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Pharm 154* > Herbals > Flashcards

Herbals Flashcards

1
Q

What should pharmacists do when a patient on warfarin is seeking advice regarding a herbal product?

A

Look up every agent for warfarin users

Warfarin has many drug interactions, so we should be very cautious

Almost every herbal interacts with warfarin

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2
Q

Is oral cod liver oil great for joints?

A

Not really, the oil breaks down in the stomach. The oil never reaches the joints

Fairly safe, so don’t fight patients too much on this front

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3
Q

Is dark chocolate effective in reducing CV risk?

A

Theoretically it does contain antioxidants, but it also comes with a lot of sugar

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4
Q

What is a good resource for herbals?

A

Natural Medicines database

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5
Q

What condition is glucosamine indicated for?

A

Used in osteoarthritis

Affects knee, hip, spine

Joint pain relief via preventing cartilage deterioration

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6
Q

What is the difference between rheumatoid and osteoarthritis?

A

Rheumatoid:
Autoimmune

Less common

Osteoarthritis:
Caused by wear and tear

More common

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7
Q

What is the efficacy of glucosamine/chondroitin in joint conditions ?

A

Evidence is not very clear

Some professionals think glucosamine doesn’t work, while others disagree

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8
Q

What are some questions pharmacists should ask from someone looking to use glucosamine?

A

Have you seen an MD for this?

What are you taking it for (get indication)?

How bad is the pain?

Go ahead and add glucosamine as long as the following apply:
Safe to add + minimal side effects
Try for 3-6 months
500mg TID

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9
Q

Should a patient stop using their other drugs when starting glucosamine?

A

No, glucosamine should be used as an add-on therapy

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10
Q

What is the efficacy of glucosamine and chondroitin at their standard doses?

A

Not great, but the following doses are given

Glucosamine sulfate 500mg TID

Chondroitin sulfate 400mg TID

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11
Q

What is the potential for side effects and drug interactions for glucosamine or chondroitin?

A

Both have a great safety record. They also have minimal drug interaction, but like all herbal products be careful when the patient is also on Warfarin

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12
Q

What is SierraSil?

A

It is indicated for arthritis.

Its contents are essentially soil extract (contains minerals like Ca2+, K+, Na+, etc

Not very effective and not recommended. Don’t fight if someone is adamant (the public doesn’t like them anyways)

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13
Q

What is bromelain (pineapple enzyme)?

A

It was indicated for a diverse set of indications (this is suspicious)

Not high efficacy

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14
Q

What is the dosing of turmeric/curcumin for arthritis?

A

30g of turmeric = 2g of curcumin

These doses have shown evidence of helping reduce arthritis pain

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15
Q

What are patients asking pharmacists about omega 3 fish oils?

A

CV risk reduction

Brain health

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16
Q

What Omega fatty acid is lacking in a Western diet?

A

Omega 3 is little harder to come by in a standard Western diet

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17
Q

What are the types of omega-3 fatty acids?

A

ALA: canola, soybeans, walnuts, flaxseed (minimal conversion into EPA and DHA, these omega-3 fatty acids have some CV risk reduction qualities)

EPA and DHA: oily fishes like cod liver, herring, mackerel, salmon, and sardines

EPA and DHA have shown to reduce CV risk

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18
Q

What are the exact benefits of Omega-3 fatty acid sub-types?

A

ALA: cell membranes + hormones

DHA/EPA: anti-inflammatory and less platelet adhesion

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19
Q

What are the undesirable effects of Omega-6 fatty acids?

A

Undesirable prostaglandins and subsequent inflammation

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20
Q

What indications are omega-3 fatty acids used for?

A

CV (primary and secondary MI prevention; high triglycerides)

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21
Q

What is the efficacy of Omega-3 fatty acids?

A

Studies over the years contradict each other, but they are very safe so use continues

Try to get Omega-3 fatty acids from food, because there is modest or no modest benefit from supplements

Helpful for elevated triglycerides

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22
Q

What is the dose for omega-3 fatty acids?

A

2 servings/week of specific fish (cod, herring, salmon)

OR

500mg supplement (EPA/DHA) daily

Secondary prevention: 1000mg of fish oil TID

Hypertriglyceremia: 2-4 g of EPA/DHA

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23
Q

What is the utility of flax in terms of reducing CV risk?

A

Flax contains ALA, only 5% of this is converted into EPA/DHA

Efficacy is even lower

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24
Q

What are some other indications besides Cv risk reduction for Omega-3 fatty acids?

A

Rheumatoid arthritis (antiinflammatory)

Depression (unclear evidence)

Dry eyes (beneficial)

ADHD (shows promise)

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25
Q

What is the efficacy of herbal alternatives for statins?

A

Natural products do not show a lot of evidence to reduce LDL

Metamucil (5% reduction, statins can reduce by over 50%)

Omega-3 fatty acids (2-4g EPA/DHA can lower triglycerides alone)

Plant sterols (2g can reduce LDL by 10%)

Soy (25g/day = 5% reduction)

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26
Q

What is ubiquinone (Co Q-10)?

A

It is a vitamin-like present in all cells. It has antioxidant activitty

It is believed to reduce cancer risk

Statins lower natural ubiquinone, so supplements can be taken to replenish those levels (low evidence that this reduces muscle symptoms)

27
Q

What are some indications that ubiquinone (Co Q-10) may be effective in treating or preventing?

