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Stack #205592

Herbal Medications

QuestionAnswer
Atropa belladonna atropine
Papaver somniferum codeine
Colchicum autumnale colchicine
Digitalis purpurea digoxin
Ephedra sinica ephedra
Rauwolfia serpentine reserpine
Salix purpurea salicylic acid
Datura stramonium scopolamine
Taxus brevifolia paclitaxel
Catharanthus roseus vincristine
Food and Drug Act of 1906 Prohibited shipment of “adulterated” or “misbranded” drugs across state line
Sherley Amendment of 1912 No false labeling claims
Federal Food, Drug and Cosmetic Act of 1938 Drugs must be tested for safety before marketing Regulations
Kefauver-Harris Amendment of 1962 Market drugs must be proven to be safe AND effective Drugs marketed before 1938 were exempt from this law
Category I- OTC recognized as safe and effective, not misbranded
Category II- OTC not recognized as safe and effective(most herbal meds classified here)
Category III- OTC insufficient data
1994 Dietary Supplement Health and Education Act (DSHEA) Established first legal definition of “dietary supplement” -Restructured regulations on how supplements can be manufactured, sold, and promoted -Limited FDA authority on safety and efficacy of products, Saftey burden on FDA
DSHEA--Definition of Dietary Supplement A product intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb, or other botanical Intended for ingestion in the form of a capsule, powder, soft gel, or gel cap
Herbs rich in cardioactive glycosides Cardiotoxic
Herbs rich in colcichine Cardiotoxic and Neurotoxic
Licorice root Cardiotoxic
Ma huang Cardiotoxic, Hepatotoxic and Neurotoxic
Ephedra Cardiotoxic and Contraindicated During Pregnancy
Pokeweek leaf Cardiotoxic
Scotch broom Cardiotoxic
Squirting cucumber Cardiotoxic and renal toxicity
Cape aloes Renal Toxicity
Chaparral Renal Toxicity
Chinese Yew Renal Toxicity
Herbs rich in aristolochic acid Renal Toxicity
Jering fruit Renal Toxicity
Pennyroyal oil Renal Toxicity, Hepatotoxic and Neurotoxic
Star Fruit Renal Toxicity and Neurotoxic
Aconite root tuber Neurotoxic
Essential oils of ascaridole and thujone Neurotoxic
Herbs rich in podophyllotoxin Neurotoxic
Nux vomica Neurotoxic
Chaparral* Hepatotoxic
Germander* Hepatotoxic
Herbs rich in podophyllotoxin Hepatotoxic
Kava* Hepatotoxic
Kombucha Hepatotoxic
Skull cap Hepatotoxic
Soy phytoestrogens* Hepatotoxic
Persistent use of echinacea* Hepatotoxic
Ashwagandha Contraindicated During Pregnancy
Bitter melon Contraindicated During Pregnancy
Black cohosh Contraindicated During Pregnancy
Burdock Contraindicated During Pregnancy
Cat’s Claw Contraindicated During Pregnancy and Renal Toxicity
Celery Contraindicated During Pregnancy
Chamomile Contraindicated During Pregnancy
Devil’s Claw Contraindicated During Pregnancy
Feverfew Contraindicated During Pregnancy
Ginseng, Panax Contraindicated During Pregnancy
Golden Seal Contraindicated During Pregnancy
Gotu Kola Contraindicated During Pregnancy
Hawthorn Contraindicated During Pregnancy
Kava Kava Contraindicated During Pregnancy
Licorice Contraindicated During Pregnancy
Red Clover Contraindicated During Pregnancy
Red Yeast Rice Contraindicated During Pregnancy
Rosemary Contraindicated During Pregnancy
Schisandra Contraindicated During Pregnancy
St. John’s Wort Contraindicated During Pregnancy
Stinging Nettle Contraindicated During Pregnancy
Uva Ursi Contraindicated During Pregnancy
Yohimbe Contraindicated During Pregnancy
Chamomile Uses -mild sedative-antispasmodic-antiseptic
Chamomile ADR / Interactions 1)Allergic Reaction in ppl with allergies to ragweed2) Increased Effects of Warfarin-Contains Coumarin (active ingredient in Coumadin, monitor closely
Echinacea Uses 1) Immune system booster
Echinacea ADR / Interactions 1) Hepatotoxicity when: a)used >8weeksb) used with methotrexate--Rheumatrexamiodarone--Cordarone,ketoconazole--Nizoralanabolic steroid,acetaminophen--Tylenol2) May counter effects of Immunosuppresants:NOT recommended to be used w/ immunsupp
