Apex- Herbal supplements

Question 1

4G drugs that increase bleeding tendency

do they increas the risk of spinal hematoma?

are they contraindications to regional?

Answer 1

Garlic
Ginger
Ginseng
Ginko Biloba

no

no, as long as they arent on other OACs

Question 2

2 supplements known to reduce MAC due to their increased GABA actions

Answer 2

kava kava & valerian

Question 3

St. John’s Wort is considered an SSRI
SSRI’s are generally considered enzyme inhibitors
how is St. John’s Wort different?

Answer 3

it INDUCES CYP 3A4

3A4 inducers = “ERS has TB, C!” ; inhibitors = “CAGES”

3A4=
Opioids: fent, su, al; methadone
Locals: **Lido, BPV, **Ropi
Benzos: Midaz & Diaz

Bold= high hepatic extraction ratios (blood flow dependent)
italic = low ERs (enzyme depdendent)

Question 4

What is Saw Palmetto used for and what’s the risk

Answer 4

BPH, increased bleeding

no data on how long to stop it before surgery

Question 5

How long to stop St. Johns Wort prior to surgery

Answer 5

5 days

Question 6

T/F: there are no currentguidelines that say surgery must be postponed in the patient taking an herbal supplmement

Answer 6

True

Question 7

Match the following supplements with their beneifit:

Garlic, Ginger, Ginseng, Gingko Biloba

Anti-aging, poor circulation
Antioxidant
Nausea
Anti-platelet, HTN, HLD

Answer 7

Anti-aging, poor circulation → Ginko Biloba
Antioxidant → Ginseng
Nausea→ Ginger
Anti-platelet, HTN, HLD → Garlic

Question 8

Match the following supplements with their benefit:
Kava Kava, Licorice, Saw Palmetto, St. John’s wort

Depression
BPH
Anxiety
Gastric and duodenal ulcers

Answer 8

Depression → St. Johns Wort
BPH → Saw Palmetto
Anxiety → Kava Kava (and Valerian)
Gastric and duodenal ulcers → Licorice

Question 9

Ingestion of what supplement can mimic conns syndrome

Answer 9

Licorice

mimics aldosterone

increased sodium and water retention
decreased K and hydrogen