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Stack #205592
Herbal Medications
Question | Answer |
---|---|
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 |