Supplements and herbals

Question 1

Echinacea

Answer 1

Activates cell-mediated immunity

Allergic rx, decreased effectiveness of immunosuppressants, long-term use may cause immunosuppression

Question 2

Garlic

Answer 2

Antiplatelet, increases fibrinolysis

May increase risk of bleeding

Question 3

Ginger

Answer 3

Antiemetic, antiplatelet

May increase risk of bleeding

Question 4

Ginkgo

Answer 4

Inhibits platelet-activating factor

May increase risk of bleeding

Question 5

Ginseng

Answer 5

Lowers blood glucose, antiplatelet

Hypoglycemia, may increase risk of bleeding, may decrease anticoagulation by warfarin

Question 6

Green tea

Answer 6

Antiplatelet, inhibits TXA2 formation

May increase risk of bleeding, may decrease warfarin anticoag

Question 7

Kava

Answer 7

Sedation, anxiolysis

May increase sedative effects of anesthetics

Question 8

Saw palmetto

Answer 8

Inhibits 5a-reductase and COX

May increase risk of bleeding

Question 9

St. John’s wort

Answer 9

Inhibits neurotransmitter reuptake

Induces CYP450 enzymes, decreases digoxin levels, delayed emergence

Question 10

Valerian

Answer 10

Sedation

May increase sedative effect of anesthetics, benzo-like acute withdrawal, may increase anesthetic requirement with chronic use

Question 11

Ephedra/ma huang

Answer 11

Used for weight loss, increased energy, to treat asthma/bronchitis
*Contains ephedrine, pseudoephedrine, norephedrine, methylephedrine, norpseudoephedrine

Fatal cardiac/CNS complications, elevated BP, HR, vasoconstriction/spasm of coronaries and cerebral arteries -> MI and stroke, hypersensitivity myocarditis and tachyphylaxis with chronic use
*With MAOI, can cause life-threatening hyperpyrexia, HTN, coma