Chapter 25: Herbals, Vitamins & Supplements Flashcards Preview

Pharmacology > Chapter 25: Herbals, Vitamins & Supplements > Flashcards

Flashcards in Chapter 25: Herbals, Vitamins & Supplements Deck (104):
1

 

 

alternative medicine

 

 

not typically taught in medical schools

includes various therapies like herbals, acupuncture, mind-body therapies

2

 

 

complementary medicine

 

 

use of alternative medications within or alongside conventional medical practice

3

 

 

integrative medicine

 

 

combine the best of conventional therapy with evidence based alternative therapeutics

4

 

 

types of supplements

 

 

botanical

vitamins

biologically based

homeopathic

5

 

 

botanical medicine (phytomedicines)

 

 

preparations of whole herbs, herb parts, or extracts of herbs

6

 

 

what vitamin might be prescribed with metformin and why

 

 

Vitamin B12 because metformin can cause B12 deficiency

7

 

 

biologically based therapies

 

 

nonbotanical, nonvitamin therapies sauch as

fish oil, glucosamine, melatonin

8

 

 

homeopathic remedies

 

 

least dosing principle

active ingrediant can be either plant, mineral, or animal part

9

 

 

herbals used for infections

 

 

echinacea (common cold)

cranberry (prophylaxis for UTI)

elderberry (can reduce severity of flu)

10

 

 

 echinacea

 

  • mechanism of action: stimulates an increase in the production of  interferons and interleukins which limits viral spread and reduces duration of illness
  • side effects: low-grade malaise
  • contraindications: pregnancy, autoimmune disease, HIV patients, ragweed allergy

11

 

 

why should fresh ederberries be avoided

 

 

they are toxic raw

12

 

 

 probiotics 

 

 

Most made from human strains of Bifidobacterium and lactobacillus

used for upset stomach, gastritis, antibiotic-induced diarrhea, IBD

can cause sepsis in compromised immune system, especially premature infants and those with short intestines

13

 

 

herbals used to treat menopause and menstrual disorders

 

black cohosh

dong quai

red clover

chaste tree berry

evening primrose oil

soy

14

 

 

 black cohosh

 

 

improves mood, night sweats, sleep disturbance, and hot flash relief

does NOT improve bone density, reverse vaginal atrophy

superior safety and side effect profile

periodically monitor LFTs

15

 

 

 dong quai

 

PMS, dymenorrhea, menopause

adverse effects: increase in menstrual blood loss, photosensitivity

contraindicated: breast cancer, warfarin

16

 

 

red clover

 

 

used for hot flashes

second line after failure of black cohosh

dc 10-14 days prior to surgery

17

 

 

 chaste berry tree

 

used for PMS and menopause

contraindication: breast cancer, taking medicines that modulate dopaminergic system

18

 

 

evening primrose oil

 

PMS and menopause

high doses should not be used with anticoagulant therapy

19

 

 

soy

 

lowers risk of breast cancer, menopausal symptoms, and osteoporosis

side effects: occasional nausea and bloating

excessive use can cause hypothyroidism in patients with iodine deficiency

20

 

 

herbals used for BPH

 

stinging nettle

pumpkin seed extract or oil

saw palmetto

pygeum

21

 

 

stinging nettle

 

adverse effects: nausea, diarrhea, skin irritation

interactions: warfarin, hypoglycemic agents, antihypertensives, and sedatives

22

 

 

saw palmetto 

 

acts as a 5-alpha reductase inhibitor preventing conversion of testosterone to DHT

contraindicate in women of childbearing age

23

 

 

herbals used for energy and well-being

 

 

ginseng (Panax)

dehydroepiandrostenedione (DHEA)

ashwagandha

24

 

 

ginseng 

 

 

counteraction of antihypertensives

potentiation of hypoglycemic agents

25

 

 

 ashwagandha

 

 

effects vary: sedation, immunomodulation, smooth muscle relaxation, thyroid stimulation

26

 

 

hebals used for memory enhancement and cognitive function

 

 

ginko biloba

docosahexaenoic acid (DHA)

27

 

 

 ginko biloba

 

 

main side effects: inhibits platelet aggregation so it can increase bleeding time, can cause menorrhagia

28

 

 

herbals used for reflux esophagitis

 

 

slippery elm

deglycyrrhizinated licorice (DGL)

29

 

 

herbals used for nausea

 

 

ginger

30

 

 

herbals used for bloating and gas

 

