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
2
Q
What plant was morphine isolated from?
A
opium
3
Q
What plant was digitalis derived from?
A
purple fox glove
4
Q
What plant was atropine derived from?
A
Belladonna
5
Q
How many individuals use herbal medications?
A
1:3 or 5 adults
6
Q
There has been a recent increase in the use of:
A
CBD oils
7
Q
Why are supplements referred to as “dietary supplements” and not medications?
A
the lack of testing and regulation by the FDA
8
Q
What percent of supplements are actually tested?
A
1%
9
Q
When should supplements be discontinued prior to surgery?
A
at least two weeks
10
Q
What percent of patients actually disclose the use of herbals?
A
30%
11
Q
What herbal supplement can cause hypertension?
A
Ephedra
12
Q
What herbal supplement most commonly causes coagulopathies?
A
Gingko
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
14
Q
Does herbal medicine induce or inhibit CYP450 enzyme?
A
BOTH/EITHER
15
Q
What causes patients to refrain from disclosing herbal usage?
A
not medicine
“all natural”
fear of reaction
fear of healthcare bias
16
Q
Herbal medicine is very common in which two cultures?
A
native american
asian
17
Q
What is belladona used for?
A
anticholinergic
18
Q
What is cocaine derived from?
A
Erythozylon coca- local anesthetic
19
Q
What cause chondrodendon cause?
A
NMB
20
Q
What is foxglove used for?
A
antiarrythmic effects
21
Q
What is ephedrine used for?
A
CNS stimulant
22
Q
What is datura metel used for?
A
Scopolamine alternative/ Anti-emetic
23
Q
What are the effects of Dong quai on platlets?
A
decreases activation
24
Q
what is the indication for Dong Quai?
A
migraines, anemia, hypertension, menstrual cramping
25
Dong Quai is made of an herb used for:
anticoagulation/coumadin derivative
26
Dong quai can also cause:
antithrombotic, antiarrythmic, phototoxic, and carcenogenic effects
27
What is echinachea used for?
Treats viral, bacterial, and fungal URIs by modulating cytokine signaling and stimulation of macrophages and NK cewlls
28
What are the effects of echinachea on wound healing?
Treats chronic wounds and arthritis
29
What does echinachea work well with?
decreases Chemo drug side effects
30
What are the adverse effects of echinachea?
unpleasent taste, GI upset, headache, dizziness
31
Why is echinachea contraindicated in a renal transplant patient?
it can cause acute rejection
32
Patients with SLE, HIV, cancer, and rheumatoid arthritis should not take:
echinachea
33
Does echinachea inhibit or induce CYP450 activity?
inhibits
34
greater than eight weeks of echinachea use can cause
immunosupression
35
Why was ephedra banned?
many deaths occured after using it
36
What are other names for ephedra?
herbal ecstasy, natural ecstasy, cloud 9, ultimate xyphoria
37
What does ephedra cause?
weight loss, increased energy, bronchodialation, treats URI
38
What is ephredra typically used to treat?
asthma and bronchitis
now: aphrodisiac, increases energy, decreases appetite
39
Prolonged use of ephedra can cause
Catecholamine depleted state: hemodynamic instability and tachyphylaxis
40
Adverse effects of ephedra:
palpatations, HTN, hyperthermia, seizures, stroke, MI, cardiomyopathy, vasoconstriction
41
How does ephedra cause stroke and mi?
Vasoconstriction can lead to coronary and cerebral artery vasospasm
42
Long term ephedra use in combination with halothane can cause:
myocardial hypersensitivity
43
What can occur with ephedra use in combination with an MAOI?
life threatening hypertension, hyperpyrexia, and coma
44
What is feverfew used for?
fever, migraines, and menstrual irregularities
45
What is a contraindication for feverfew usage?
chamomile, ragweed, and yarrow allergies
46
Can feverfew be taken by an individual also taking warfarin?
no, it inhibits platelet activity
47
What is an indication for ginger usage?
motion sickness, n/v, arthitis
48
What are adverse effects of ginger?
inhibits platelet aggregation
large quantities: CNS depression, potentiation of CCB
49
Why is garlic beneficial?