Feverfew Uses 1)Migraines2)Muscle Aches(believed to block synthesis of leukotrienes, prostaglandins, and thromoboxanes)*decreased effect if used with NSAIDs
Feverfew ADR / Interactions 1) Don't use in Pt allergic to Ragweed or Chamomile2) Contraindicated in Pregnancy3) Interacts with Warfarin, Heparin, and Antiplatlets (plavix, ticlid, asa, aggrenox)
Garlic Uses(Allium Sativum) 1)Antispasmodic2)Antiseptic3)?Antiviral4)?Lower BP5)?Lower Cholesterol (~10-15%)*raw garlic may have these properties but the tablets don't really even contain RAW garlic.(Must crush or chop Garlic to get active ingredient Alliin out)
Alliin -active portion of garlic. Garlic needs alliinase to activate alliin. This occurs when chopping or crushing raw garlic.-The formulations that garlic supplements come in are unstable for alliin :: not as good.
Garlic ADR 1) Increased risk of bleeding due to antiplatelet effects. (use w/ caution w/ Warfarin)
4 Types of Interactions B/W Warfarin and Herbals. 1) Antiplatlet effects of herbals2) Herbals contain chemical constituent similar to Warfarin3) 2C9 and 3A4 are inhibited4) 2C9 and 3A4 are induced
Ginger Uses 1) Nausea and stomach upset*volatile oils shogaol and gingerol stimulate gastric secretions and peristalsis
Ginger ADR 1) Can prolong bleeding time2) Caution in Pregnant women
Ginko Biloba Uses 1) Memory Enhancer(flavoglycosides act as free radical scavengers and increase cerebral blood flow)2) Antiplatelet Activity
Ginko Biloba ADR 1) Caution with Warfarin, Heparin, antiplatlet drugs (plavix, Ticlid, asa, aggrenox)
Ginseng Use 1) Mood Elevator (fatigue/stress)2) Energy enhancer
Ginseng ADR 1) Stevens-Johson Syndrome2)? Estrogenic Effects (vaginal bleeding case reports)3)Hypotension (high doses)4)Possible increase QTc interval5) Alters glucose regulation (caution in DM pt)
Ginseng Drug Interactions 1)Increasing AND Decreasing Warfarin (case reports)2) Inc. bleeding w/ ASA, NSAIDs, other antiplatelts.3) Inc. tremors and nervousness seen with certain antidepressants (Nardil, Parnate)4) Enhance Effects of hypoglycemis agents and antihypertensives
Glucosamine Uses 1) Sx relief of Osteoarthritis- modified sugar moleculemay stimulate cell growth and inhibit inflamation-derived from shells of crabs, lobsters, and shrimp
Chondroitin Uses 1) Sx relief of Osteoarthritis-gives cartilage its elasticity/resilence.-extracted from animal cartilage (shark, cattle trachea)
Glucosamine ADR 1) caution in brittle diabetics2) Caution in pt with SHELLFISH allergy
Chondroitin ADR 1) Chemical structure similar to heparin :: caution in pt on anticoagulants
St. John's Wort Uses(Hypericum perforatum) 1) Anxiety2) Depression3) Sleep Disorders(*similar to amitriptyline (Elavil))
St. John's Wort Drug Interactions(Hypericum perforatum) Induces CYP450 **3A41)1)Immunosuppressants (Cyclosporine(Sandimmune, Neoral), Tacrolimus (Prograf))Sirolimus (Rapamune)- dec effectiveness2)PI - dec []3)Oral Contraceptives- dec effect and bleed4)Digoxin-dec in [] 5)MAOI,TCA,SSRI- seroton syndro Contra
St. John Wort ADR 1) Photosensitizer(inc risk of burn w/ use of tetracyclines, certain NSAIDs, diuretics or water pills, amiodarone, and other drugs associated with photosensitivity
Valerian and Kava Kava Use 1) Sleep aid(acts similar to benzos)
Valerian and Kava-kava Drug Interactions 1) Inc risk for CNS depression when used with Alcohol or barbituates2) *Kava-kava can be hepatotoxic
Ephedra Usesaka "ma huang" 1)Weight Loss2)Energy (Inc concentration(3)Enhance athletic performance*CNS stimulant-inc BP and HR, and peripheral vasc constriction* can stimulate uterine contractions
Ephedra ADR nervousnessHAinsomniadizzinesspalpitationsskin flushingvomintimgAND MORE!PULLED FROM MARKET FOR TIA,STROKE,SEIZURES(bitter orange used to replace it...)
