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SUMPHARM > Supplement&Herbs > Flashcards

Supplement&Herbs Flashcards

1
Q

What is feverfew used for?

A

migraine prophylaxis;-reduce migraine frequency
-less severe symptoms,
Grade A - possibly effective 3/5 trials found efficacy, but well designed trial found no difference than placebo

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2
Q

MOA theories for feverfew

A

inhibits platelet aggregation,
serotonin release,
leukotrienes,
prostaglandin synthesis

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3
Q

Cautions for feverfew

A
  • safe for up to 4 months (length of study)
  • does not work for acute attacks
  • taper dose to prevent withdrawal
  • do not use if allergic to ragweed or related plants
  • caution in pts taking warfarin
  • *do NOT use during pregnancy/lactations
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4
Q

What is coenzyme Q10 used for?

A

migraine prophylaxis-reduces migraine attack frequency, headache-days, days w/ nausea! can also be used for Co-Q10 deficiency, CHF, angina.
Grade A - more effective than placebo

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5
Q

MOA for coenzyme Q10 and migraine prophylaxis

A

-might improve mitochondrial oxidative phosphorylation

well tolerated!

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6
Q

What is riboflavin (Vitamin B2) used for?

A

migraine prophylaxis:may affect mitochondrial dysfunction Grade A

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7
Q

What are the claims for riboflavin in regards to migraine prophylaxis?

A

high dose may reduce the frequency of migraines
does not reduce severity or duration,
must be used 3 months to see improvement

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8
Q

ADE for migraine prophylaxis w/ riboflavin?

A

-higher dose may cause diarrhea and polyuria -yellow-orange discoloration of urine

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9
Q

What is the MOA of Mg for migraine prophylaxis?

A

low Mg levels may induce cerebral arterial vasoconstriction –> increase platelet aggregation –> promote serotonin release *more likely to benefit pts with low Mg levels
Grade A -

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10
Q

ADE for magnesium?

A

diarrhea

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11
Q

What is St. John’s Wort indicated for?

A

depression - mild-to-moderate

Grade A -

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12
Q

What is the major active constituent of St. John’s Wort?

A

hyperforin

inhibits reuptake of serotonin, norepinephrine, dopamine

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13
Q

ADE of St. John’s Wort

A
  • incidence similar to placebo and less than conventional antidepressants
  • sexual dysfunction less than SSRIs
  • serotonin syndrome
  • hypertensive crisis reported with tyramine-containing foods
  • can induce abortion –> do not use during pregnancy!!
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14
Q

Drug interactions of St. John’s Wort*

A

Potent inducer of CYP450 3A4

Reduce levels of

  • Amitriptyline and nortriptyline
  • Midazolam and alprazolam
  • cyclosporine and tacrolimus
  • indinavir and nevirapine
  • imatinib and irinotecan
  • digoxin, fexofenadine, methadone, omeprazole, oral contraceptives, simvastatin, theophylline, verapamil, warfarin
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15
Q

Very important drug interactions to remember with St. John’s Wort!

A
  • FDA -protease inhibitors and non-nucleoside reverse transcriptase inhibitors
  • additive effects with antidepressants
  • allow 14 day washout period after treatment with an MAOI before starting St. John’s Wort
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16
Q

What is S-adenosylmethionine (SAMe) indicated for?

A
  • depression Grade C

- osteoarthritis-Grade B

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17
Q

What is the MOA for SAMe for treatment of depression?

A

increase dopamine & norepinephrine levels

**may be effective as TCAs for depression

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18
Q

ADE for SAMe

A

additive effect on drugs that increase serotonin levels –> * not to combine SAMe with other antidepressants

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19
Q

What is glucosamine/chondroitin indicated for?

A

osteoarthritis- alone alleviate symptoms and slow joint deterioration in osteoarthritis

G - chitin (building block of exoskeletons of crustaceans) and stimulates the manufacturing of substances essential for proper joint function and joint repair stimulation; analgesic effects
C - bovine or shark cartilage, and acts as chondroprotective

20
Q

What are the grades of evidence for both glucosamine/chondroitin?

A

G: Grade A - mild-moderate knee OA Grade B - general OA

C: Grade A - OA of knee and other joints Grade B - urinary incontinence/detrusor instability

21
Q

ADE of glucosamine/chondroitin

A

-GI (nausea, indigestion, vomiting)
-headache
asthma exacerbations with chondroitin
AVOID-allergy to shellfish

22
Q

What is methylsulfonylmethane (MSM) indicated for?

