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Herbal medicines 311

Week 3

Herbal remedies Use of plant-derived products to promote health and relieve symptoms of disease
What's the most common form of alternative medicine? Herbal medicines
Why are herbal meds being used more and more? Available without prescription Frequently cheaper Perception that herbs are safer and healthier than conventional drugs Some people like the sense of empowerment that comes from self-diagnoses Frustrated with conventional meds Aggressive marketing
Dietary Supplement Health and Education Act of 1994 Exempts herbs, vitamins, minerals, and botanical products from FDA regulation -Dietary supplements can be made and sold without giving the FDA any proof they are safe or effective
How must herbal products be labeled? As dietary supplements, not regulated by FDA, cannot claim to diagnose, prevent, or treat disease, allowed to make claims about products ability to favorably increase body structure, but cannot say it diagnoses, treats, or cures
Accuracy of herbal labels? FDA doesn't require accuracy, therefore there is no assurance that a product actually contains the ingredients listed or contains them in stated amounts -Leading to impurities and lack of uniformity among similarly labeled products
What concentration of herbal formulas are preferred most? Solid extracts (tablet or capsule)
Nurses responsibility with herbal products? Teach patient to use lowest dose Is it the right drug for them? What are they using it for? Is it safe to continue?
Aloe uses Primarily for skin ailments (scalds, burns, acne, eczema) Oral aloe is used to relieve constipation
Aloe preparations Aloe gel (aloe vera) is extracted from inner portion of aloe leaf - for topical therapy only Aloe latex is derived from layer just beneath the outer skin of leaf - taken only as oral laxative
Aloe actions Contains salicylic acid, bradykinin, and superoxide dismutase Gel promotes healing of burns by inhibiting thromboxane (product of arachidonic acid metabolism) Aloe gel also works as mild antimicrobial product and moisturizer
Aloe adverse effects When applied to skin, rarely any ADRs Hypersensitivity reactions may occur Oral aloe latex can cause severe diarrhea
Black Cohosh uses Treats acute symptoms of menopause (hot flashes, vaginal dryness, palpitations, depression, irritability, and sleep disturbances)
Black Cohash actions Black Cohash suppresses the release of LH from pituitary (unregulated LH release causes menopause symptoms) 2 ingredients - 1 mimics action of estrogen at receptors in pituitary, 1 acts through an estrogen-independent mechanism
Black Cohash ADR Safe for routine use (no more than 6 months) Rarely, user may get upset stomach Should not be taken during pregnancy (due to estrogenic effects)
Black Cohash interactions with conventional drugs Increases hypotensive effects of antihypertensive drugs as well as the hypoglycemic effects of insulin and oral hypoglycemics May increase the effects of estrogens used for hormone replacement therapy or contraception
Black Cohash vs. Blue Cohash Blue cohash promotes menstruation and labor (causes uterine contractions) and can elevate BP, increase intestinal motility, and accelerate respiration
Echinacea uses Oral - taken to stimulate immune function, suppress inflammation, and treat viral infections (including influenza and common cold) Topical - treats wounds, burns, eczema, psoriasis, and herpex simplex infection
Echinacea preparations Dried roots, freeze-dried plants, dry-powder extracts, teas, and tinctures Preparations from roots and leaves are most active
Echinacea actions Contains cichoric acid, polysaccharides, flavenoids, and essential oils Produce antiviral, anti-inflammatory, and immunostimulant effects through: -mobilization of phagocytes, stimulation of T-lymphocyte proliferation, stimulation of interferon
Echinacea effectiveness Taken widely to prevent and treat colds, efficacy is questionable
Echinacea ADR Few have been reported Unpleasant taste Allergies It stimulates immune system, so it should be avoided in patients with autoimmune disease Oppose effects of conventional immunosuppressant drugs
Feverfew uses Prophylaxis and treatment of migraines Applied topically to treat infection and relieve toothache
Feverfew actions Active ingredient - parthenolid -works by blocking formation of a gene transcription factor required for activation and proliferation of certain inflammatory cells that may be critical to pathogenesis of migraine
Feverfew effectiveness Evidence suggests it benefits patients with migraines, and can reduce frequency and severity of attacks Less effective when taken to abort an ongoing attack
Feverfew ADR Well tolerated People allergic to ragweed may also be allergic to feverfew
Feverfew interactions with conventional drugs Suppresses platelet aggregation (thereby increase the risk of bleeding in patients taking antiplatelet or anticoagulant therapy)
Garlic uses Effects cardiovascular system Taken to reduce triglyceride and LDL cholesterol, and increase HDL Reduce BP, suppress platelet aggregation, and decrease formation of atherosclerotic plaque
Garlic actions Allicin is active ingredient and gives it bad smell (when crushed) MORE????
