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Dietary Supplements and Herbal Medications Flashcards

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1
Q

What is the nature of echinacea?

A

Leaves and roots of echinacea species (Echinacea purpurea) contain flavonoids, polyacetylenes, and caffeoyl conjugates.

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2
Q

What are the main pharmacologic effects of echinacea?

A
  1. Cytokine activation and anti-inflammatory properties.

2. Some evidence for efficacy of above-ground parts of E.purpurea plants in the early treatment of colds.

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3
Q

What are the possible side effects of echinacea?

A
  1. Unpleasant taste
  2. GI effects
  3. Dizziness/headache
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4
Q

What drugs are derived from ephedra (Ma huang)?

A
  1. Ephedrine

2. Pseudoephedrine

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5
Q

Why has FDA banned the marketing of dietary supplements containing ephedrine alkaloids?

A

Due to cardiovascular risk.

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6
Q

What is the mechanism of action of ephedra?

A

Indirect acting sympathomimetic that release NE. (like ephedrine/pseudoephedrine).

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7
Q

What is the conditions in which ephedra is used?

A
  1. Nasal decongestion
  2. Asthma/bronchitis
  3. Cold/flu
  4. As mild CNS stimulants
  5. Also for weight loss and athletic performance enhancement.
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8
Q

What extra applications has ephedra in Chinese medicine?

A
  1. Diuresis

2. Relief of bone and joint pain

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9
Q

What are the major side effects of ephedra?

A

Those of ephedrine:

  1. Dizziness
  2. Insomnia
  3. Tachycardia
  4. Palpitations
  5. Flushing
  6. Anorexia
  7. Urinary retention
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10
Q

What are the contraindications for the use of ephedrine?

A
  1. Anxiety states
  2. Bulimia
  3. Arrhythmias
  4. Diabetes
  5. CHF
  6. HTN
  7. Glaucoma
  8. Hyperthyroidism
  9. Pregnancy
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11
Q

How can renal elimination of ephedra be faciliated?

A

By urinary acidification (ephedra is a weak base).

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12
Q

What is the nature of garlic?

A

Contains organic thiosulfinates that can form allicin (responsible for the characteristic odor) via enzymes activated by disruption of the garlic bulb.

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13
Q

What are the main pharmacologic effects of garlic?

A
  1. HMG-CoA reductase inhibition
  2. ACE inhibition
  3. Platelet aggregation block
  4. Incr. NO
  5. Fibrinolytic
  6. Antimicrobial
  7. Decr. carcinogen activation
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14
Q

What are the possible side effects of garlic?

A
  1. Nausea
  2. Hypotension
  3. Allergic reactions
  4. Problems with patients on anticoagulants
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15
Q

What is the nature of ginkgo?

A

Prepared from the leaves of Gingko biloba, ginkgo contains flavone glycosides and terpenoids.

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16
Q

What are the main pharmacologic effects of ginkgo?

A
  1. Antioxidant and radical-scavenging effects.
  2. Incr. NO
  3. Reduced blood viscosity
  4. Changes in CNS neurotransmitters
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17
Q

What is the common intended use of ginkgo?

A
  1. Treatment of intermittent claudication
  2. Cerebral insufficiency
  3. Dementia
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18
Q

What are the possible side effects of ginkgo?

A
  1. GI effects
  2. Anxiety
  3. Insomnia
  4. Headache
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19
Q

What are the conditions in which ginkgo is contraindicated?

A
  1. Patients receiving anticoagulants

2. Patients with a history of seizures - may be epileptogenic.

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20
Q

What is the nature of ginseng?

A

From the plant of the genus Panax, which contain multiple triterpenoid saponin glycosides (ginsenosides).

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21
Q

What are the pharmacologic effects of ginseng?

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A
  1. Improve mental and physical perfomance (limited evidence).
  2. Some evidence that may have some effect in cold prevention and in lowering postprandial glucose.
22
Q

What are the side effects of ginseng?

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A
  1. Estrogenic effects –> mastalgia and vaginal bleeding.

2. Insomnia, nervousness, and HTN have been reported.

23
Q

In what conditions should ginseng be used cautiously?