A

osteoarthritis-Grade C = conflicting data

23
Q

What is black cohosh indicated for?

A

menopausal symptoms-Grade C

  • may relieve hot flashes
  • NO affect estrogen receptors
  • NO affect endometrial or breast tissue
24
Q

What groups should avoid black cohosh?

A

women w/ hx or family h/o breast CA

25
Q

What is soy used to treat?

A

menopausal symptoms *conflicting data on efficacy for hot flashes
metabolite INC estrogen activity

26
Q

What groups should avoid soy?

A

Pt estrogen receptor positive breast cancer

27
Q

What is saw palmetto used to treat?

A

BPH Grade A!
-antiandrogenic, antiproliferative, anti-inflammatory properties -significantly improves many BPH symptoms –> frequent urination, painful urination, hesitancy, urgency

28
Q

Side effects of saw palmetto

A
  • well tolerated w/ few side effects
  • dizziness and GI
  • less impotence than finasteride
  • does not decrease PSA levels
  • INR w/warfarin
29
Q

What are the grades of evidence for garlic and what it’s able to treat?

A

Grade A = hyperlipidemia, HTN Grade B = decrease CVD risks

antimicrobial, antiviral, immune-enhancing, antispasmodic, antihypertensive, cholesterol lowering

30
Q

What are drug interactions of garlic?

A
  • reduces saquinavir by ~50%
  • advise pts on protease inhibitors not to start or stop
  • INC bleeding time and INR w/warfarin
31
Q

ADE of garlic

A
  • may inhibit platelet aggregation

- postop bleeding and spinal epidural hematoma

32
Q

What are the claims of ginkgo biloba?

A

memory enhancement, cognitive improvement, and antiplatelet activity.
Grade A = claudication (PVD),
dementia Grade B = cerebral insufficiency

33
Q

Drug interactions of ginkgo

A
  • potent inhibitors of platelet-activating factor
  • may also CYP450 enzymes
  • DI warfarin, aspirin, ibuprofen
  • serotonergic effects
  • don’t take w/ MAOIs and SSRIs!
  • NOT recommended if using w/ antiplatelet agents
34
Q

ADE of ginkgo

A
  • intracerebral hemorrhage, spontaneous bleeding in the eye, postop bleeding
  • variable insulin levels DM caution
35
Q

What are the claims of ginseng?

A 
'mental performance' and 'increase energy' 
- immune function, antioxidant activity,
 analgesic effects,
 improved *glucose homeostasis, 
reduces cancer risk
36
Q

What is the grade of evidence for ginseng and what it’s able to treat?

A

Grade B = CV conditions, hyperglycemia in healthy individuals, immune system enhancement, DM2

37
Q

ADE of ginseng

A

insomenia, nervousness, HTN

38
Q

What supplements should be avoided with warfarin?

A

3 G’s! Gingko, garlic, ginseng*

39
Q

What is echinacea indicated for?

A

‘immune modulating’ agent - increases production of interleukins and NK cell activity, demonstrated weak antibiotic/antiviral/antifungal effects
Grade B for URTI prevention/treatment-marketed to reduce duration of cold if started within 24hrs

40
Q

ADE for echinacea

A

flu-like symptoms, unpleasant taste, GI discomfort

41
Q

What is melatonin?

A

a serotonin derivative produced by pineal gland helps regulate sleep/wake cycles - release coincides w/ darkness and is suppressed by daylight

42
Q

What are the grades of evidence for melatonin and what it’s able to treat?

A

Grade A - jet lag Grade B - delayed sleep phase syndrome, insomnia in elderly, sleep disorders, sleep enhancement in healthy people

43
Q

How to give melatonin for insomnia and jet lag?

A

At sunset!
insomnia - QD HS
jet lag- first dose at departure, 1-3 nights after arrival

44
Q

ADE of melatonin

A

Rare

next day drowsiness, vivid dreams, HA

45
Q

Does vitamin B3/Niacin prevent cancer!?

A

nonmelanoma skin cancer- Niacinamide 500mg BID Continue topical sunscreen

46
Q

What supplements should never ever use!?

A

Comfrey- inflammatory ADE- liver failure irreversible; deaths reported

Kava-GAD; ADE-liver liver failure -death reported

Yohimbe- impotence; ADE-*changes in BP, arrhythmias, respiratory depression, heart attack

SUMPHARM (26 decks)

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