treats infection, tumor, diabetes, hypertension, hyperlipidemia, and atherosclerosis
50
What is the compound in garlic that is beneficial?
cystiene, allicin inhibits biosynthesis of cholesterol
51
What are adverse effects of garlic?
nausea, inhibits platelet aggregation, reduces blood sugar
52
What is the most expensive, popular herb?
ginseng
53
What is ginseng used for?
stimulant, tonic, diuretic, immunomodulation, mood elevation, increased vitality, hypoglycemia
54
What is the active part of ginseng?
ginsenoside- a glycosylated steroid
55
What is the MOA of ginseng?
augments adrenal steroidogenesis
increased IgG and IgM production
increased interferon production
enhanced NK and cell mediated
56
What is the major ginseng drug interaction?
phenelzine- causes tremulousness and mania
Others: warfarin, heparin, ASA, NSAIDs
57
cause in taking ginseng for individuals
with HTN, heart disease, or using stimulants
58
What is the indication for Gingko biloba?
neuroprotective: treats alzheimers, memory loss, and multi infarct dementia
Peripheral vascular disease- decreases blood viscosity
59
What is the MOA of gingko?
increases cholinergic transmission in the brain via anticholinesterase
also possibly a free radical scavenger
60
How does gingko effect bleeding?
increases, by inhibiting platelet aggregation
61
What are the side effects of gingko?
Gi upset, headache, bleeding
62
What two drugs interact with gingko?
NSAIDs, and anticoagulants
63
What are different terms for Kava?
tonga, intoxicating pepper, root of petter plant
64
What is Kava for?
anxiolytic, sedative, sleep enhancer, anticonvulsant
65
What is the MOA of kava?
inhibits Na and Ca channels to decrease SVR
66
How does long term kava use affect anesthetic dose?
increases dose requirement
67
What are adverse effects of kava?
increase effects of ETOH, barbiturates, and other drugs
can prolong anesthetic agents
kava dermopathy- scaly cutaneous lesions
68
What is papain?
a digestive aid; treats infammatory disorders, hemorrhoids, worms, diarrhea, tumors, and URI
69
Papain is contraindicated with what drug?
warfarin
70
Why do people take saw palmetto?
BPH, diuretic, urinary antiseptic
*interacts with Barbiturates*
71
What drug class does saw palmetto interact with?
barbiturates
72
What is the MOA of saw palmetto?
inhibits estrogen receptors
prevents testosterone conversion
blocks prolactin
alpha1 antagonism
anti inflammatory effects
73
What is St. john's wort used for?
depression and anxiety
74
What is the MOA of St. john wort?
inhibits serotonin reuptake
weakly inhibits monoamine oxidase A and B
inhibits norepi and dopamine reuptake
75
What are the adverse effects of st john wort?
gi upset, dizziness, confusion, headache, photosensitivity
76
What drugs should not be given with St johns wort?
tricyclic antidepressants, MAOIs, cyclosporin, and digoxin - messes up the levels
77
How does St. Johns wort affect anesthesia?
can delay emergence
78
What is valerian root?
herb used for anxiolytic, restlessness, and sleep aids
79
Most all herbal sleep aids contain:
Valerian root
80
What is the MOA of valerian?
is mediated by modulation of GABA
81
Valerian root has prolonged effects when taken with:
Thiopental and pentobarbital
82
Adverse effects of valerian root include:
Gi upset, headache, tremor, cardiac disturbances
Can potentiate effects of benzos
83
T/F valerian root can be abruptly stopped the night before surgery
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
How does valerian root affect anesthesia?
delays emergence
85
What is the indication for turmeric (curcumin longa)?
antioxidant and anti-inflammatory
possibly thrombolytic, anti-carcinogenic
86
What is the indication for an individual to take turmeric after experiencing a CVA?
It has neuroprotective properties
87
What herbal supplement can lower amyloid protein depositions?
