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CDM 1 > Supplements/Herbal > Flashcards

Supplements/Herbal Flashcards

1
Q

Reasons to re-evaluate herbal use

A

Babies (pregnant or breastfeeding)

Bleeding (Surgery/invasive procedures)

Immunosuppressed (cancer/chemo)

Change in medicine or condition

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2
Q

Most potent phytoestrogen (plant estrogen)

A

Isoflavones

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3
Q

Herbal supplements used for menopause

A

Soy, Black cohosh, Red clover, Flaxseed

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4
Q

Soy uses

A

Menopause (hot flashes)

Cholesterol

Blood Pressure

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5
Q

Soy Protein (food) may decrease____?

A

severity and frequency of hot flashes

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6
Q

Soy may take up to __ _____ to work?

A

2 months

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7
Q

Soy Protein is found in

A

food

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8
Q

Soy extracts is found in

A

pills/supplements

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9
Q

When to avoid soy supplements

A
  • if taking tamoxifen
  • women with estrogen-dependent cancers

*Soy Supplements is never the correct answer

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10
Q

Uses of Black Cohosh

A

menopause (may reduce hot flashes)

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11
Q

Effectiveness of Black Cohosh

A

may reduce hot flash frequency compared to baseline but not placebo

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12
Q

Black Cohosh is not effective for treating hot flashes related to ___?

A

breast cancer

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13
Q

Mechanism of action of Black Cohosh

A

Similar to SSRIs

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14
Q

Adverse reactions of Black Cohosh

A
  • Rash
  • GI complaints
  • Breast tenderness
  • Headache
  • Weight gain
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15
Q

Black Cohosh has been linked to reports of liver damage. For this reason ______ ____ is recommended?

A

Periodic LFTs

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16
Q

Contraindications of Black Cohosh

A

In Pregnancy it can increased risk of miscarriage

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17
Q

Use of Red Clover

A

Menopause (hot flashes)

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18
Q

Efficacy of Red Clover

A

Mixed evidence but mainly no benefit over placebo

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19
Q

Adverse effects of Red Clover

A
  • Nausea
  • Myalgia (muscle pain)
  • Vaginal spotting
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20
Q

Red Clover should be avoided

A
  • if taking tamoxifen

- in women with estrogen-dependent cancers

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21
Q

Red Clover can increase risk of ____ with ____ or ____

A

bleeding; anti-platelet agents or anticoagulants

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22
Q

Use of Flaxseed

A

Menopause (hot flashes)

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23
Q

Efficacy of flaxseed is

A

questionable

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24
Q

___g/day of flaxseed may improve hot flashes

A

40

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25
Q

Flaxseed may take __ to ___ months to see any beneficial effect

A

1 to 2

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26
Q

Adverse effects of Flaxseed

A
  • Bloating
  • Flatulence
  • Abdominal pain
  • Diarrhea
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27
Q

Herbal supplements used for weight loss

A

Caffeine, Ephedra, Bitter Orange, Garcinia, Acai

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28
Q

What are the two thermogenic agents used for weight loss?

A

Ephedrine (increases NE which decreases appetite; increases HR, BP, thermogenesis)

Caffeine (decreases breakdown of NE in synaptic cleft)

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29
Q

Use of Ephedra

A

Weight loss

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30
Q

Adverse effects of Ephedra

A
  • Heart Attack
  • Arrhythmia
  • Stroke
  • Psychosis
  • Seizures
  • Death
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31
Q

Adverse effects of Caffeine

A
  • Increased heart rate
  • Increased BP
  • Diuretic effects
  • mental acuity
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32
Q

Adverse effects of Bitter Orange

A
  • May prolong QT-interval

- Caution in anyone with hypertension or heart disease

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33
Q

Bitter Orange is a derivative of

A

ephedrine

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34
Q

Professional sports and Olympic Committee banned the use of ___ and ___ by athletes

A

ephedrine and derivaties

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35
Q

Use of Garcinia Cambogia

A

weight loss

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36
Q

Efficacy of Garcinia Cambogia

A

2020 Review of 11 studies found no significant effect on weight loss

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37
Q

Adverse effects of Garcinia Cambogia

A
  • Generally mild GI
  • Liver toxicity requiring transplant
  • -> abdominal pain, jaundice, fatigue, confusion
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38
Q

What is the active ingredient in Garcinia Cambogia?

