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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
Flaxseed may take __ to ___ months to see any beneficial effect
1 to 2
26
Adverse effects of Flaxseed
- Bloating - Flatulence - Abdominal pain - Diarrhea
27
Herbal supplements used for weight loss
Caffeine, Ephedra, Bitter Orange, Garcinia, Acai
28
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)
29
Use of Ephedra
Weight loss
30
Adverse effects of Ephedra
- Heart Attack - Arrhythmia - Stroke - Psychosis - Seizures - Death
31
Adverse effects of Caffeine
- Increased heart rate - Increased BP - Diuretic effects - mental acuity
32
Adverse effects of Bitter Orange
- May prolong QT-interval | - Caution in anyone with hypertension or heart disease
33
Bitter Orange is a derivative of
ephedrine
34
Professional sports and Olympic Committee banned the use of ___ and ___ by athletes
ephedrine and derivaties
35
Use of Garcinia Cambogia
weight loss
36
Efficacy of Garcinia Cambogia
2020 Review of 11 studies found no significant effect on weight loss
37
Adverse effects of Garcinia Cambogia
- Generally mild GI - Liver toxicity requiring transplant - -> abdominal pain, jaundice, fatigue, confusion
38
What is the active ingredient in Garcinia Cambogia?
Hydroxycitric acid (HCA)
39
Uses of Acai
weight loss | anti-aging
40
Adverse effects of Acai
- Generally, well tolerated | - Chagas disease (parasitic protozoan) from contaminated raw fruit and juice
41
Effectiveness of Acai
Insufficient evidence
42
Who could be harmed by the use of immunostimulants?
- Patients with allergies - Autoimmune conditions - People on immunosuppressants
43
Herbs that have possible immunostimulant effects
- Echinacea - Garlic - Ginseng - Goldenseal
44
Uses of Echinacea
- Common cold | - Upper respiratory infections
45
Echinacea has limited benefit for ___ of a cold but does not effect ___ of a cold
prevention; length (does not shorten)
46
Adverse effects of Echinacea
- GI: nausea, vomiting, upset stomach - Rash (especially in children) - Allergic reactions
47
Echinacea should be avoided in patients with
- ragweed allergy, history of asthma, atopy, or allergic rhinitis - autoimmune disorders
48
Uses of Ginseng
- General well being - Immune stimulant - Sexual dysfunction
49
The species of ginseng we are focused on is
Panax ginseng
50
Adverse effects of Ginseng
- Insomnia - Headache - Estrogenic effects (mastalgia, amenorrhea, vaginal bleeding) -rare
51
Two interactions of Ginseng are
- Increased risk of bleeding - -> anti-platelet agents - -> anticoagulants - Diabetes medications - -> Hypoglycemia
52
What herbal supplements are used for cardiovascular health
Fish oil, Garlic, Soy
53
Two omega-3 fatty acids found in fish oil
Eicosapentaenoic acid (EPA) ``` Docosahexaenoic acid (DHA) --> lower triglycerides ```
54
Uses of Fish Oil
- Hyperlipidemia - Cardiovascular disease - Heart Failure - Mental development (infants)
55
How does fish oil effect hyperlipidemia
Decreases TG- high doses, Rx
56
How does fish oil effect Cardiovascular disease
Reduces Blood Pressure (2-5 SBP/1-3 DBP)
57
How does fish oil effect heart failure
Dietary fish oil reduces risk of chronic heart failure by 15%
58
The AHA recommends ___ servings/week, non-fried fish in place of other proteins
2
59
Greater than __g of fish oil can inhibit platelet aggregation
3
60
Adverse effects of fish oil
- "Fishy burp" - Halitosis - Heartburn - Loose stools - Increased LDL
61
Uses of Garlic
- Cholesterol | - Hypertension
62
Adverse effects of garlic
- Heartburn - Flatulence - Nausea/vomiting - Contact dermatitis
63
Garlic interacts with
Anti-platelet agents and anticoagulants Induces p-gp efflux pump
64
How often do you have to take garlic to see clinical benefits
must take daily for >2 months
65
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
66
Health Claim: Consuming ___ grams of soy protein per day reduces risk of heart disease
25
67
Herbal supplements that effect neurologic/psychologic function
St. John's wort, SAMe, Ginkgo, Melatonin, Valerian
68
Mechanism of action of St. John's Wort