Turmeric
88
What type of drug interacts with turmeric?
antacid medications such as PPIs and H2A
89
What is Garcinia cambogia?
tropical fruit rind used as herbal medicine
90
What is garcinia used for?
weight loss, diabetes, hyperlipidemia
91
What is a major adverse reaction to garcinia?
heptotoxicity
92
What two supplements can cause hypertension?
ephedra and licorice
93
What 3 supplements **DO NOT** increase bleeding risk?
increase clotting: ephedra, garcinia
no effect: St. John's wort
94
What supplements are hepatotoxic?
Echinacea, ephedra, saw palmetto, garcinia
95
immunosuppressive vs immunostimulating
echinacea (long term use suppresses)
echinacea, garlic, st john wort, ginseng, garcinia
96
Which supplements are immunostimulating?
echinacea, garlic, st john wort, ginseng, garcinia
97
Which supplements induce CYP450?
garlic, st john wort, ginseng, and garcinia
98
Which supplements inhibit MAO?
ephedra, st john wort
99
What supplements can cause hypotension?
gingko, ginger, kava
100
What two supplements can cause arrythmias?
ginger, garcinia
101
What supplements can cause sedation?
ginger, st johns wort, saw palmetto, valerian, kava
102
Which 5 supplements can cause delayed emergence?
St. John wort, Valerian root, Kava, ginger, saw palmetto
103
What is an example of a chemically modified opiate?
oxycodone
104
What is an example of a fully synthetic opioid?
fentanyl
105
What are the opioid receptors?
Mu, delta, kappa
106
What type of receptors are Mu receptors?
G-couples protein receptors
107
What two factors lead to the development of an addiction?
genetic and environmental
108
What is the "pleasure-repeat" pathway?
Mesdimbic pathway
109
What are the effects of cAMP and mu receptors?
Activated Mu receptors bind to and decrease cAMP
110
What two body systems experience withdrawal symptoms?
GI and Brain
111
What type of receptors are inactivated by opioids: chemoreceptors or baroreceptors?
chemoreceptors
112
What is the noncompetitive receptor antagonist used to treat opioid overdoses?
naloxone
113
What are the effects of opiates on volatile anesthetics?
decreases MAC
114
T/F: opioids always cause amnesia but not always unconciousness
False: they cause unconsciousness but not always amnesia
115
What are two off label uses for opioids?
cough suppressant, antidiarrheal
116
What is the difference between M1 and M2 receptors?
M1 is primarily responsible for analgesia, while M2 is responsible for respiratory depression, bradycardia, and dependance
117
What does the kappa receptor do?
inhibits neurotransmission
118
Why doesnt merperidine cause bradycardia?
it has an atropine like additive
119
What are the two histamine releasing drugs that cause itching?
merperidine and morphine
120
What can occur when mixing opioids with MAOIs?
seretonin toxicity
121
What are s/s of seretonin toxicity?
fever, diapheresis, shivering, myoclonus, agitation, confusion, coma
122
What is the #1 drug used to reverse opioid overdose?
naloxone: nonselective, works on all three receptors
123
What are side effects of naloxone?
n/v, htn, tachy, dysrhythmias, pulmonary edema
124
What is the dosage of naloxone?
1-4mcg/kg, redose 60-90mins
125
What drug treats shivering?
merperodine
126
What is fentanyl used for during induction?
to blunt sympathetic response to intubation
127
What is unique about remifentanyl?
prevents movement without the use of a NMB when used as a gtt
128
How early before the end of the case should sufentanyl be turned off?
30 minutes
129
What is methadone composed of?
L methadone: opioid, R methadone: NMDA, longest half life of any opioid
130
What are the effects of cannabis on the nervous system?
inhibits PNS, induces SNS
131
What malignant arrhythmias can cannabinoids cause?
VTach, VFib, brugada pattern
sinus arrest in chronic use
132
What are the effects of cannabis on thermoregulation?
decreases thermoregulation which can result in severe postoperative shivering
133
How does cannabis effect bleeding tendencies?
increases bleeding by decreasing platelets and increasing clotting time
134
What is the most common vascular side effect with cannabis use?
ischemic stroke
135
How do steroids work in multimodal anesthesia?
reduces local inflammation triggered by afferent stimulation of the parasympathetic nervous system
