Term 1 Pharm - Herbal Medicine Flashcards
What type of medicine worldwide do most people have access to?
Traditional plant-based medicines are the only treatments available for much of the world
In 2003 WHO reports
Digoxin is made from what plant?
Foxglove
Artemisinin
Qinghaosu
Effective against all the malaria-causing protozoal organisms
NaturalProducts (“dietary supplements”)
- Herbs (botanicals, phytochemicals)
- Vitamins and minerals
- Probiotics
Mind and BodyPractices
- Acupuncture
- Massage therapy
- Meditation techniques
mindfulness meditation, transcendental meditation - Movement therapies
Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, and Trager psychophysical integration. - Relaxation techniques
Breathing exercises, guided imagery, and progressive muscle relaxation - Spinal manipulation
- Tai chi and qi gong; Yoga
- Healing touch; Hypnotherapy
Herbal medicine makes how much peryear
$14.8 billion
Main group of dietary/supplemental use:
Rich, white, insured, who exercise & don’t smoke
Why is herbal medicine popular?
- Viewed as “natural”, and therefore relatively safe with few side effects (compared to synthetic drugs)
- Perceived as validated through traditional usage over generations
- Considered a lower cost alternative to conventional medicine
- Avoids the stress/fear/discomfort of visiting a physician or health care professional
Internet resources for herbal medicine
Resources to assess safety & efficacy
- NCCIH – National Center for Complementary & Integrative Health (Within NIH; formerly NCCAM)
- ODS – Office of Dietary Dietary Supplements (Within NIH)
- MedlinePlus
- PubMed
General concerns regarding
most herbal medicines?
- Can directly cause adverse effects
- Can indirectly interfere with conventional pharmacological treatments through herb-drug interactions
- Absence of definitive proof of efficacy
- Limited number/quality of controlled clinical trials
Concerns pertaining to commercial preparation:
- Are often mixtures containing many compounds
- May lack standardized active ingredients, or have inconsistent composition or formulation (batch to batch variation)
- Some commercial products may contain adulterants, impurities or contaminants
Ephedra
- Active components are ephedrine & pseudo ephedrine
- In combination with caffeine, ephedra appears to facilitate weight loss
- Adverse effects were observed: high blood pressure, tachycardia, CNS excitation, arrhythmia, myocardial infarction and stroke
- In 2004, the FDA banned the sale of dietary supplements containing ephedrine in the US…Most evidence around the risks associated with ephedra use is based on higher doses or combination use with caffeine.
Adverse effects may be slow to
manifest themselves.
Aristolochia, or birthwort, has been used for centuries in traditional medicine in China (and ancient Greece before that) to treat arthritis and ease childbirth, among other conditions.
Aristolochic acid, a compound found in birthwort, is linked to what type if disease?
Urinary Tract Cancer
Herbal medicines share the same drug metabolizing enzymes and drug transporters with several clinically important drugs, what are some of these?
- cytochrome P450 enzymes (CYPs)
- UDP-glucuronosyl transferases (UGTs)
- P-glycoprotein (P-gp)
(Herb-drug interactions can significantly alter pharmacokinetic properties of administered drugs, which occur when absorption, distribution, metabolism, and elimination (ADME) of drugs are altered
Primarily based on inhibition and/or induction of the metabolic enzymes CYPs and UGTs, and drug transporter P-gp)
Cyclosporine interferes with which drug?
St. John’s wort
What is the rating system for the safety of supplements?
LIKELY SAFE = The product has undergone a rigorous scientific evaluation equivalent to a review by the FDA, Health Canada, or other governmental authority and has been found to be safe when used appropriately. Or reputable references generally agree that the product is safe when used appropriately based on two or more randomized, controlled, clinical trials involving several hundred to several thousand patients and published in refereed journals; or based on large-scale post-marketing surveillance showing a low incidence of significant adverse effects.
POSSIBLY SAFE = Reputable references agree that the product might be safe when used appropriately, and there are human studies reporting no serious adverse effects.
POSSIBLY UNSAFE = There is some evidence suggesting that use of the product might be unsafe.
LIKELY UNSAFE = Reputable references agree that the product can be harmful, based on human studies or reliable case reports of significant adverse effects.
UNSAFE = The product has undergone a rigorous scientific evaluation or a review by a reliable regulatory agency and found to often cause clinically significant harm to humans. Or large-scale post-marketing surveillance shows a high incidence of significant adverse effects.
