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Advanced Pharm Exam 2 > Week 7 Herbals and Opioids > Flashcards

Week 7 Herbals and Opioids Flashcards

1
Q

T/F individuals with little education and low socioeconomic status commonly use supplements

A

False, most individuals who use supplements have a higher income and education

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2
Q

What plant was morphine isolated from?

A

opium

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3
Q

What plant was digitalis derived from?

A

purple fox glove

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4
Q

What plant was atropine derived from?

A

Belladonna

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5
Q

How many individuals use herbal medications?

A

1:3 or 5 adults

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6
Q

There has been a recent increase in the use of:

A

CBD oils

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7
Q

Why are supplements referred to as “dietary supplements” and not medications?

A

the lack of testing and regulation by the FDA

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8
Q

What percent of supplements are actually tested?

A

1%

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9
Q

When should supplements be discontinued prior to surgery?

A

at least two weeks

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10
Q

What percent of patients actually disclose the use of herbals?

A

30%

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11
Q

What herbal supplement can cause hypertension?

A

Ephedra

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12
Q

What herbal supplement most commonly causes coagulopathies?

A

Gingko

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13
Q

What are the indirect health effects of using herbal supplements?

A

contaminants such as mercury, arsenic, lead, heavy metals
variation in potency
decreased concentration of conventional medications

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14
Q

Does herbal medicine induce or inhibit CYP450 enzyme?

A

BOTH/EITHER

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15
Q

What causes patients to refrain from disclosing herbal usage?

A

not medicine
“all natural”
fear of reaction
fear of healthcare bias

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16
Q

Herbal medicine is very common in which two cultures?

A

native american
asian

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17
Q

What is belladona used for?

A

anticholinergic

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18
Q

What is cocaine derived from?

A

Erythozylon coca- local anesthetic

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19
Q

What cause chondrodendon cause?

A

NMB

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20
Q

What is foxglove used for?

A

antiarrythmic effects

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21
Q

What is ephedrine used for?

A

CNS stimulant

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22
Q

What is datura metel used for?

A

Scopolamine alternative/ Anti-emetic

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23
Q

What are the effects of Dong quai on platlets?

A

decreases activation

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24
Q

what is the indication for Dong Quai?

A

migraines, anemia, hypertension, menstrual cramping

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25
Q

Dong Quai is made of an herb used for:

A

anticoagulation/coumadin derivative

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26
Q

Dong quai can also cause:

A

antithrombotic, antiarrythmic, phototoxic, and carcenogenic effects

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27
Q

What is echinachea used for?

A

Treats viral, bacterial, and fungal URIs by modulating cytokine signaling and stimulation of macrophages and NK cewlls

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28
Q

What are the effects of echinachea on wound healing?

A

Treats chronic wounds and arthritis

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29
Q

What does echinachea work well with?

A

decreases Chemo drug side effects

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30
Q

What are the adverse effects of echinachea?

A

unpleasent taste, GI upset, headache, dizziness

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31
Q

Why is echinachea contraindicated in a renal transplant patient?

A

it can cause acute rejection

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32
Q

Patients with SLE, HIV, cancer, and rheumatoid arthritis should not take:

A

echinachea

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33
Q

Does echinachea inhibit or induce CYP450 activity?

A

inhibits

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34
Q

greater than eight weeks of echinachea use can cause

A

immunosupression

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35
Q

Why was ephedra banned?

A

many deaths occured after using it

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36
Q

What are other names for ephedra?

A

herbal ecstasy, natural ecstasy, cloud 9, ultimate xyphoria

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37
Q

What does ephedra cause?

A

weight loss, increased energy, bronchodialation, treats URI

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38
Q

What is ephredra typically used to treat?

A

asthma and bronchitis
now: aphrodisiac, increases energy, decreases appetite

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39
Q

Prolonged use of ephedra can cause

A

Catecholamine depleted state: hemodynamic instability and tachyphylaxis

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40
Q

Adverse effects of ephedra:

A

palpatations, HTN, hyperthermia, seizures, stroke, MI, cardiomyopathy, vasoconstriction

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41
Q

How does ephedra cause stroke and mi?

A

Vasoconstriction can lead to coronary and cerebral artery vasospasm

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42
Q

Long term ephedra use in combination with halothane can cause:

A

myocardial hypersensitivity

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43
Q

What can occur with ephedra use in combination with an MAOI?

A

life threatening hypertension, hyperpyrexia, and coma

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44
Q

What is feverfew used for?

A

fever, migraines, and menstrual irregularities

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45
Q

What is a contraindication for feverfew usage?

A

chamomile, ragweed, and yarrow allergies

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46
Q

Can feverfew be taken by an individual also taking warfarin?

A

no, it inhibits platelet activity

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47
Q

What is an indication for ginger usage?

