Supplements/Herbal Flashcards
Reasons to re-evaluate herbal use
Babies (pregnant or breastfeeding)
Bleeding (Surgery/invasive procedures)
Immunosuppressed (cancer/chemo)
Change in medicine or condition
Most potent phytoestrogen (plant estrogen)
Isoflavones
Herbal supplements used for menopause
Soy, Black cohosh, Red clover, Flaxseed
Soy uses
Menopause (hot flashes)
Cholesterol
Blood Pressure
Soy Protein (food) may decrease____?
severity and frequency of hot flashes
Soy may take up to __ _____ to work?
2 months
Soy Protein is found in
food
Soy extracts is found in
pills/supplements
When to avoid soy supplements
- if taking tamoxifen
- women with estrogen-dependent cancers
*Soy Supplements is never the correct answer
Uses of Black Cohosh
menopause (may reduce hot flashes)
Effectiveness of Black Cohosh
may reduce hot flash frequency compared to baseline but not placebo
Black Cohosh is not effective for treating hot flashes related to ___?
breast cancer
Mechanism of action of Black Cohosh
Similar to SSRIs
Adverse reactions of Black Cohosh
- Rash
- GI complaints
- Breast tenderness
- Headache
- Weight gain
Black Cohosh has been linked to reports of liver damage. For this reason ______ ____ is recommended?
Periodic LFTs
Contraindications of Black Cohosh
In Pregnancy it can increased risk of miscarriage
Use of Red Clover
Menopause (hot flashes)
Efficacy of Red Clover
Mixed evidence but mainly no benefit over placebo
Adverse effects of Red Clover
- Nausea
- Myalgia (muscle pain)
- Vaginal spotting
Red Clover should be avoided
- if taking tamoxifen
- in women with estrogen-dependent cancers
Red Clover can increase risk of ____ with ____ or ____
bleeding; anti-platelet agents or anticoagulants
Use of Flaxseed
Menopause (hot flashes)
Efficacy of flaxseed is
questionable
___g/day of flaxseed may improve hot flashes
40
Flaxseed may take __ to ___ months to see any beneficial effect
1 to 2
Adverse effects of Flaxseed
- Bloating
- Flatulence
- Abdominal pain
- Diarrhea
Herbal supplements used for weight loss
Caffeine, Ephedra, Bitter Orange, Garcinia, Acai
What are the two thermogenic agents used for weight loss?
Ephedrine (increases NE which decreases appetite; increases HR, BP, thermogenesis)
Caffeine (decreases breakdown of NE in synaptic cleft)
Use of Ephedra
Weight loss
Adverse effects of Ephedra
- Heart Attack
- Arrhythmia
- Stroke
- Psychosis
- Seizures
- Death
Adverse effects of Caffeine
- Increased heart rate
- Increased BP
- Diuretic effects
- mental acuity
Adverse effects of Bitter Orange
- May prolong QT-interval
- Caution in anyone with hypertension or heart disease
Bitter Orange is a derivative of
ephedrine
Professional sports and Olympic Committee banned the use of ___ and ___ by athletes
ephedrine and derivaties
Use of Garcinia Cambogia
weight loss
Efficacy of Garcinia Cambogia
2020 Review of 11 studies found no significant effect on weight loss
Adverse effects of Garcinia Cambogia
- Generally mild GI
- Liver toxicity requiring transplant
- -> abdominal pain, jaundice, fatigue, confusion
What is the active ingredient in Garcinia Cambogia?
Hydroxycitric acid (HCA)
Uses of Acai
weight loss
anti-aging
Adverse effects of Acai
- Generally, well tolerated
- Chagas disease (parasitic protozoan) from contaminated raw fruit and juice
Effectiveness of Acai
Insufficient evidence
Who could be harmed by the use of immunostimulants?
- Patients with allergies
- Autoimmune conditions
- People on immunosuppressants
Herbs that have possible immunostimulant effects
- Echinacea
- Garlic
- Ginseng
- Goldenseal
Uses of Echinacea
- Common cold
- Upper respiratory infections
Echinacea has limited benefit for ___ of a cold but does not effect ___ of a cold
prevention; length (does not shorten)
Adverse effects of Echinacea
- GI: nausea, vomiting, upset stomach
- Rash (especially in children)
- Allergic reactions
Echinacea should be avoided in patients with
- ragweed allergy, history of asthma, atopy, or allergic rhinitis
- autoimmune disorders
Uses of Ginseng
- General well being
- Immune stimulant
- Sexual dysfunction
The species of ginseng we are focused on is
Panax ginseng
Adverse effects of Ginseng
- Insomnia
- Headache
- Estrogenic effects (mastalgia, amenorrhea, vaginal bleeding) -rare
Two interactions of Ginseng are
- Increased risk of bleeding
- -> anti-platelet agents
- -> anticoagulants
- Diabetes medications
- -> Hypoglycemia
What herbal supplements are used for cardiovascular health
Fish oil, Garlic, Soy
Two omega-3 fatty acids found in fish oil
Eicosapentaenoic acid (EPA)
Docosahexaenoic acid (DHA) --> lower triglycerides
Uses of Fish Oil
- Hyperlipidemia
- Cardiovascular disease
- Heart Failure
- Mental development (infants)
How does fish oil effect hyperlipidemia
Decreases TG- high doses, Rx
How does fish oil effect Cardiovascular disease
Reduces Blood Pressure (2-5 SBP/1-3 DBP)
How does fish oil effect heart failure
Dietary fish oil reduces risk of chronic heart failure by 15%
