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Natural Products > Heart failure > Flashcards

Heart failure Flashcards

1
Q

some things to tell patients about NHPs

A 
can interact with meds
could have detremental effects on the body 
need to be looked at seriously 
tell HCP about your use
include on medication lists
educate on reliable sources of info
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2
Q

what are patients with heart failure at an increased risk of

A

polypharmacy
have multiple comorbid conditions and prescribers and pharmacies
delicate fluid electrolyte balance
elderly have renal/hepatic impairment

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3
Q

are NHP taken seriously

A

patients dont think theyre medicine
dont tel HCP
often left out of med histories

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4
Q

CV benefit with which PUFA

A

DHA EPA

found in fish oil, flax seed, canola oil, soybeans

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5
Q

PUFA adverse effects

A 
fish burp 
halitosis
heartburn 
dyspnea
nausea
loose stools 
rash
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6
Q

omega 3 MOA

A 
lower triglyceride levels at higher doses
prevent serious arrthymias
decrease platelet aggregation
lower blood pressure
lower resting HR
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7
Q

american heart association recommends daily use of omega 3 in the form of DHA and EPA for what

A

secondary prevention of CV disease

updated to patients with HFrEF

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8
Q

what cant be garunteed for omega 3

A

not standardized so may not be reliable

get from a reliable source

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9
Q

what is coenzyme q

A

vit compound found in the body high concentrations in mitochondria of the heart liver and kidney

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10
Q

coenzyme q MOA

A

important role in production of ATP
patients with HF have reduced levels
inhibition of ATP production can cause cell death and tissue dmaage
replacing the coenzyme q might improve cellular energy production and prevent cell death in people with HF

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11
Q

sources of coenzyme q

A

some in meats and seafood

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12
Q

side effects of coenzyme q

A

just GI no toxicity

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13
Q

coenzyme q drug interactions

A

warfarin - decreased effect becuase structurally similar to vitamin k so warfarin binds to this instead
increase the antihypertensive effects of some BP lowering drugs

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14
Q

bottom line for vit D supplementation in HF

A

seen loewr vit D levels at increased risk of CVD but supplementation does nothing
can recommend for general health doesnt cause any harm but wont dhave any benefit

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15
Q

vit E role in HF

A

advise against

increase risk of hospitalization, mortality, HF

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16
Q

what drug is hawthorn like

A

digoxin

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17
Q

pharmacological effects of the flavonoids in hawthorn

A

reduce BP and HR
positive inotroph
vasodilatory
reduce afterload

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18
Q

potential benefits of hawthorn

A

may help with symptoms but no decrease in mortality

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19
Q

hawthorn drug interactions

A

enhances digoxins activity

inhibits synthesis of thromboxane 2, increase risk of bleeding in patients on antiplatelets or anticoagulants

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20
Q

examples of herbal diuretics

A

dandelion
stinging nettle
corn silk

21
Q

herbal diuretuics recommendation

A

advise not to use as no evidence that they reduce edema in patients with HF

22
Q

what is l carnitine

A

amino acid cofactor in skeletal muscles and the heart

23
Q

lcarnitine proposed mechanism

A

genereates energy within the cells causing a positive inotropic effect
HF patients have lower levels in their heart tissue

24
Q

what is l-arginine do

A

amino acid for protein synthesis

substrate for NOS enzyme which forms nitric oxide causing vasodilation

25
Q

caution for l-arginine

A

causes hypotension

usually safe

26
Q

potential l-arginine drug interaction

A

may decrease the activity of ACE

27
Q

what is st.johns wort used for

A

depression
anxiety
sleep disorders

28
Q

drug interactions with st johns wort

A

induces cyp3A4
avoid with: amiodarone, apixiban, rivaroxaban, beta blockers, CCB, ACe, statin
induces pgp - decreases digoxin

29
Q

ginseng effects

A

immune stimulant (stimulant = bad)
hypertensive and hypotensive effects
used in HF for CHF

30
Q

ginseng drug interactions

A

warfarin - may decrease efficiency

digoxin - can falsely increase or decrease levels

31
Q

what is saw palmetto used for

A

treat BPH

32
Q

drug interactions with saw palmetto

A

antiplatelet effects

avoid with antiplatelets and anticoagulants

33
Q

what is ginko biloba used for

A

alzheimers and dementia

34
Q

ginko biloba drug interactions

A

inhibit platelet activating factor causing decreased platelet aggregation
bleed risk high
get patients off

35
Q

garlic uses

A

antimicrobial, IS enhancer
lowers cholesterol
antihpertensive
inhibits platelet aggregation

36
Q

drug interactions with garlic

A

increased risk of bleeding - ASA and warfarin
increase prothrombin time
may have hypotensive effect
discontinue supplements 10 days before surgery

37
Q

use of danshen

A

traditional chinese medicine for treatment of CAD

38
Q

danshen drug interactions

A

digoxin like effects dont use together
hypotensive effect
antiplatelet effect
reduced elimination of warfarin

39
Q

echinacea uses

A

stimulate IS and prevent infections

40
Q

echinacea drug interactions

A

may potentiate hepatotoxicity long term

increase hepatotoxic effects of other drugs - amiodarone, statin

41
Q

licorice use

A

expectorant

42
Q

licorice drug interactions

A

mineralcorticoid effect can causse fluid retention and increase BP
may cause hypokalemia
increased risk for ventricular arythmias
increased risk of bleeding ASA and warfarin

43
Q

motherwort uses

A

palpitations/tachycardia

44
Q

motherwort drug interactions

A

cardiac depressant effects
anticoagulant - decreases fibrinogen
antiplatelet effects increased risk of bleeding

45
Q

amiodarone drug interactions

A

echinacea
kava containing products
digoxin like substances

46
Q

digoxin drug interactions we talked about

A

hawthorn
stjohns wort
licorice
danshen

47
Q

NOAC interactions with NHPs

A

NHPs that are strong cyp3A4 and pgp inducers can decreased the plasma concentration

48
Q

what is l-arginine most likely to interact with

A

sildenafil

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