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Flashcards in 1: Herbals and Supplements Deck (26)
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difference b/w dietary supplement and a drug

dietary supplements:
-can't be sold as drugs
-can't say they are good for any disease state
-CAN say helps you relax/etc.
-can't patent

essentially don't have definitive proof for FDA


Dietary Supplement and Non-Rx Drug Consumer Protection Act (DSHEA)

-required manufacturer to report serious adverse effects


St. John's Wort - where found, uses

-perennial weed in USA, Europe, Asia (hypericum perforatum)
-for mild/moderate depression
-clinical studies show efficacy


St. John's Wort - active ingredients, mechanism, side effects

-active ingredients: hyperforin, hypericin
-induces CYP3A4, 2C9, P-gp
-AE: photosensitivity, reduced efficacy of some drugs (oral contraceptives!!)


Echinacea - uses, actions

-for common cold and flu
-immunostimulant - potential decreased Sx and duration


Echinacea - active ingredients, side effects, contraindications

-active: polysaccharides, chicoric acid, alkamides
-AE: minimal - GI upset, headache
-don't use in kids
-don't take more than 10d
-don't use in patients using immunosuppressants or with immunodeficiency/autoimmune diseases


Ginkgo - uses, actions

-proven for peripheral vascular disease
-unproven to prevent cognitive impairment or dementia
-antagonize platelet activating factor
-increase NO release


Ginkgo - active ingredients, side effects, contraindications

-flavone glycosides, terpenoids, antioxidants
-AE: headache, GI upset, some bleeding
-don't use with antiplatelet or anticoagulant drugs
-don't use for epileptics


Ginseng - uses, actions

-some evidence for preventing colds, cancer, and reducing postprandial blood glucose levels
-stimulates immune system
-antiplatelet activity


Ginseng - active ingredients, contraindications

-triterpenoids (ginsenosides)
-methylxanthines - caffeine like effect
-don't use with antipsychotics, estrogens, hypoglycemics, or anticoagulants


Garlic = allium sativum - uses, actions

-may reduce incidence of some cancers
-not proven to reduce LDL cholesterol

-antiplatelet, fibrinolytic, antioxidant


Garlic - active ingredients, contraindications

-contains organosulfur compounds including allicin
-don't co-administer with anticoagulants


Milk Thistle = silybum marianum - uses, actions

-some anti-inflammatory activities
-reduced leukotriene formation
-reduced leukocyte migration


Milk Thistle - side effects

-few AE or drug interactions reported
-no clear evidence for prevention of alcoholic liver cirrhosis or other hepatotoxicities


Red clover = trifolium pratense - uses, actions

-may prevent hot flashes, osteoporosis, and CV disease
-may bind estrogen receptor and cause selective estrogen-mediating effects


Soy bean = glycine max - uses, actions

-may prevent hot flashes, osteoporosis, and CV disease
-may bind estrogen receptor and cause selective estrogen-mediating effects


Saw palmetto = serenoa repens - uses, actions

-no clear evidence for improvement of symptoms of BPH
-phytosterols inhibit 5a reductase in vitro (enzyme that forms active form of testosterone)


Saw palmetto - side affects, contraindications

-low incidence of side effects
-no reported drug interactions


vitamin C supplement

-MDR based on deficiency symptoms
-high doses = immunostimulant, antioxidant
-regular supplementation decreases duration of colds


vitamin E supplement

-claims cardioprotective over 800 IU/day
-meta-analysis showed increased death with 400 IU
-safe up to 130 IU/day
-MDR 30 IU/day


coQ 10 (ubiquinone) - uses, actions

-electron carrier in mitochondria of all tissues
-highest in heart, some in brain
-decreases with age

-used in therapy of mitochondrial disease (ex: Leigh's encephalomyopathy)
-some benefit in ischemic heart disease


coQ - side effects

-may increase bleeding with warfarin


Leigh's encephalomyopathy

-ataxia, decreased growth
-familial defect in coQ 10 synthesis


melatonin - uses, actions

-principal indoleamine in pineal gland
-synthesis controlled by light
-5 methoxy-N-acetyl tryptamine (lipid soluble)
-0.3 - 8 mg p.o. used as sleep aid and for jet lag
-metabolized by CYP1A2


melatonin - side effects, contraindications

-drowsiness and ataxia
-synergistic with alcohol
-may interfere with warfarin action


dietary supplements for osteoarthritis

-mixed results in clinical trials for improvement of function and reduction of pain
-glucosamine: substrate for production of articular cartilage
-chondroitin sulfate: proteoglycan may modify extracellular matrix to stabilize articular cartilage
-largest clinical trial to date found no benefit
-AE: may increase bleeding in patients on warfarin