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D&T 4, Exam 3 (Liver) > Valentovic - Herbal Products > Flashcards

Valentovic - Herbal Products Flashcards

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1
Q

Herbal Agents that became drugs

Drug Natural Agent Clinical Purpose

Aspirin ____________ _____________

Digitalis ____________ _____________

Morphine . ____________ . ______________

Placlitaxel . _____________ ______________

Eribuline ____________ ______________

A
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2
Q

True or False: Herbal products are included in government regulation by the US Food, Drug and Cosmetic Act.

A

False - excluded!!

No standard for efficacy, safety, validation!

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3
Q

Fact: Herbals…

  • cannot claim for cure or treatment of disease
  • CAN SAY they improve, support, promotes, etc…
A
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4
Q

Fact: Complexity of Herbal Preps

  • Herbs are not uniform in nature
  • Active ingredient varies with climate, soil and fertilization
  • Herbs contain a complex of ingredients
  • Herb product activity dependent on family of compounds
  • Multiple components may have synergistic effect
A
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5
Q

What herb?

  • marketed for Cardiovascular action
  • lowering cholesterol
  • preventing heart attack
  • contains allin converted to allicin by allinase in plant and GI tract
  • crushing releases ____________ (found in garlic capsules, chopped garlic and cold extracted garlic in vegetable oil)
  • heat volatilizes thiosulfinate compound and diallyl sulfides releasing in to air
A

Garlic

Allinase

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6
Q

Effects of what Herb?

  • lowers cholesterol (6-12%) –> comparable to Cholestyramine
  • 900 mg/day powder or 1 clove
  • HMG CoA reductase inhibitor*
  • *-inhibits Platelet aggregation** –> similar to Ibuprofen (reversible inhibitor)
  • ingredients: ajoene (allicin metabolism) and diallyl trisulfiide
  • inhibit platelet COX**
  • reduces platelet TXA2 generation**
A

Garlic

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7
Q

When utilizing high doses (4 cloves/day) Garlic herbal supplements, it is important to be cautious of using in combination with __________ drugs.

Chopped garlic in oil needs to be stored in refrigerator. Why?

A

antiplatelet drugs

Clostridium infection

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8
Q

What herbal supplement?

  • marketed to improve vasculature (decrease leg fatigue and pain)
  • -> Varicose Veins (Venostat)

-Activity attributed to Saponins

Good Herb: Escin - decreases capillary edema/pain

Bad Herb: Aesculin - adverse effects, similar to Warfarin, potential for bleeding; anti-coagulant

A

Horse Chestnut

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9
Q

Horse Chestnut

Good Herb: __________ (standardized to 16.7%)

  • reduces leg pain (4x) and swelling (p<0.05)
  • decreases vascular permeability of venous capillaries

Bad Herb: __________

  • anticoagulant
  • similar to hydroxycoumarin (Warfarin)
  • bleeding gums, nose, etc.
A

Escin

Aesculin

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10
Q

What are contraindications for Horse Chestnut?

1.

2.

3.

A
  1. Anticoagulants (Warfarin), NSAIDS –> increased bleeding
  2. Pregnancy (Category X)
  3. Breast Feeding
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11
Q

What herbal supplement?

  • sharpens mental focus
  • improves cerebral circulation
  • improves peripheral circulation (perfusion of capillaries)
  • standardized for ginkgo flavonglycosides (active ingredients: quercetin, kaempferol, isorhamnetine)
A

Ginko

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12
Q

Effects of ________

Cardiovascular: improves blood flow in skin (brain?)

CNS
-Kaempferol
-anti-oxidant reduces free radical damage, may slow aging and improve
mental focus
-improves utilization of ATP and glucose in brain
-slows cancer cells in Ovarian cancer

-Kaempferol & Apigenin: inhibitors of MAO-A and MAO-B

A

Ginki

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13
Q

What is the major adverse effect of Ginko?

A

Bleeding (bleeding times can double)

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14
Q

Adverse Effects of what Herb?

-Major adverse effect is bleeding (Bleeding times can double)

-Drug Interactions with increased risk of bleeding*****
◦ Inhibits platelet activating factor
◦ Aspirin, NSAIDs (inhibit platelet function)
◦ Warfarin and heparin
◦ Platelet IIb/IIIa receptor antagonists (Clopidogrel)

-Lethal Ingestion of ginko seeds (contain ginkotoxin) results in seizures and death –> neurotoxin
◦ ginkotoxin (4’-O-Methylpyridoxine) - antimetabolite
◦ Anti-vitamin B6 interferes with amino acid metabolism

A

Ginko

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15
Q

What Herbal Supplement?

  • Improving Mood (Depression)
  • Sleep Disorders
  • Weight Loss
  • Standardized for Hypericin and Hyperforin (active components)
A

St. John’s Wort

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16
Q

What Herb?

-mediated by multiple mechanisms d/t neurotransmitters are altered

  • Serotonin re-uptake inhibitor –> mood benefit
  • dependent on Hyperforin
  • MAO inhibition
  • Hypericin and Hyperforin
  • SSRI > MAO inhibitor
  • Activation of GABA
  • inhibited by Flumazenil (given for BZD overdose)
A

St. John’s Wort

17
Q

Fact: St. John’s Wort

  • *Alcohol Extract is best for anti-depressant action**
  • minimum of 3% hyperforin and/or .3% hypericin (FYI)

Effective for Mild Depression ONLY

A
18
Q

Side Effects of what herb?

