Test 4: 50 herbals

Question 1

pts with kidney disease should use caution when using

Answer 1

parsley- can irritate/damage renal epithelium

licorice root: mineralocorticoid effects: sodium and water retention and potassium loss (leading to HTN, edema and hypokalemia)

Question 2

What herbals not for pt with autoimmune disease

Answer 2

echinacea, reishi & maitake mushrooms, astragalus

Question 3

pt with liver disease should not use — herbal

Answer 3

eucalyptus: – Induces liver enzyme activity

Used for respiratory tract inflammation

Question 4

pts with thyroid disease should avoid

Answer 4

Kelp: may contain iodine and result in either hyper OR hypothyroidism

Bugleweed (gypsy wort): may cause a potentially harmful decrease in thyroid function

Question 5

pyrrolizidine alkaloids result in — disease

Answer 5

hepatovenocclusive

(cause closing of small veins in the liver)

Question 6

what can make senecio’s pyrrolizidine more toxic

Answer 6

time of year
geography
storage conditions and length (decreases over time)

pyrrolizidine alkaloids: cause hepatovenocclusive disease

Question 7

what is white willow bark similar to

Answer 7

Aspirin

do not give to cats

Question 8

what are adulterants

Answer 8

meds added to “herbals” and not put on list of ingredients

Question 9

garlic, ginkgo and ginseng can interact with

Answer 9

warfarin and cause increased bleeding

Question 10

kava can interact with

Answer 10

alprazolam and cause sedation

Question 11

st john’s wart can interact with

Answer 11

Paroxetine: serotonin syndrome
Warfarin: decrease in clotting activity
Digoxin: reduced plasma concentrations

Question 12

pennyroyal oil works by

Answer 12

Causes direct damage to target cellular proteins and depletes hepatic glutathione levels

used for:
* orally: abortifacient, digestive tonic, diuretic;
* topically: insect repellant, antiseptic

Question 13

clinical signs of pennyroyal oil toxicity

Answer 13

Depletes hepatic glutathione levels and causes direct cellular damage similar to acetaminophen toxicity

Large doses: miscarriage, irreversible kidney damage, hepatic damage, and death

Topically, pennyroyal can cause a urticarial rash and dermatitis

Question 14

treatment of pennyroyal toxicity

Answer 14

decontamination and symptomatic supportive care.

Possibly n-acetylcysteine. (NAC)

Question 15

white willow bark works by

Answer 15

may have analgesic, anti- inflammatory, and antipyretic effects. Willow bark inhibits platelet aggregation, but to a lesser degree than aspirin.

Question 16

clinical signs of white willow bark toxicity

Answer 16

GI upset, salicylate poisoning (e.g., CNS toxicity, acid-base disturbances, fluid and electrolyte imbalances, coagulopathy)

Cats are especially sensitive to salicylates (aspirins)

CNS depression, vomiting, GI hemorrhage, hyperpnea, pyrexia

Question 17

treatment for white willow bark toxicity

Answer 17

decontamination, symptomatic supportive care, sodium bicarbonate

Question 18

garlic MOA

Answer 18

inhibits platelet function, increases fibrinolytic activity, decreases blood lipid levels, lowers blood sugar

herbal use: infections, heartworm treatment, flea repellant (po), general health tonic

Question 19

clinical signs of garlic toxicity

Answer 19

affect GI, hematopoietic
system → GI irritation, platelet dysfunction (bleeding)

Cats are especially at risk for Heinz body anemia

Question 20

treatment of garlic toxicity

Answer 20

decontamination and
symptomatic supportive care

Question 21

clinical signs of tea tree oil (melaleuca) toxicity

Answer 21

ataxia, incoordination, weakness, tremors, altered behavior

Question 22

MOA of comfrey

Answer 22

binds to proteins, DNA and RNA
causing cell damage and death. May be carcinogenic.

Uses: (topically): wound healing, joint inflammation; GI upset, cough, cancer

pyrrolizidine alkaloid that oral use was banned by FDA

Question 23

clinical signs of comfrey toxicity

Answer 23

hepatic failure

Question 24

treatment of comfrey toxicity

Answer 24

decontamination and symptomatic supportive care. Early use of n-acetylcysteine may be of benefit.

Question 25

MOA of st johns wort

Answer 25

natures prozac

inhibits monoamine oxidase and serotonin reuptake (similar to SSRIs or MAOIs); topically: inhibits epidermal inflammatory response

Uses: anti-inflammatory (topically), phobias, anxiety, depression

Question 26

st john’s wort toxicity

Answer 26

affects uptake of serotonin and monoamine oxidase

photosensitivity, serotonin syndrome (muscle rigidity, confusion, diarrhea, HTN, tachycardia)

Many drug interactions

Question 27

MOA of kava kava

Answer 27

may act as a central dopaminergic receptor antagonist; local anesthetic

used for anxiety

acts as sedative

Question 28

clinical signs of kava kava toxicity

Answer 28

hepatic failure (unknown mechanism), alteration of CNS transmission

ataxia, sedation, extrapyramidal effects, jaundice, fatigue, elevated LFTs

germany, UK and Canada have banned kava due to risks of liver toxicity

Question 29

treatment of kava kava toxicity

Answer 29

decontamination and
symptomatic supportive care

Germany, UK and Canada have banned kava due to risks of liver toxicity