 

fennel

caraway seed

31

 

 

herbals used for intestinal cramping

 

 

chamomile

peppermint oil

32

 

 

slippery elm

 

 

contains mucilage that coats irritated mucus membranes and stimulates secretion of extra mucous to soothe irritated tissues

33

 

 

DGL

 

 

use before meals to minize reflux

 

34

 

 

ginger

 

used to treat nausea in naval cadets, chemotherapy, gastroparesis, morning sickness

potential anti-inflammatory at high doses

raw ginger less effective than dried ginger

use in capsule if for inflammation as high doses can irritate esophageal mucosa

1G TID for arthritis

35

 

 

fennel

 

 

has GRAS status

36

 

 

caraway seed

 

 

reduces gastrointestinal motility

side effect when combined with peppermint are nausea and heartburn

37

 

 

chamomile

 

 

inhibits COX and LOX to exert anti-inflammatory effect

can cause sedation at high doses

high doses can interact with warfarin (no more than once daily)

38

 

 

peppermint oil

 

 

relaxes bowel motility and spacticity once past pylorus

adverse effects: heartburn, nausea, anal burning

never give to infants (can induce laryngospasm)

avoid H2 antacids

39

 

 

herbals used for constipation

 

aloe

triphala senna

cascara

konjac glucomannan

phosphate salts

40

 

 

aloe

 

not for long-tern (can cause hypokalemia and dehydration)

adverse effects: abdominal pain, cramps, diarrhea, hypokalemia

interactions: potentiation of diuretic potassium depletion and other stimulant laxatives

41

 

 

triphala

 

 

combination of stimulant and bulk forming laxative

42

 

 

senna

 

powerful stimulant laxative

can cause dependence if use long term

works in about 8 hours

side effects: cramping, nausea, excessive potassium depletion

interacts with warfarin

43

 

 

cascara

 

 

long term can cause diarrhea, cramping, hypokalemia, and dependence

44

 

 

konjac glucomannan

 

 

most viscous water soluble fiber in nature

can block throat if not taken with a full glass of water

can improve cholesterol

45

 

 

phosphate salts

 

 

cause water to be drawn into the gut to increase peristalsis

 

 

46

 

 

herbals used for diarrhea

 

 

black and green tea

cinnamon

rhubarb

47

 

 

black and green tea

 

 

contain polyphenols

1 cup per diarrhea stool

use caffeine free

48

 

 

cinnamon

 

 

tannins reduce fluid excretion in large intestine

GRAS status

oil should not be used for diarrhea (skin irritation, dizziness, sedation)

49

 

 

rhubarb

 

 

GRAS status

tannin effects in low doses

high doses can cause diarrhea

50

 

 

supplements for sleeping and sedation

 

 

melatonin

valerian

chamomile

hops

51

 

 

melatonin

 

 

most effective within 30 minutes of bed at low dose

reduce light in the evening

52

 

 

valerian

 

 

GRAS status

acts on GABA receptors but not as potent as benzos

interacts with CNS depressants

53

 

 

herbals used for anxiety

 

 

passionflower

kava kava

54

 

 

passionflower

 

 

contains flavonoids that cause sedation

higher doses can be used for opiate withdrawal

55

 

 

kava kava

 

 

in high doses has anticonvulsant properties

don't use unless certain it is root sourced as areal sourced can cause liver failure

56

 

 

supplements used for depression

 

 

st. john's wort

S-adenosylmethionin (SAM-e)

57

 

 

st. johs wort

 

 

acts on GABA and MAO systems

many drug interactions

58

 

 

SAM-e

 

 

risk of serotonin syndrome with SSRIs and MAOIs

good for depression with body aches

59

 

 

Oral herbals for arthritis

 

 

chondoitin sulfate/glucosamine sulfate

methylsulfonylmethane (MSM)

turmeric/curcumin

ginger

60

 

 

glucosamine

 

can take up to 2 weeks to see effects

61

 

 

MSM

 

 

often used in combo with glucosamine

 

62

 

 

turmeric

 

 

act as COX2 inhibitors to inhibit prostaglandins, leukotrienes, and thromboxanes

effects are maxiized when taken with fat-containing food or black pepper

63

 

 

topical herbs used for arthritis

 

 

capsaicin

ginger and tumeric

wintergreen oil

borage

64

 

 

capsaicin

 

 

causes substance P release resulting in diminished pain signal over time

causes intense burning that subsides after recurrent use

65

 