The AHA recommends ___ servings/week, non-fried fish in place of other proteins
2
Greater than __g of fish oil can inhibit platelet aggregation
3
Adverse effects of fish oil
- “Fishy burp”
- Halitosis
- Heartburn
- Loose stools
- Increased LDL
Uses of Garlic
- Cholesterol
- Hypertension
Adverse effects of garlic
- Heartburn
- Flatulence
- Nausea/vomiting
- Contact dermatitis
Garlic interacts with
Anti-platelet agents and anticoagulants
Induces p-gp efflux pump
How often do you have to take garlic to see clinical benefits
must take daily for >2 months
Effectiveness of Soy in cardiovascular diseases
Soy Protein may decreases LDL cholesterol by up to 10%
Soy Protein may reduce blood pressure in person with hypertension
Health Claim: Consuming ___ grams of soy protein per day reduces risk of heart disease
25
Herbal supplements that effect neurologic/psychologic function
St. John’s wort, SAMe, Ginkgo, Melatonin, Valerian
Mechanism of action of St. John’s Wort
-inhibits re-uptake of serotonin, norepinephrine, dopamine
Similar to SSRI, SNRI
-GABA effects
Is St. John’s Wort effective in treating depression
mixed results in treating mild-moderate depression
high placebo effect
Uses of St. John’s Wort
Mild-moderate depression
How long does it take to see maximal effect of St. John’s Wort
3-4 weeks
Why do you need to taper when discontinnuing St. John’s Wort
To avoid withdrawal effects
Adverse Effects of St. John’s Wort
- Dizziness
- Insomnia
- Vivid dreams
- Restlessness
- Fatigue
- Dry mouth
- Photosensitivity (5-10mg hypericin)
St. John’s Wort is a potent inducer of
3A4, P-gp
examples: Digoxin, Benzodiazepines, Oral Contraceptives, Phenytoin, Protease inhibitors, NNRTI’s Warfarin
St. John’s Wort is a mild inducer of
1A2, 2C9, 2C19
St. John’s Wort also interacts with other ___ medications
serotonergic
Mechanism of action for SAMe (S-adenosyl-L-methionine)
increases serotonin, norepinephrine, and dopamine levels
How effective is SAMe
insufficient evidence of effectiveness
Adverse effects of SAMe
- Headache
- Dry Mouth
- Insomnia
- N/V, diarrhea
The two concerns about the use of SAMe are ___ and ___
product quality; cost
Use of SAMe
depression
Uses of Ginkgo
- Dementia
- Peripheral arterial disease
Effectiveness of Ginkgo in the treatment of dementia
improves cognitive symptoms but no benefit in slowing or preventing the disease
Adverse effects of Ginkgo
Allergic Reactions (poison oak, poison ivy or mango rind)
Why do you need to stop the use of Ginkgo 2 weeks before surgery
It interacts with antiplatelet agents or anticoagulants which can lead to bleeding
Ginkgo should not be taken with medications that lower what
the seizure threshold (ginkgo toxin from seeds can cause seizures)
Ginkgo induces CYP___
2C19
Use of Melatonin
- Jetlag
- Insomnia
Mechanism of action of melatonin
- Natural hormone secreted from pineal gland
- Regulates circadian rhythms
Dosing of melatonin for insomnia
2-3 mg QHS
Uses of Valerian
Insomnia
Mechanism of action of Valerian
May increase GABA activity in the CNS by inhibiting enzymes that metabolizes GABA
Benzodiazepine-like effects
How does Valerian compare to benzodiazepines in treating insomnia
It is not as fast as benzodiazepines
Adverse Effects of Valerian
- Headache
- Nervousness
- Excitability
- Hepatotoxicity (rare)
Valerian may take ____ for full effect
a few days to weeks
When discontinuing Valerian
medication should be tapered
Uses for Glucosamine
Osteoarthritis
Glucosamine sulfate: improves pain and functionality for osteoarthritis of the __ when used for >__ weeks
knee; 4
Glucosamine shows no improvement in osteoarthritis of the ___
hip
Adverse effects of Glucosamine
Mild GI complaints
Glucosamine interacts with
Warfarin (increased INR)
shellfish allergy
Glucosamine is derived from the exoskeletons of
shrimp, lobster, and crabs or made synthetically
Uses of Saw Palmetto
BPH (Benign prostatic hyperplasia)
Adverse Effects of Saw Palmetto
- Dizziness
- Headache
- Decreased libido
- GI complaints
Saw Palmetto interactions
prolonged bleeding time
Mechanism of action of Saw Palmetto
- Antiandrogenic
- Anti proliferative
- Anti-inflammatory
- 5-alpha reductase activity
How does Saw Palmetto compare in effectiveness to 5-alpha reductase inhibitors
may be similar in relieving BPH symptoms
How does Saw Palmetto compare in effectiveness to Alpha 1 blockers
Saw Palmetto is less effective for urinary symptoms and reducing prostate volume
Saw Palmetto is likely ___ for BPH
ineffective
Uses of Cranberry
urinary tract infections
Mechanism of action of cranberry
- acidification of urine
- prevents bacterial adhesion to urinary tract walls (UROEPITHELIAL) CELLS
Which mechanism of action contributes to cranberry effectiveness in treating UTIs
preventing bacterial adhesion to urinary tract walls
How effective is cranberry in treating UTIs
not effective
Cranberry could be effective in prevention of UTIs, decreasing risk by
1/3
Cranberry interactions
Warfarin (increases INR)
May inhibit CYP3A4