Garlic effectiveness Favorably effects BP and plasma lipids Depends on quality and preparation When high quality prep is used - it decreases cholesterol, LDL cholesterol, and TG (but not as much as conventional drugs) Can decrease BP Need 1-2 whole cloves twice daily
Garlic ADR Generally well tolerated Unpleasant taste and bad breath Can cause heartburn, flatulence, nausea, vomiting, diarrhea, and a burning sensation in mouth
Garlic interactions with conventional drugs Significant antiplatelet effects (increase risk of bleeding on ppl taking antiplatelet/anticoagulant drugs) Can increase insulin levels (can increase hypoglycemic effects of drugs) Can reduce levels of saquinavir, which is used to treat HIV
Ginger root uses Suppress nausea and vomiting caused by motion sickness, morning sickkness, and chemotherapy Anti-inflammatory and analgesic properties that may help people with arthritis and other inflammatory conditions
Ginger root actions May be through blocking serotonin receptors in chemoreceptor trigger zone of brain or neurons in GI tract (activation of these receptors trigger emesis) Anti-inflammatory actions have been attributed to stopping synthesis of inflammatory mediators
Ginger root effectiveness Benefits prevention and treatment of motion sickness, morning sickness, seasickness, and postoperative nausea and vomiting Needs 9x higher dose than using Dramamine Reduces pain, improve joint mobility, and decrease swelling and morning stiffness
Ginger root ADR Very well tolerated Severe toxicity never reported, but could cause CNS depression and cardiac dysrrhythmias Used in caution during pregnancy High doses can stimulate uterus, and might cause spontaneous abortions
Ginger root interactions with conventional drugs Inhibit production of thromboxane by platelets and thereby suppress platelet aggregation (increases risk of bleeding in patients receiving antiplatelet or anticoagulant therapy)
Best sources of ginger root? Produce section of grocery store, peel skin and chew medium slice
Ginkgo uses -Improve memory, sharpen concentration, and promote clear thinking -Being looked at to help pts with Alzheimers disease -Counteract erectile dysfuncttion induced by antidepressants (especially fluoxetine)
Ginkgo preparation Acetone extraction of leaves from Ginkgo biloba tree -Has flavenoids (24%) and terpenoids (6%)
Ginkgo actions Multiple biological effects Most benefit from improved blood flow secondary to ginkgo-induced vasodilation In brain, it appears to increase blood flow by stimulating synthesis of prostaglandins
Ginkgo effectiveness Supports benefits of ginkgo for patients with cognitive impairment secondary to low cerebral blood flow Improves short term memory in adults Improved erection due to increased blood flow
Ginkgo ADR Can cause upset stomach, dizziness, or vertigo Suppresses coagulation and should be used in caution in pts taking antiplatelet or anticoagulant drugs May promote seizures
Goldenseal uses Treats bacterial, fungal, and protozoal infections of mucous membranes Skin and eye irritations, still in some sterile eye washes
Goldenseal actions Alkaloids - suppresses inflammation of mucous membranes, stimulate peristalsis, altering BP, promote homeostasis, induces secretion of bile, and possess astringent and antiseptic properties Berberine - inhibits attachment of bacterial cells to epithelial
Goldenseal ADR High doses can cause nausea, vomiting, diarrhea, and stimulation of CNS Toxic doses can cause hypertension, convulsions, and death from respiratory failure
Kava uses Relieves anxiety, promotes sleep, and relaxes muscles
Kava actions Active ingredients - alpha-pyrones or kava-lactones Mechanism of action is unknown
Kava effectiveness Does relax skeletal muscles and relieves tension and anxiety Must be taken for weeks before effects develop
Kava ADR Can cause CNS depression, skin problems, liver damage, impaired vision, muscle incoordination, dry flaking skin, reddened eyes, yellow color of skin, hepatitis, cirrhosis, and liver failure
Kava interactions with conventional drugs Can intensify effects of other CNS depressants
Ephedra uses Reduce appetite, increase energy, overcome tiredness, treat narcolepsy, relieve bronchospasm, and ehance athletic performance
Ephedra actions Alpha 1 - constriction of aterioles in skin and mucous membranes Beta 1 - increases HR and force of contraction Beta 2 - promotes bronchodilation Activation of receptors in brain cause appetite suppression and CNS stimulation
Ephedra ADR Death Banned in US
St. Johns Wort uses Treats depression
St. Johns Wort action Hypericin - decreases uptake of serotonin, NE, and dopamine, binds GABA receptors, and mildly inhibits MAO (same as traditional anti-depressants)