-Side effects
◦ Headache and loss of appetite

-Should not be taken with
◦ MAO inhibitors
◦ Selective serotonin re-uptake inhibitors (SSRIs)

-Induces P450 isozyme Cyp 3A4********
◦ May need to increase dose of oral contraceptives, theophylline, warfarin

A

St. John’s Wort

19
Q

What Herbal supplement?

for INSOMIA

Active ingredients: Valerenic Acid, Valtrate, Glutamine

  • binds to GABA-A receptor (similar to BZD)
  • GABA opens the Cl- channel, hyperpolization and decreased neuronal activity

Major Side Effect: Sedation

A

Valerian

20
Q

What Herbal Supplement?

  • Capsules, tablets, tea alcohol extracts
  • lessens symptoms of colds, flu and infections
  • stimulates phagocytosis and chemotaxis
  • alcohol extract better than water extract
  • action on the immune system
  • Arabinogalactan releases IL-1 and TNFa
  • Heteroxylan stimulates PMN phagocytosis
A

Echinacea

21
Q

True or False: Echinacea prevents colds.

A

FALSE!! Does NOT prevent colds, but people say they felt better during colds (less congestion, lethargy and cough)

22
Q

Side Effects of what Herb?

  • avoid use if allergic to plants in the daisy or ragweed family
  • avoid use with IMMUNOSUPPRESSANTS (Azathioprine, Corticosteroids, Cyclosporine)
A

Echinacea

23
Q

What Herbal supplement?

  • improve health of prostate
  • diuretic effect
  • active component in berries
  • inhibitor of 5alpha-reductase
  • inhibits conversion of testosterone –> dihydrotestosterone (active test molecule in the body)

-may block the translocation of the cytosol androgen receptor when bound to DHT in to the nucleus

A

Saw Palmetto

24
Q

What drug is used in comparison to Saw Palmetto?

A

Finasteride (5alpha-reductase inhibitor)

25
Q

Fact.

A
26
Q

What Herbal Supplement?

  • anti-oxidant, anti-aging, anti-cancer, adaptogen
  • most active ingredients: Ginsenosides
  • *-Cardiovascular**
  • Lipid lowering and increases HDL (red)
  • Panax ginseng inhibits platelet aggregation (preventing MI)

-Stimulate nitric oxide production (vasodilators = improved blood flow)

  • *-Adaptogen**
  • reduces cortisol and neurotransmitters during stress
A

Ginseng

27
Q

What herbal supplement?

-Anti-cancer
◦ Lower incidence of stomach and colon cancer with use
◦ Inhibits tumor growth, stimulates apoptosis of cancer cells

-Immune system
◦ Improves chemotaxis of PMNs
◦ Stimulates interferon production

-Endocrine
◦ Improves glycemic control in diabetics
- Promotes glycogen storage (glucose –> glycogen storage)
- 10% improvement in blood glucose

A

Ginseng

28
Q

Fact: Ginseng Adverse Effects

  • *-Nervousness, Insomia**
  • avoid use with caffeine
  • *-Ginseng Abuse Syndrome**
  • insomnia, nervous, excitable
A
29
Q

What Herbal Supplement?

  • used for sedation*** and relaxation as an alternate to alcohol
  • originated in the South Pacific
  • interaction with GABA receptors

SIDE EFFECTS: Hepatic Toxicity (FDA BLACK BOX WARNING)****
sedation - do NOT mix with alcohol, BZD
Yellow pigmentatio to skin (eyelids) and nails

A

Kava

30
Q

What is the Herbal Supplement?

  • *-migrane relief
  • arthritis pain**
  • leaves contain sesquiterpene lactones
  • active component: parthenolide
  • inhibits phospholipase A2 (rate limiting step in release of Arachadonic acid from membrane phospholipids)
  • lower PGs
  • lower leukotriene production
  • inhibits platelet serotonin release
  • part of the initiation phase of migrane
  • alternate to drug therapy, not more effective for prevention
A

Feverfew

31
Q

Adverse effects of what herb?

  • Joint pain, muscle aches, insomnia when abruptly stopped
  • Causes uterine contraction DO NOT use in pregnancy****
  • Menstrual irregularities and heavier blood flow
A

Feverfew

32
Q

Herbs Products to Avoid Prior to Surgery:

_________: inhibits platelet aggregation (ajoene and diallyl trisulfide)

_________: aesculin similar to Warfarin

_________: increases bleeding times

_________: induces P450 metabolism affecting drugs taken administered during surgery

_________: affecting phospholipase and metabolism; lipoxygenase pathway helps with chemotaxis and infection; inhibitor of CYP2C9

A

Garlic

Horse Chestnut

Ginko Biloba

St. John’s Wort

Feverfew

33
Q

2 Herbs to Avoid when taking MAO Inhibitors or Serotonin Re-uptake Inhibitors?

A

St. John’s Wort

Valerian

34
Q

2 Herbs to Avoid with Alcohol, increased additive sedation?

A
  1. Valerian
  2. Kava
35
Q

Which of the following herbal agents could increase the clearance of indinavir, an HIV protease?

A. Echinacea
B. Feverfew
C. Garlic

D. St. John’s Wort

E. Saw Palmetto

A

St. John’s Wort, a CYP450 inducer

36
Q

Which ingredient in horse chestnut is responsible for reducing leg pain?

A. Ajoene
B. Aesculin
C. Escin
D. Heteroxylan

E. Parthenolide

A

A. Ajoene (antiplatelet agent in garlic)

B. Aesculin (coumarin like agent in horse chestnut)

C. Escin

D. Heteroxylan (stimulates phagocytosis-echinacea)

E. Parthenolide (feverfew inhibitor of platelet serotonin release)

D&T 4, Exam 3 (Liver) (19 decks)

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