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A 
In patients receiving:
1. Anticoagulant
2. Antihypertensive
3. Hypoglycemic
4. Psychiatric 
medications.
24
Q

What is the nature of milk thistle?

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A

Derived from the fruit and sedds of Silybum marianum, which contains flavonolignans such as silymarin.

25
What are the main pharmacologic effects of milk thistle?
1. Reduces lipid peroxidation 2. Scavenges free radicals 3. Enhance SOD 4. Inhibits formation of leukotrienes 5. Increases hepatocyte RNA polymerase activity
26
What is the common intended use of milk thistle?
1. Limitation of hepatic injury | 2. As an antidote to Amanita mushroom poisoning
27
What is the only side effect that milk thistle may cause?
Loose stools.
28
What is the nature of St.John's wort?
Made from dried flowers of hypericum perforatum, which contains the active constituents hypericin and hyperforin.
29
What is the pharmacologic action of St.John's wort?
Hyperforin --> Decreases serotonin reuptake. | Hypericin --> When photoactivated, may have antiviral and anticancer effects.
30
What is the common intended use of St.John's wort?
Treatment of mild to moderate depression.
31
What are the possible side effects of St.John's wort?
1. Mild GI effects | 2. Photosensitization
32
In what conditions should St.John's wort be avoided?
In patients: 1. Using SSRIs 2. MAOs 3. With history of bipolar or psychotic disorder
33
What metabolic effect does St.John's wort have?
1. Induce CYP450 and P-glycoprotein drug transporters. | 2. Decreases effect of --> birth control pills, cyclosporine, digoxin, HIV protease inhibitors, warfarin.
34
What is the nature of saw palmetto?
Derived from the berries of Serenoa repens or Sabal serrulata. Contains phytosterols, aliphatic alcohols, polyprenes, flavonoids.
35
What is the pharmacologic action of saw palmetto?
Inhibition of 5α-reductase and antagonistic effects at androgen receptors.
36
What is the common intended use of saw palmetto?
Improvement in symptoms of BPH.
37
What are the side effects of saw palmetto?
1. Abdominal pain with GI distress. 2. Decreased libido 3. Headache 4. HTN 5. Has NO effects on the PSA.
38
Does saw palmetto have any effect on PSA?
No effect.
39
What is the nature of coenzyme Q10 (also known as ubiquinone)?
It is a benzoquinone that serves as a cofactor in the mitochondrial electron transport chain and, in its reduced form of ubiquinol, serves as an important antioxidant.
40
After digestion, what form of coenzyme Q10 predominates in the circulation?
The reduced form.
41
What are the common intended uses of coenzyme Q10?
1. Improvement of ischemic heart disease. 2. Parkinson 3. Statin-related myopathy
42
What is the most common side effect of coenzyme Q10?
GI disturbances.
43
Mention some rare effects of coenzyme Q10?
1. Rash 2. Thrombocytopenia 3. Irritability 4. Dizziness 5. Headache
44
What is the nature of glucosamine?
Amino sugar that serves as the precursor of nitrogen-containing sugars --> including the glycosaminoglycans (major constituent of connective tissue).
45
What is the common intended use of glucosamine?
Reduction of pain associated with osteoarthritis.
46
What are the side effects of glucosamine?
1. Diarrhea 2. Nausea 3. Possible cross-allergenicity with shellfish.
47
What is the nature of melatonin?
A serotonin derivative produced mainly in the pineal gland.
48
What are the main actions of melatonin?
1. Regulate sleep-wake cycles. 2. Contraception 3. Prevention of aging 4. Protect against oxidative stress 5. Treatment of cancer 6. Major depression 7. HIV infection
49
What are the applications of melatonin?
1. Extensively used for jet lag and insomnia. | 2. Sleep disorders (ramelteon).
50
What are the side effects of melatonin?
1. Sedation 2. Next-day drowsiness 3. Headache
51
In what conditions is melatonin contraindicated?
1. In pregnancy 2. In women attempting to conceive 3. In nursing mothers
52
Mention 2 examples of purified non herbal nutritional supplements that are used widely by the public in pursuit of "alternative medicine".
1. Dehydroepiandrosterone (DHEA) | 2. Melatonin

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