Safety and Contraindicaitons Flashcards
Which herbs have been implicated in liver toxicity and failure?
Any herb containing pyrrolizidine alkaloid, like comfrey, coltsfoot, borage,
Germander, ephedra, pennyroyal, kava kava
jin bu huan (Atractylis gummifera) and guang fang chi (Aristolochia fangchi)
These herbs should not be taken for extended periods of time, and not by people with liver or kindney disease.
What are the 3 categories of pharmacodynamic interactions between herbs and drugs?
An additive interaction happens when an herb and a drug share the same actions or mechanisms, causing more of the same effect.
An antagonistic interaction happens when an herb and a drug have opposing actions or mechanisms in the body.
A synergistic interaction happens when an herb and a drug increase their potency in the body through their interaction.
What is the difference between pharmacokinetics and pharmacodynamics?
Pharmacokinetics studies the absorption, distribution, metabolism, and excretion of a drug, and pharmacodynamics studies the relationship between the drug and its receptors, its mechanism of action and therapeutic effect. … This leads to the occurrence of pharmacokinetic and pharmacodynamic differences, respectively.
What are the 4 ways in which herbs affect the pharmacokinetics of drugs?
Absorption:
Tannin-rich plants bind to and precipitate proteins. This allows them to produce the astringent activity that we know and love them for, but this action can also cause reduced absorption of alkaloids, vitamins, and minerals, whether they be from the diet, pharmaceutical drugs, or other herbs (Gardner & McGuffin, 2013).
Assimilation:
Fiber, especially insoluble fiber, can slow down the movement of food and drugs through the digestive tract. Fiber also feeds gut flora, so a change in the amount of fiber in the diet or in herbal supplementation can affect the microenvironment of the gut, resulting in a change in assimilation. Fiber-rich herbs have been reported to decrease the concentration of pharmaceutical drugs, iron, and vitamin B2 (Mills & Bone, 2000).
Along with tannin- and fiber-rich plants, herbs containing saponins, resins, and bitters may also change the way the body assimilates drugs, because they alter assimilative function (Mills & Bone, 2000).
Metabolic pathways
Another way that a pharmacokinetic HDI can occur is when a plant has an effect on the liver’s metabolism of pharmaceutical drugs. The liver has many metabolic pathways through which chemical substances are processed and broken down. When an herb shares a pathway with a drug, it can alter the effectiveness of the drug. For example, St. John’s wort (Hypericum perforatum) is metabolized by the CYP450 pathway, which is the same pathway through which antidepressant drugs, and many others, are processed. For this reason, it is not advisable to take St. John’s wort in combination with a great many pharmaceuticals (Gardner & McGuffin, 2013).
Which herbs are toxic?
Arnica (Arnica montana)* Belladonna/deadly nightshade (Atropa belladonna) Dogbane (Rauwolfia spp.) Epazote (Chenopodium ambrosioides) Ephedra (Ephedra sinica) False jessamine (Gelsemium sempervirens) Foxglove (Digitalis spp.) Greater celandine (Chelidonium majus) Henbane (Hyoscyamus niger) Jimsonweed/devil’s snare (Datura stramonium) Lily of the valley (Convallaria majuscula) Mandrake (Mandragora officinarum) Mayapple (Podophyllum peltatum) Monkshood (Aconitum spp.) Opium poppy (Papaver somniferum) Poke (Phytolacca americana) Poison ivy (Toxicodendron radicans) Pulsatilla/pasque flower (Pulsatilla vulgaris) Quinine (Cinchona spp.) Savin/savin juniper (Juniperus sabina) Yohimbe (Corynanthe yohimbe)
Which herbs should not be taken long term?
Any herbs containing: pyrrolizidine alkaloid(Liver problems/failure) comfrey, coltsfoot, anthraquinones (causes laxative dependence) Senna, rhubarb, cascara sagrada glycyrrhizin (increases blood pressure) licorice (safe in small doses as an adaptogen)
What are the safety protocols for herbs during pregnancy?
- avoid all herbs during 1st trimester
2. only take safe herbs after the 1st trimester, and only in the lowest range of the safe dose
Which herbs are considered safe during pregnancy?
chamomile (Matricaria chamomilla) flower,
red raspberry (Rubus idaeus) leaf,
echinacea (Echinacea spp.) root,
ginger (Zingiber officinale) rhizome,
cranberry (Vaccinium macrocarpon) fruit,
oat (Avena sativa) straw or fruit,
nettle (Urtica dioica) leaf (Romm, 2016).
Which herbal content and actions should be avoided during pregnancy?
High volatile oil content Alkaloid content Teratogens Emmenagogues Strong bitters Stimulants and depressants Anthraquinone laxative content Phytoestrogen content
Which herbs should be avoided during pregnancy?
Aloe (Aloe vera) Barberry (Berberis spp.) Black cohosh (Actaea racemosa) Blue cohosh (Caulophyllum thalictroides) Goldenseal (Hydrastis canadensis) Greater celandine (Chelidonium majus) Juniper (Juniperus communis) Mugwort (Artemisia vulgaris) Motherwort (Leonurus cardiaca) Oregano* (Origanum vulgare) Oregon grape (Berberis aquifolium) Pennyroyal (Mentha pulegium) Poke root (Phytolacca americana) Quinine (Cinchona spp.) Rosemary* (Rosmarinus officinalis) Rue (Ruta graveolens) Sage* (Salvia officinalis) Tansy (Tanacetum vulgare) Thuja (Thuja occidentalis) Wormwood (Artemisia absinthium)
*Culinary use is safe
Which herbal preperations should be avoided during pregnancy?
alchoholic ticntures and extracts in general. Pregnant woman should consume nutritious teas and food instead
Which herbs are known to cause contact dermatitis in sensitive individuals?
Nettle (Urtica dioica), rue (Ruta graveolens), and many members of the Apiaceae (parsley) family,
Which herbs have been known to cause anaphalaxis?
chamomile (Matricaria chamomilla),
garlic (Allium sativum),
echinacea (Echinacea spp.)
many members of the Asteraceae (daisy) family, including yarrow (Achillea millefolium) and feverfew (Tanacetum parthenium).
Which safety related questions should I ask?
Are you pregnant or nursing? Are you on any medications, prescription or otherwise? Do you have any history of liver or kidney disease? Do you have any plant allergies or have you ever reacted to an herbal preparation before?