-inhibits re-uptake of serotonin, norepinephrine, dopamine Similar to SSRI, SNRI -GABA effects
69
Is St. John's Wort effective in treating depression
mixed results in treating mild-moderate depression high placebo effect
70
Uses of St. John's Wort
Mild-moderate depression
71
How long does it take to see maximal effect of St. John's Wort
3-4 weeks
72
Why do you need to taper when discontinnuing St. John's Wort
To avoid withdrawal effects
73
Adverse Effects of St. John's Wort
- Dizziness - Insomnia - Vivid dreams - Restlessness - Fatigue - Dry mouth - Photosensitivity (5-10mg hypericin)
74
St. John's Wort is a potent inducer of
3A4, P-gp examples: Digoxin, Benzodiazepines, Oral Contraceptives, Phenytoin, Protease inhibitors, NNRTI's Warfarin
75
St. John's Wort is a mild inducer of
1A2, 2C9, 2C19
76
St. John's Wort also interacts with other ___ medications
serotonergic
77
Mechanism of action for SAMe (S-adenosyl-L-methionine)
increases serotonin, norepinephrine, and dopamine levels
78
How effective is SAMe
insufficient evidence of effectiveness
79
Adverse effects of SAMe
- Headache - Dry Mouth - Insomnia - N/V, diarrhea
80
The two concerns about the use of SAMe are ___ and ___
product quality; cost
81
Use of SAMe
depression
82
Uses of Ginkgo
- Dementia | - Peripheral arterial disease
83
Effectiveness of Ginkgo in the treatment of dementia
improves cognitive symptoms but no benefit in slowing or preventing the disease
84
Adverse effects of Ginkgo
Allergic Reactions (poison oak, poison ivy or mango rind)
85
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
86
Ginkgo should not be taken with medications that lower what
the seizure threshold (ginkgo toxin from seeds can cause seizures)
87
Ginkgo induces CYP___
2C19
88
Use of Melatonin
- Jetlag | - Insomnia
89
Mechanism of action of melatonin
- Natural hormone secreted from pineal gland | - Regulates circadian rhythms
90
Dosing of melatonin for insomnia
2-3 mg QHS
91
Uses of Valerian
Insomnia
92
Mechanism of action of Valerian
May increase GABA activity in the CNS by inhibiting enzymes that metabolizes GABA Benzodiazepine-like effects
93
How does Valerian compare to benzodiazepines in treating insomnia
It is not as fast as benzodiazepines
94
Adverse Effects of Valerian
- Headache - Nervousness - Excitability - Hepatotoxicity (rare)
95
Valerian may take ____ for full effect
a few days to weeks
96
When discontinuing Valerian
medication should be tapered
97
Uses for Glucosamine
Osteoarthritis
98
Glucosamine sulfate: improves pain and functionality for osteoarthritis of the __ when used for >__ weeks
knee; 4
99
Glucosamine shows no improvement in osteoarthritis of the ___
hip
100
Adverse effects of Glucosamine
Mild GI complaints
101
Glucosamine interacts with
Warfarin (increased INR) shellfish allergy
102
Glucosamine is derived from the exoskeletons of
shrimp, lobster, and crabs or made synthetically
103
Uses of Saw Palmetto
BPH (Benign prostatic hyperplasia)
104
Adverse Effects of Saw Palmetto
- Dizziness - Headache - Decreased libido - GI complaints
105
Saw Palmetto interactions
prolonged bleeding time
106
Mechanism of action of Saw Palmetto
- Antiandrogenic - Anti proliferative - Anti-inflammatory - 5-alpha reductase activity
107
How does Saw Palmetto compare in effectiveness to 5-alpha reductase inhibitors
may be similar in relieving BPH symptoms
108
How does Saw Palmetto compare in effectiveness to Alpha 1 blockers
Saw Palmetto is less effective for urinary symptoms and reducing prostate volume
109
Saw Palmetto is likely ___ for BPH
ineffective
110
Uses of Cranberry
urinary tract infections
111
Mechanism of action of cranberry
- acidification of urine | - prevents bacterial adhesion to urinary tract walls (UROEPITHELIAL) CELLS
112
Which mechanism of action contributes to cranberry effectiveness in treating UTIs
preventing bacterial adhesion to urinary tract walls
113
How effective is cranberry in treating UTIs
not effective
114
Cranberry could be effective in prevention of UTIs, decreasing risk by
1/3
115
Cranberry interactions
Warfarin (increases INR) May inhibit CYP3A4

CDM 1 (15 decks)

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