A

motion sickness, n/v, arthitis

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48
Q

What are adverse effects of ginger?

A

inhibits platelet aggregation
large quantities: CNS depression, potentiation of CCB

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49
Q

Why is garlic beneficial?

A

treats infection, tumor, diabetes, hypertension, hyperlipidemia, and atherosclerosis

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50
Q

What is the compound in garlic that is beneficial?

A

cystiene, allicin inhibits biosynthesis of cholesterol

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51
Q

What are adverse effects of garlic?

A

nausea, inhibits platelet aggregation, reduces blood sugar

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52
Q

What is the most expensive, popular herb?

A

ginseng

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53
Q

What is ginseng used for?

A

stimulant, tonic, diuretic, immunomodulation, mood elevation, increased vitality, hypoglycemia

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54
Q

What is the active part of ginseng?

A

ginsenoside- a glycosylated steroid

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55
Q

What is the MOA of ginseng?

A

augments adrenal steroidogenesis
increased IgG and IgM production
increased interferon production
enhanced NK and cell mediated

56
Q

What is the major ginseng drug interaction?

A

phenelzine- causes tremulousness and mania
Others: warfarin, heparin, ASA, NSAIDs

57
Q

cause in taking ginseng for individuals

A

with HTN, heart disease, or using stimulants

58
Q

What is the indication for Gingko biloba?

A

neuroprotective: treats alzheimers, memory loss, and multi infarct dementia
Peripheral vascular disease- decreases blood viscosity

59
Q

What is the MOA of gingko?

A

increases cholinergic transmission in the brain via anticholinesterase
also possibly a free radical scavenger

60
Q

How does gingko effect bleeding?

A

increases, by inhibiting platelet aggregation

61
Q

What are the side effects of gingko?

A

Gi upset, headache, bleeding

62
Q

What two drugs interact with gingko?

A

NSAIDs, and anticoagulants

63
Q

What are different terms for Kava?

A

tonga, intoxicating pepper, root of petter plant

64
Q

What is Kava for?

A

anxiolytic, sedative, sleep enhancer, anticonvulsant

65
Q

What is the MOA of kava?

A

inhibits Na and Ca channels to decrease SVR

66
Q

How does long term kava use affect anesthetic dose?

A

increases dose requirement

67
Q

What are adverse effects of kava?

A

increase effects of ETOH, barbiturates, and other drugs
can prolong anesthetic agents
kava dermopathy- scaly cutaneous lesions

68
Q

What is papain?

A

a digestive aid; treats infammatory disorders, hemorrhoids, worms, diarrhea, tumors, and URI

69
Q

Papain is contraindicated with what drug?

A

warfarin

70
Q

Why do people take saw palmetto?

A

BPH, diuretic, urinary antiseptic
interacts with Barbiturates

71
Q

What drug class does saw palmetto interact with?

A

barbiturates

72
Q

What is the MOA of saw palmetto?

A

inhibits estrogen receptors
prevents testosterone conversion
blocks prolactin
alpha1 antagonism
anti inflammatory effects

73
Q

What is St. john’s wort used for?

A

depression and anxiety

74
Q

What is the MOA of St. john wort?

A

inhibits serotonin reuptake
weakly inhibits monoamine oxidase A and B
inhibits norepi and dopamine reuptake

75
Q

What are the adverse effects of st john wort?

A

gi upset, dizziness, confusion, headache, photosensitivity

76
Q

What drugs should not be given with St johns wort?

A

tricyclic antidepressants, MAOIs, cyclosporin, and digoxin - messes up the levels

77
Q

How does St. Johns wort affect anesthesia?

A

can delay emergence

78
Q

What is valerian root?

A

herb used for anxiolytic, restlessness, and sleep aids

79
Q

Most all herbal sleep aids contain:

A

Valerian root

80
Q

What is the MOA of valerian?

A

is mediated by modulation of GABA

81
Q

Valerian root has prolonged effects when taken with:

A

Thiopental and pentobarbital

82
Q

Adverse effects of valerian root include:

A

Gi upset, headache, tremor, cardiac disturbances
Can potentiate effects of benzos

83
Q

T/F valerian root can be abruptly stopped the night before surgery

A

False, due to the fact that cessation can cause benzo like withdrawal symptoms, patient may need to do a taper to stop prior to surgery

84
Q

How does valerian root affect anesthesia?

A

delays emergence

85
Q

What is the indication for turmeric (curcumin longa)?

A

antioxidant and anti-inflammatory
possibly thrombolytic, anti-carcinogenic

86
Q

What is the indication for an individual to take turmeric after experiencing a CVA?

A

It has neuroprotective properties

87
Q

What herbal supplement can lower amyloid protein depositions?

A

Turmeric

88
Q

What type of drug interacts with turmeric?

A

antacid medications such as PPIs and H2A

89
Q

What is Garcinia cambogia?