A

Hydroxycitric acid (HCA)

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39
Q

Uses of Acai

A

weight loss

anti-aging

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40
Q

Adverse effects of Acai

A
  • Generally, well tolerated

- Chagas disease (parasitic protozoan) from contaminated raw fruit and juice

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41
Q

Effectiveness of Acai

A

Insufficient evidence

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42
Q

Who could be harmed by the use of immunostimulants?

A
  • Patients with allergies
  • Autoimmune conditions
  • People on immunosuppressants
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43
Q

Herbs that have possible immunostimulant effects

A
  • Echinacea
  • Garlic
  • Ginseng
  • Goldenseal
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44
Q

Uses of Echinacea

A
  • Common cold

- Upper respiratory infections

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45
Q

Echinacea has limited benefit for ___ of a cold but does not effect ___ of a cold

A

prevention; length (does not shorten)

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46
Q

Adverse effects of Echinacea

A
  • GI: nausea, vomiting, upset stomach
  • Rash (especially in children)
  • Allergic reactions
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47
Q

Echinacea should be avoided in patients with

A
  • ragweed allergy, history of asthma, atopy, or allergic rhinitis
  • autoimmune disorders
48
Q

Uses of Ginseng

A
  • General well being
  • Immune stimulant
  • Sexual dysfunction
49
Q

The species of ginseng we are focused on is

A

Panax ginseng

50
Q

Adverse effects of Ginseng

A
  • Insomnia
  • Headache
  • Estrogenic effects (mastalgia, amenorrhea, vaginal bleeding) -rare
51
Q

Two interactions of Ginseng are

A
  • Increased risk of bleeding
  • -> anti-platelet agents
  • -> anticoagulants
  • Diabetes medications
  • -> Hypoglycemia
52
Q

What herbal supplements are used for cardiovascular health

A

Fish oil, Garlic, Soy

53
Q

Two omega-3 fatty acids found in fish oil

A

Eicosapentaenoic acid (EPA)

Docosahexaenoic acid (DHA)
--> lower triglycerides
54
Q

Uses of Fish Oil

A
  • Hyperlipidemia
  • Cardiovascular disease
  • Heart Failure
  • Mental development (infants)
55
Q

How does fish oil effect hyperlipidemia

A

Decreases TG- high doses, Rx

56
Q

How does fish oil effect Cardiovascular disease

A

Reduces Blood Pressure (2-5 SBP/1-3 DBP)

57
Q

How does fish oil effect heart failure

A

Dietary fish oil reduces risk of chronic heart failure by 15%

58
Q

The AHA recommends ___ servings/week, non-fried fish in place of other proteins

A

2

59
Q

Greater than __g of fish oil can inhibit platelet aggregation

A

3

60
Q

Adverse effects of fish oil

A
  • “Fishy burp”
  • Halitosis
  • Heartburn
  • Loose stools
  • Increased LDL
61
Q

Uses of Garlic

A
  • Cholesterol

- Hypertension

62
Q

Adverse effects of garlic

A
  • Heartburn
  • Flatulence
  • Nausea/vomiting
  • Contact dermatitis
63
Q

Garlic interacts with

A

Anti-platelet agents and anticoagulants

Induces p-gp efflux pump

64
Q

How often do you have to take garlic to see clinical benefits

A

must take daily for >2 months

65
Q

Effectiveness of Soy in cardiovascular diseases

A

Soy Protein may decreases LDL cholesterol by up to 10%

Soy Protein may reduce blood pressure in person with hypertension

66
Q

Health Claim: Consuming ___ grams of soy protein per day reduces risk of heart disease

A

25

67
Q

Herbal supplements that effect neurologic/psychologic function

A

St. John’s wort, SAMe, Ginkgo, Melatonin, Valerian

68
Q

Mechanism of action of St. John’s Wort

A

-inhibits re-uptake of serotonin, norepinephrine, dopamine

Similar to SSRI, SNRI

-GABA effects

69
Q

Is St. John’s Wort effective in treating depression

A

mixed results in treating mild-moderate depression

high placebo effect

70
Q

Uses of St. John’s Wort

A

Mild-moderate depression

71
Q

How long does it take to see maximal effect of St. John’s Wort

A

3-4 weeks

72
Q

Why do you need to taper when discontinnuing St. John’s Wort

A

To avoid withdrawal effects

73
Q

Adverse Effects of St. John’s Wort

A
  • Dizziness
  • Insomnia
  • Vivid dreams
  • Restlessness
  • Fatigue
  • Dry mouth
  • Photosensitivity (5-10mg hypericin)
74
Q

St. John’s Wort is a potent inducer of

A

3A4, P-gp

examples: Digoxin, Benzodiazepines, Oral Contraceptives, Phenytoin, Protease inhibitors, NNRTI’s Warfarin