St. Johns Wort effectiveness Superior to placebo, and equal to standard antidepressants Mild antidepressant effects
St. Johns Wort ADR May increase photosensitivity and risk for cataracts Induces cytoP450 enzymes (decreases effectiveness of various drugs, including oral contraceptives, cyclosporine, indivavir (HIV protease inhibitor))
Saw Palmetto uses Relieves urinary symtpoms associated with prostatic hypertrophy
Saw Palmetto actions Inhibits the enzyme that converts testosterone to DHT (the active form of testosterone in prostate)which would reduce the urinary tract obstruction - same as conventional drug
Saw Palmetto effectiveness Relieves urinary problems associated with BPH although prostate size remains unchanged
Saw Plametto ADR Upset stomach or headache rarely Reduces levels of prostate specific antigen, a marker for prostate cancer (causing a false-negative on test) Pregnant women should avoid touching or using
Valerian uses Promotes sleep
Valerian actions Increases availability of GABA at synapses in the CNS
Valerian effectiveness Helped people fall asleep, but didn't prevent waking during night Takes days-weeks to work
Valerian ADR May cause headache, nervousness, or cardiac abnormalities Reduces alertness so should exercise caution while driving or operating heavy machinery Does not seem to potentiate CNS depression effects of alcohol
Coenzyme Q10 uses Treats heart failure, muscle injuries caused by statins, and mitochrondrial encephalopathies (muscle and nervous system injury caused by deranged mitochrondial metabolism)
Coenzyme Q10 actions Found in every cell in body Potent antioxidant and participates in many metabolic pathways, most notably, the production of ATP
Coenyme Q10 effectiveness In patients with Q10 deficiency, replacement therapy helped Improves quality of life but doesn't improve objective measures in heart failure One form is effective to treat mitochrondrial encephalopathies Not enough evidence to treat statins
Coenzyme Q10 ADR Well tolerated High doses may produce GI disturbances (gastritis, reduced appetite, nausea, and diarrhea)
Coenzyme Q10 interactions with conventional drugs Structurally similar to vit. K so may antagonize the effects of warfarin Shares pathway with cholesterol Drugs like statins (which inhibit production of cholesterol) can also inhibit synthesis of Q10
Soy uses Prevention of breast cancer, and in postmenopausal women, treats vasomotor symptoms (hot flashes), and prevents osteoporosis
Soy actions Structurally similar to estradiol (endogenous estrogen) and can bind with estrogen receptors In women with normal estrogen levels, soy appears to antagonize the endogenous estrogen In postmenopausal women, soy acts as estrogen agonists
Soy effectiveness Studies have show it reduces hot flashes Trials have shown that soy may reduce the risk of developing breast cancer It does increase mineral density or slows the progression of osteoporosis in women
Soy ADR GI effects are most common, but usually well tolerated Can cause migraine, because of estrogenic effects May increase risk of kidney stones Goider and hypothyroidism in infants who drank soy-based formula
Soy interactions with conventional drugs Should not be combined with tamoxifen and other drugs that can block estrogen receptors Antibiotics may decrease the effectiveness of soy
Probiotics uses Composed of potentially beneficial bacteria or yeasts Treats IBS, ulcerative colitis, antibiotic-associated diarrhea, and rotavirus diarrhea
Probiotic actions Help metabolize food and some drugs Promote nutrient absorption Reduce colonization of gut by pathogenic bacteria Control bacterial overgrowth by producing hydrogen peroxide
Probiotic effectiveness Reduces duration of diarrhea, improves stool consistency, and decreases stool frequency May reduce bloating and abdominal pain
Probiotic ADR Generally well tolerated Most common - bloating and flatulence Infection of the blood with bacteria reported only with patients who were severely immunocompromised
Probiotic interactions with conventional drugs May be altered by antibiotics and antifungals
Ginseng uses Immune stimulant Slows aging Lowers blood glucose Energy/stress Lowers BP Sexualitty- erectile dysfunction Means "all healing"
Ginseng concerns Genseng abuse syndrome Nephrotoxic contaminant germanium (damages cells) Warfarin Hormones/pregnancy
Verbal order rules Enter the order while on phone, and read it back to them! SBAR -Situation -Background -Assessment -Recommendations
Created by: 542954668



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