A

tropical fruit rind used as herbal medicine

90
Q

What is garcinia used for?

A

weight loss, diabetes, hyperlipidemia

91
Q

What is a major adverse reaction to garcinia?

A

heptotoxicity

92
Q

What two supplements can cause hypertension?

A

ephedra and licorice

93
Q

What 3 supplements DO NOT increase bleeding risk?

A

increase clotting: ephedra, garcinia
no effect: St. John’s wort

94
Q

What supplements are hepatotoxic?

A

Echinacea, ephedra, saw palmetto, garcinia

95
Q

immunosuppressive vs immunostimulating

A

echinacea (long term use suppresses)
echinacea, garlic, st john wort, ginseng, garcinia

96
Q

Which supplements are immunostimulating?

A

echinacea, garlic, st john wort, ginseng, garcinia

97
Q

Which supplements induce CYP450?

A

garlic, st john wort, ginseng, and garcinia

98
Q

Which supplements inhibit MAO?

A

ephedra, st john wort

99
Q

What supplements can cause hypotension?

A

gingko, ginger, kava

100
Q

What two supplements can cause arrythmias?

A

ginger, garcinia

101
Q

What supplements can cause sedation?

A

ginger, st johns wort, saw palmetto, valerian, kava

102
Q

Which 5 supplements can cause delayed emergence?

A

St. John wort, Valerian root, Kava, ginger, saw palmetto

103
Q

What is an example of a chemically modified opiate?

A

oxycodone

104
Q

What is an example of a fully synthetic opioid?

A

fentanyl

105
Q

What are the opioid receptors?

A

Mu, delta, kappa

106
Q

What type of receptors are Mu receptors?

A

G-couples protein receptors

107
Q

What two factors lead to the development of an addiction?

A

genetic and environmental

108
Q

What is the “pleasure-repeat” pathway?

A

Mesdimbic pathway

109
Q

What are the effects of cAMP and mu receptors?

A

Activated Mu receptors bind to and decrease cAMP

110
Q

What two body systems experience withdrawal symptoms?

A

GI and Brain

111
Q

What type of receptors are inactivated by opioids: chemoreceptors or baroreceptors?

A

chemoreceptors

112
Q

What is the noncompetitive receptor antagonist used to treat opioid overdoses?

A

naloxone

113
Q

What are the effects of opiates on volatile anesthetics?

A

decreases MAC

114
Q

T/F: opioids always cause amnesia but not always unconciousness

A

False: they cause unconsciousness but not always amnesia

115
Q

What are two off label uses for opioids?

A

cough suppressant, antidiarrheal

116
Q

What is the difference between M1 and M2 receptors?

A

M1 is primarily responsible for analgesia, while M2 is responsible for respiratory depression, bradycardia, and dependance

117
Q

What does the kappa receptor do?

A

inhibits neurotransmission

118
Q

Why doesnt merperidine cause bradycardia?

A

it has an atropine like additive

119
Q

What are the two histamine releasing drugs that cause itching?

A

merperidine and morphine

120
Q

What can occur when mixing opioids with MAOIs?

A

seretonin toxicity

121
Q

What are s/s of seretonin toxicity?

A

fever, diapheresis, shivering, myoclonus, agitation, confusion, coma

122
Q

What is the #1 drug used to reverse opioid overdose?

A

naloxone: nonselective, works on all three receptors

123
Q

What are side effects of naloxone?

A

n/v, htn, tachy, dysrhythmias, pulmonary edema

124
Q

What is the dosage of naloxone?

A

1-4mcg/kg, redose 60-90mins

125
Q

What drug treats shivering?

A

merperodine

126
Q

What is fentanyl used for during induction?

A

to blunt sympathetic response to intubation

127
Q

What is unique about remifentanyl?

A

prevents movement without the use of a NMB when used as a gtt

128
Q

How early before the end of the case should sufentanyl be turned off?

A

30 minutes

129
Q

What is methadone composed of?

A

L methadone: opioid, R methadone: NMDA, longest half life of any opioid

130
Q

What are the effects of cannabis on the nervous system?

A

inhibits PNS, induces SNS

131
Q

What malignant arrhythmias can cannabinoids cause?

A

VTach, VFib, brugada pattern
sinus arrest in chronic use

132
Q

What are the effects of cannabis on thermoregulation?

A

decreases thermoregulation which can result in severe postoperative shivering

133
Q

How does cannabis effect bleeding tendencies?

A

increases bleeding by decreasing platelets and increasing clotting time

134
Q

What is the most common vascular side effect with cannabis use?

A

ischemic stroke

135
Q

How do steroids work in multimodal anesthesia?

A

reduces local inflammation triggered by afferent stimulation of the parasympathetic nervous system

Advanced Pharm Exam 2 (3 decks)

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