75
Q

St. John’s Wort is a mild inducer of

A

1A2, 2C9, 2C19

76
Q

St. John’s Wort also interacts with other ___ medications

A

serotonergic

77
Q

Mechanism of action for SAMe (S-adenosyl-L-methionine)

A

increases serotonin, norepinephrine, and dopamine levels

78
Q

How effective is SAMe

A

insufficient evidence of effectiveness

79
Q

Adverse effects of SAMe

A
  • Headache
  • Dry Mouth
  • Insomnia
  • N/V, diarrhea
80
Q

The two concerns about the use of SAMe are ___ and ___

A

product quality; cost

81
Q

Use of SAMe

A

depression

82
Q

Uses of Ginkgo

A
  • Dementia

- Peripheral arterial disease

83
Q

Effectiveness of Ginkgo in the treatment of dementia

A

improves cognitive symptoms but no benefit in slowing or preventing the disease

84
Q

Adverse effects of Ginkgo

A

Allergic Reactions (poison oak, poison ivy or mango rind)

85
Q

Why do you need to stop the use of Ginkgo 2 weeks before surgery

A

It interacts with antiplatelet agents or anticoagulants which can lead to bleeding

86
Q

Ginkgo should not be taken with medications that lower what

A

the seizure threshold (ginkgo toxin from seeds can cause seizures)

87
Q

Ginkgo induces CYP___

A

2C19

88
Q

Use of Melatonin

A
  • Jetlag

- Insomnia

89
Q

Mechanism of action of melatonin

A
  • Natural hormone secreted from pineal gland

- Regulates circadian rhythms

90
Q

Dosing of melatonin for insomnia

A

2-3 mg QHS

91
Q

Uses of Valerian

A

Insomnia

92
Q

Mechanism of action of Valerian

A

May increase GABA activity in the CNS by inhibiting enzymes that metabolizes GABA

Benzodiazepine-like effects

93
Q

How does Valerian compare to benzodiazepines in treating insomnia

A

It is not as fast as benzodiazepines

94
Q

Adverse Effects of Valerian

A
  • Headache
  • Nervousness
  • Excitability
  • Hepatotoxicity (rare)
95
Q

Valerian may take ____ for full effect

A

a few days to weeks

96
Q

When discontinuing Valerian

A

medication should be tapered

97
Q

Uses for Glucosamine

A

Osteoarthritis

98
Q

Glucosamine sulfate: improves pain and functionality for osteoarthritis of the __ when used for >__ weeks

A

knee; 4

99
Q

Glucosamine shows no improvement in osteoarthritis of the ___

A

hip

100
Q

Adverse effects of Glucosamine

A

Mild GI complaints

101
Q

Glucosamine interacts with

A

Warfarin (increased INR)

shellfish allergy

102
Q

Glucosamine is derived from the exoskeletons of

A

shrimp, lobster, and crabs or made synthetically

103
Q

Uses of Saw Palmetto

A

BPH (Benign prostatic hyperplasia)

104
Q

Adverse Effects of Saw Palmetto

A
  • Dizziness
  • Headache
  • Decreased libido
  • GI complaints
105
Q

Saw Palmetto interactions

A

prolonged bleeding time

106
Q

Mechanism of action of Saw Palmetto

A
  • Antiandrogenic
  • Anti proliferative
  • Anti-inflammatory
  • 5-alpha reductase activity
107
Q

How does Saw Palmetto compare in effectiveness to 5-alpha reductase inhibitors

A

may be similar in relieving BPH symptoms

108
Q

How does Saw Palmetto compare in effectiveness to Alpha 1 blockers

A

Saw Palmetto is less effective for urinary symptoms and reducing prostate volume

109
Q

Saw Palmetto is likely ___ for BPH

A

ineffective

110
Q

Uses of Cranberry

A

urinary tract infections

111
Q

Mechanism of action of cranberry

A
  • acidification of urine

- prevents bacterial adhesion to urinary tract walls (UROEPITHELIAL) CELLS

112
Q

Which mechanism of action contributes to cranberry effectiveness in treating UTIs

A

preventing bacterial adhesion to urinary tract walls

113
Q

How effective is cranberry in treating UTIs

A

not effective

114
Q

Cranberry could be effective in prevention of UTIs, decreasing risk by

A

1/3

115
Q

Cranberry interactions

A

Warfarin (increases INR)

May inhibit CYP3A4

CDM 1 (15 decks)

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