 

ginger and turmeric as topical agents

 

 

COX inhibitors

water and oil based pastes can be made

will stain clothing but does not have burning sensation

66

 

 

wintergreen oil

 

 

does not cause burning sensation

drug interaction are possible if used over a large surface area

(especially warfarin)

67

 

 

borage

 

 

can be used topically for arthritis and also for PMS and menopausal symptoms, bronchitis, colds

68

 

 

yohimbe

 

used for impotence

has hallucinogenic properties

lots of side effects and drug interactions

69

 

 

herbals for headaches

 

 

feverfew

riboflavin

magnesium

70

 

 

feverfew

 

used to decrease frequency of migraines

if leaves are chewed can cause heartburn and oral ulceration

71

 

 

riboflavin

 

 

waer soluble B2

can cause deep yellow urine

72

 

 

magnesium

 

 

migraine prophylactic

most common side effect is diarrhea

can affect absorption of medications

73

 

 

herbal used for glycemic control

 

 

cinnamon

potentiates hypoglycemic agents

74

 

 

herbals used for lipid control

 

omega3 fish oil

olive oil

red yeast rice

phytosterols

gum

75

 

 

Omega-3 fish oils

 

 

 

contain ALA, EPA, and DHA

effective dose ranges between 1-3gm daily

side effects: fishy breath. increased bruising

interactions: potentiates anticoagulants and antihypertensives

caution against high doses of fish LIVER oil to avoid vitamin A toxicity

76

 

 

olive oil

 

 

reduces cholesterol levels when used as a replacement for saturated fats

also an anti-inflammatory

interactions mainly involve hypoglycemics and antihypertensives

77

 

 

red yeast rice

 

 

uses the same mechanism of statin drugs to lower cholesterol

side effects are mild and may include heartburn, dizziness, and gas

 

 

78

 

 

phytosterols (Plant sterols)

 

 

act as adsorbents in the gut to prohibit enterohepatic recirculation of conjugated cholesterol

found in margarines, liquid fiber sources, nuts, seeds, cereals, legumes, and vegetable oils

caution against more than 2-3 servings daily as excessive use can block drug absorption 

79

 

 

gum

 

 

resin that provides soluble fiber to trap  cholesterol and fats to prevent enterohepatic recircultion

side effects: nausea and bloating

interactions reduced absorption of drugs including ABTs, hypoglycemics, digoxin, and oral contraceptives

80

 

 

herbals used for topical wound treatment

 

tea tree oil

aloe vera

antioxidant and anticancer supplements

81

 

 

tea tree oil

 

topically for skin infections like acne, minor cuts and scrapes, and tinea infections

chronic use can cause dry skin

do not use in ear canal cause it may be ototoxic

full strength on nails for onychomycosis and diluted to 5-10% strength for use on skin

do not use on mucous membranes or internally

82

 

 

aloe vera

 

 

 

do not use on severe burns

may be alternated with slivadene for 2nd degree burns

83

 

 

antioxidant and anticancer supplements

 

 

 

 

 

 

 

melatonin

ashwagandha

omega-3 fatty acids

indole-3 carbinole

84

 

 

melatonin as antioxidant/anticancer supplement

 

 

high doses can slow solid tumor growth

should be used only under clinical supervision as it far exceeds reccomended dosage for sedation

85

 

 

ashwagandha

 

 

can decrease chemotherapy induced cardiomyopathy in patients recieving doxorubicin

given after chemotherpy

may interact with CNS depressants and sedatives

86

 

 

omega-3 fatty acids as antioxidant/anticancer supplements

 

 

can reduce progression of adenomatous polyps in the colon

prudent for colon cancer patients

87

 

 

indole-3 carbinole (I3C)

 

 

found in broccoli and other cruciferous vegetables

used as a chemoproventive agent in those at high risk for breast cancer

interactions: lowers serum concentration of drugs metabolized by 1A2

 

88

 

 

fat soluble vitamins as food supplements

 

vitamin A (retinoic acid)

vitamin D (calcitrol)

vitamin E (tocopherols/tocotrienols)

vitamin K (phytonadione)

89

 

 

what two groups are vitamins divided into

 

 

fat-soluble and water-soluble

90

 

 

when should vitamins be taken

 

fat soluble - before meals

water soluble - after meals

91

 

 

vitamin A

 

needed for normal development of retina, cornea, skin, bones, teeth, and normal immune system function

deficiency is the most common cause of child blindness

toxicity can cause liver failure, hemolysis, and headaches

92

 