A

Congestive Heart Failure (high preload) -treatment

Hypertension - treatment

Heart attack-prevention

Migraine headache-prevention

28
Q

What is better, ubiquinol or ubiquinone?

A

It doesn’t really matter, either are fine

29
Q

What percentage of Canadians have chronic insomnia?

A

10% of general population experiences chronic insomnia

30
Q

Are OTC agents effective in insomnia?

A

Not as good as Rx agents, no real herbal products

31
Q

What is Cognitive-Behaviour Therapy for insomnia (CBT-I) therapy?

A

This could be a first thing a practitioner could try initially in a patient reporting insmonia

CBT-I is effectively therapy that tries to calm down insomnia

May need to forward patient to an insomnia therapist

32
Q

What is the efficacy of chamomile in insomnia?

A

Chamomile itself is not doing much, perhaps its the ambiance of drinking tea.

Maybe the hot drink makes you drowsy

33
Q

What is the efficacy of lavender for insomnia?

A

Low

34
Q

What is the efficacy of valerian in insomnia?

A

Not very high

35
Q

Should pharmacists reccomend homeopathic medicine for insomnia?

A

Nope, no efficacy at all

36
Q

What is the efficacy of diphenhydramine in insomnia?

A

It is the most sedating effects out of all first gen antihistamines

Patients will feel a little sleepy after a dose (won’t knock you out)

Tolerance can develop in long-term use

37
Q

Is diphenhydramine safe in seniors?

A

No, they can cause urinary retention

38
Q

What is the efficacy of Melatonin in insomnia?

A

It is better vs. the other OTC products for insomnia

New research suggests that it isn’t significantly effetive in improving insomnia

39
Q

When do natural melatonin levels peak?

A

Usually peak in the middle of the night (12-4am)

Melatonin production decreases with age

40
Q

What are some doses for melatonin for insomnia?

A

Try 1-2mg HS for 2 weeks, then 5mg for 2 weeks, then reassess

Melatonin may not be dose-dependent

No signs of tolerance or negative efffects on sleep

41
Q

What are some safety concerns with melatonin?

A

Mild GI

Additive drowsiness if added to other agent that can also cause drowsiness

Safety if used over several years (what is the root cause of insomnia)

42
Q

What should we ask a patient who has insomnia?

A

Have you seen an MD?

How long has this been a problem

Any link to an event?

Affect on quality of life?

43
Q

Is Nytol (diphenhydramine) better for insomnia than melatonin?

A

No, we should urge patients to shioft from Nytol to melatonin if they have insomnia

44
Q

Can pharmacists reccomend sleep aids in children?

A

Need to refer to MD

45
Q

What are some indications for flaxseed?

A

Flaxseed contains omega-3 fatty acids (ALA, only 5% is converted into EPA/DHA)

Flaxseeds need to be ground but it is used to help with the following:

CV (low efficacy)
Constipation (source of fibre)
Menopause (low efficacy, maybe)

46
Q

Should we recommend a flaxseed dose for menopause?

A

We shouldn’t say any number, the efficacy is really iffy

47
Q

What is the efficacy of Echinacea?

A

Low efficacy

48
Q

What are some indications for garlic?

A

Antimicrobial or antiviral (low evidence, don’t recommend)

49
Q

What is the efficacy of ginseng in reducing colds?

A

Not really effective

50
Q

What is St. John’s Wort?

A

It contains Hypericin

It is effective in helping with mild-moderate depression (equivalent efficacy as SSRIs)

Less efficacy for major depression

51
Q

Is St. John’s Wort a very safe medication?

A

No, it has a relatively high risk for herbal products

It has lots of CYP 450 related drug interactions (reduces concentration of drugs that are broken down by CYP 450)

Therefore this is under MD care (not even closely within the realm of self-care)

52
Q

How do SSRIs work?

A

They prevent the reputable of serotonin, leaving more serotonin in the synapse. This means more receptor stimulation

53
Q

What is the mechanism of action for St Johns Wort?

A

Similar to SSRIs

54
Q

What are some side effects of St John Wort?

A

It is well tolerated, better adverse effect profile than TCAs and SSRIs

55
Q

What are some notable drugs that have drug interactions with St John’s Wort?

A

Birth Control Pills

Warfarin

Both are broken down faster due to St John’s Wort-induced CYP 450 activity

56
Q

What is serotonin syndrome?

A

A condition that occurs when there is too much serotonin in the body

Can occur if a patient is on multiple drugs that increase free serotonin (ex. Patient is on SSRIs, St Johns Wort, DM, etc.)

57
Q

What are some symptoms of severe serotonin syndrome?

A

Fever (over 38*C)

Confusion/delirium

Sustained clonus/rigidity

Rhabdomyolysis

Death

58
Q

What is the dosing for St John’s Wort?

A

300mg TID (0.3% Hypericin —> active ingredient)

59
Q

Can pharmacists prescribe for UTIs?

A

Yes

60
Q

What is the mechanism of action of cranberry juice in UTI?

A

It can prevent E. coli adhesion onto urinary tract

61
Q

What is the efficacy of cranberry juice in patients with UTIs?

A

They can possibly prevent UTIs, no luck for treatment

Low efficacy is due to the active ingredients being digested before they reach the urinary tract

Long-term antibiotics are more effective than cranberry juice for preventing recurrent UTIs

62
Q

What is the definition of recurrent UTIs

A

3 or more culture-positive infections in 1 year

May need to be put on prophylaxis

63
Q

What is the most effective herbal product covered?

A

St John’s Wort

Pharm 154* (18 decks)

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