Milk Thistle Uses 1) Liver "protectant"*active ingredient silymarin/silybin
Milk Thistle Drug Interactions Inhibitor of CYP3A4
Black Cohosh Uses 1) Menopausal Sx*recently proven to be ineffective-contains some phytoestrogens and salicylic acid
Black Cohosh ADR 1) Contraindication in Women with hx of estrogen-dependent tumors or endometrial cancer2) Use caution in pt with ASA allergy3) antiplatelet effects similar to ASA
White Willow Bark Uses 1) Anti-inflammatoryEssentially ASA :: all applies to ASA applies to it.
Hawthorn Uses 1)Angina2)HTN3)HF+ionotrope and chronotrope
Hawthrone ADR Caution in pt on concomitant cardiovascular agents-inc risk of orthostatic Hypotension in elderly
Herbal Medications to DC Preoperatively 1)Ephedra, ma huang (24hr)2)Garlic (7d)3)Ginseng (7d)4)Gingko (36hr)5)Kava (24hr)St. John's Wort (5d)
Signs and Symptoms of Digoxin poisoning N/V/Dblurred vision, greenish yellow halosdec HRarrythmiascardiac arrest
Products containing substances similar to Digoxin Adonis, false hellebore, pheasant’s eye, dogbane, milkweed, lily of the valley, foxglove preparations, Siberian ginseng, motherwort, white squill, figwort, uzara root
Licorice and Digoxin Effect -Licorice used for GI complaints (peptic ulcer dx), effects K+ balance which can greatly inc toxic effects of digoxin DO NOT USE TOGETHER
Herbals that Cause Decrease in Phenobarbital's ability to control seizures sage (used for flatulence), wormwood (used as GI stimulant),evening primrose oil
Supplements that may interact with Warfarin--> Increase Bleeding Risk Alfalfa, Angelica, Aniseed, Arnica, Celery, **Chamomile, **Chondroitin, Clove, Dong quai, Fenugreek, **Feverfew, **Garlic, **Ginger, **Gingko, **Ginseng, **Horse chestnut, Horseradish, Licorice, Meadowsweet, Poplar, Prickly ash, **Red Clover, Willow
Supplements that may interact with Warfarin--> Decrease Bleeding Risk Coenzyme Q10, Ginseg, St. John's Wort, Green Tea (contains a lot of Vit K)
Avoid use of Kava and ______ Alprazolam (Xanax)*any type of sedative-hepatotoxic drugs
Avoid use of Zinc Lozenge and ______ 1)Immunosuppressants (steroids, cyclosporine, azathioprine, mtx) 2) If you have an autoimmune dx bc can worsen your condition
Herbs Containing Tannin that should not be used Iron supplementation b/c can lead to anemia chamomile, platain, black cohash, saw palmetto, feverfew, st. johns wort, valerian
Avoid use of Horseradish and ______ Thyroid Meds
Avoid use of Nardil and Parnate with ______ yohimbe,ephedra, licorice,St. JOhn's wort
Avoid use of Estrogen Replacement Therapy and the following herbals containing Phytoestrogens soy beans, black cohash, red clover, alfalfa, dong quai
Created by: stormesk
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