 

vitamin D

 

can be made in the body under optimal circumstances

deficiency syndromes include: myalgias, HTN, depression, hyperkerototic skin lesions, insuin resistance, and osteopenia

excessive intake without deficiency can cause hypercalcemia and arrhythmia

93

 

 

vitamin E

 

found in whole grains, nuts, fruits, eggs, poultry, vegetables, grain and vegetable oils

deficiency causes muscle weakness, decrease RBC survival

excessive use an cause nausea, diarrhea, and fatigue

94

 

 

vitamin K

 

fund in dark, leafy vegetables

needed for normal blood clotting, bone growth and maintenance

deficiency caused by long-term ABTs and warfarin

toxicity: hypercoagulability, soft tissues calcification in dialysis patients, hemolysis in patients with G6PD

95

 

 

water soluble vitamins

vitamin B1 (thiamine)

vitamin B2 (riboflavin)

vitamin B3 (niacin)

vitamin B6 (pyridoxine)

vitamin B9 (folate)

vitamin B12 (cyanocobalamine)

vitamin C (ascorbic acid)

Vitamin Coenzyme 10 (CoQ10)

96

 

 

vitamin B1 (thiamine)

 

acts as a catalyst in carbohydrate metabolism

deficiency causes beriberi (musclular weakness cardiomegaly, leg cramps)

found in pork, organ meats, brewers yeast, lean meats, eggs, leafy green vegetables, whole/enriched cereals, wheat germ, berries, nuts, legumes

deficiency is uncommon except in alcoholics (causes wernicke's encephalopathy, korsakoff's psychoses, and wernicke-korsakoff syndrome

97

 

 

vitamin B2 (riboflavin)

 

coenzyme in the metabolism of carbs, fats, and respiratory proteins

maintains mucus membranes

deficiency: perioral dermatitis and photosensitivity

best sources: liver, milk, meat, dark green vegetables, whole grain and enriched cereals, pasta, bread, and mushrooms

98

 

 

vitamin B3 (niacin)

 

deficiency causes pellagra (manifests as photosensitive rash, glossitis, diarrhea, mental confusion, and irritability)

best sources: liver, poultry, meat, canned tuna and salmon, whole grain and enriched cereal, dried beans and peas, and nuts

side effects: rash, flushing, GI upset

99

 

 

vitamin B6 (pyridoxine)

 

needed for absorption and metabolism of amino acids, and production of B12 and folate

deficiency: skin disorders, cracks at the mouth corners, smooth tongue, seizures, dizziness, nausea, anemia, kidney stones

best sources: whole but not enriched grains, cereals, bread, liver, avocados, spinach, green beans, and bananas

high doses (300+ mg) can cause irreversible peripheral neurotoxicity (NTE 50mg daily unless under physician supervision)

100

 

 

vitamin B9 (folate) deficiency

 

 

deficiency: high incidenc of neural tube defect and impaired hematopoeisis causing anemia

can also cause poor growth, tongue inflammation, gingivitis, anorexia, SOB, diarrhea, irritability, forgetfulness, and mental sluggishness

deficiency can be caused by celiac's, chrohn's, long term methotrexate use, disorders that cause high marrow turnover (sickle cell, spherocytosis)

101

 

 

vitamin B9 (folate)

 

childbearing: 0.4mg and continue that dose through 1st trimester

men (200mcg) postmenopausal women (180mcg)

sources: organ meat, leafy green vegetables, legumes, nuts, whole grains, brewers yeast

patients undergoing chemo should not take until cleared by oncologist because chemo may deliberately deplete folate stores

102

 

 

vitamin B12 (cyanocobalamin)

 

needed for formation of nucleoproteins, proteins, and RBCs, and for the functioning of the nervous system

deficiency often d/t inability of stomach to produce intrinsic factor (antibodies to parietal cells, prolonged PPIs and H2 blockers, aging)

symptoms: ineffective production of RBCs, faulty myelin synthesis, loss of GI tract epithelium

obtained only from animal sources (vegetarians should supplement)

103

 

 

vitamin C (ascorbic acid)

 

needed for collagen synthesis, maintenance of soft tissue structures, hemostasis, wound healing, enhances iron absorption

deficiency: scurvy (bleeding gums, loosened teeth, hemorrhagic lesions)

500-1000mg

large prolonged doses can cause kidney and bladder stones

104

 

 

CoQ10