clotting
Vitamin B
B1= thiamine = alcoholics are at high risk for Wernicke’s encephalopathy
B2 ( riboflavin) = may decrease headache
B3 ( niacin) : used to treat hyperlipidemia
B12 : could lead to megablastic anemia
Folate
Critical to the production of new cells
Found in green leafy veggies, fruits, dried legumes
Deficiency Occurs in pregnancy
Preg: 600mcg day
Minerals
Calcium = need for muscle contraction, bone health, heat health
Iron = need for oxygen transport, pt will develop microcytic-hypochromic anemia
Fatty acids
Must be consumed ( nuts)
Heart health
Children with autism or ADD may benefit to omega three
Plant sterols
Compete with cholesterol in the intestine
Can lower LDL
Pre / Pro / Symbiotics
Reduces antibtiocs associated diarrhea
May improve IBD and necrotizing enterocolitis
