E5: Herbie Hancock-Herbal Drugs Flashcards by Austin Shackelford

Important things to consider for your herbal patient: Beware of and assess the truthfulness of _________

non-disclosure

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Important things to consider for your herbal patient: Do not _______ or criticize and maintain their ________

judge….condfidentiality

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Important questions for your herbal pt: How _____ have you been using one or more herbs?

LONG

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Important questions for your herbal pt: Are you using herbs for: Promotion or maintenance of _______? Treatment of _______ problems?

oral health

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Important questions for your herbal pt: Have you had any _______ from herbs?

side effects

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Important questions for your herbal pt: Which herbs do you take _______ (at least once a week)?

regularly

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Important questions for your herbal pt: Have you recently ______ taking any herbs?

stopped

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Important questions for your herbal pt: Have you _______ herbs for Rx or OTC drugs?

substituted

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What are the three main groups that could see adverse effects of Herbals?

peds, gerris, pregos

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A national survey conducted in 2007 found that _____ of American adults had used “natural products” in the past 12 months

17.7%

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What are the 5 most popular herbal products used?

1.Fish oil/omega 3/DHA 2.Glucosamine 3.echinacea 4.flaxseed oil 5.ginseng

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___% of adult respondents said they had used some type of SUPPLEMENT in the last 30 days….what are 4 examples?

52%…1. mutivitamins 2.vit E and C 3.Calcium 4.B vitamins

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____% (n = 41) were at risk of having at least one possible drug and herbal-supplement INTERACTION

31.5%!!!

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What are the 4 most common reasons patients take an herbal product/dietary supplement?

1.Improve generall wellness 2.manage arthritis 3.prevent/manage colds 4.improve memory

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What are the 5 most common herbal meds that have documented drug interactions???

St. John’s Wort 2.Magnesium 3.Calcium 4.Iron 5.Ginkgo

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What are the three main systemic conditions that people used herbal meds/supps for?

1.CNS disorders 2.CardioVascular Sys disorders 3.Systemic Anti-Infectives

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What is the #1 Rx med that has interactions with herbal meds? What about the rest of the top 5?

1.WARFARIN (100+ interactions with herbal meds/supps) 2.Insulin 3.Aspirin 4.Digoxin 5.Ti-Clo-pid-ine (antiplatelet)

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HDS products containing _____ were more likely to have documented interactions with medications and contraindications than _____, ______ and other types of dietary supplements.

herbs more likely than vitamins, minerals

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What is the main way that herbal meds interfere with Rx meds? Like what does it do to their “safety”?

Patients using medications that have a NARROW THERAPUTIC RANGE (i.e. warfarin, digoxin) = greater risk for adverse outcomes because of HDS–drug interactions

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Important for patients on __________ who concomitantly took Herbals

anticoagulants

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It is estimated that GREATER THAN ____% of patients with chronic diseases or cancers use HDS

50% !!!!!

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Many herbs act as ________ or ________ medications

anti-platelet…anticoagulant

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Effects may be _______ if taking one or more of these herbs and/or if taking aspirin, ibuprofen, warfarin, etc.

ADDITIVE

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Patients are _______ of these effects

unaware

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Many herbal products contain ________: patients may not always know what is contained within their supplements

multiple herbs

What kind of evidence is used for supporting the bleeding effects of herbal meds? (4)

1.Anecdotal 2.Case Studies 3.Animal Studies 4.Lab studies

What are the 4 common herbs that cause bleeding issues? WHY do they cause these issues?

the 4 G's!!! 1.Ginkgo 2.Garlic 3.Ginseng 4.Ginger....They ANTAGONIZE PLATELET ACTIVATING FACTOR (PAF)

Should herbal meds be discontinued before surgery? If so how long before?

YES! 14 days prior to surgery (including oral surgery)

SWEET! She's giving us a mnemonic: How do I know if an herb is assoc with a bleeding effect?

the "g" is followed by a VOWEL (G'i'nkgo)

SWEET! She's giving us a mnemonic: How do I know if a herb is NOT a concern for bleeding?

the "g" is followed by a cononant (G'r'een tea)

SWEET! She's giving us a mnemonic: What are the 5 examples of the 'A Few G's will help you' mnemonic?

FeverFEW, Ginkgo biloba, Ginger, Garlic, Ginseng

What are the 4 'Anti' effects of garlic? (BESIDES anti-vampire)

1.Anti-Lipiemic 2.Antimicrobial 3.Anti-asmatic 4.Anti-inflammatory

What are the 3 components in GARLIC implicated with bleeding?

AAS......1.A-joe-ne 2.Allicin 3.Sulfur containing compounds

The 3 components Ajoene, Allicin, and Sulfur in GARLIC have _________ effects... What are the 2 chemical mediators that they inhibit?

ANTI-PLATELET.....1.Platelet Activating Factor 2.Adenosine (decreasing platelet function)

What are the 3 benefits of GINKGO?

1.PREVENT decreased cerebral funciton 2.Peripheral Vascular insufficiency associated with Alzheimer's disease or age-related dementia 3.Improve memory and cognition

What is the component of GINKGO implicated with anti-bleeding? They are Potent antagonists of _________ and they have _______ and ________ onset with oral dosing

Terpenoids!....platelet activating factor.... Long-lasting and rapid

The anti platelet effect of the Terpinoids of Gingko is that: Effect: antiplatelet = increases _________ and decreases __________

prothrombin time.....platelet activity

________ has had MANY case reports of severe bleeding

Gingko

Gingko: Risk for severe spontaneous bleeding with concurrent use of _______ and ________

aspirin and warfarin

What are the 7, YES 7 (how bad do you want this?!?!) benefits of GinSeng?

1.Anti-Cancer 2.Slows aging 3.Prevent Heart Attack 4.Improve Digestion 5.Reduce hypertension 6.Strengthen immunity 7.CNS stimulant (wow! get me some!)

What are the components of Ginseng associated with bleeding?

Ginsen-osides

What are the 4 anti-platelet effects of Ginseng's ginsenosides?

1.inhibit PAF 2.Inhibit Platelet Aggregation 3.inhibit thrombin 4.inhibit thromboplastin

Ginseng ANTAGONIZES the effect of ________

warfarin

What are the 4 drugs that when combined with GINSENG potentiate bleeding??

1.aspirin 2.NSAIDS 3.warfarin 4.heparin

What are the 4 benefits of Ginger?

1.Relive motion sickness 2.Releive morning sickness 3.Decrease arthritis pain/inflammation 4. Relive upset stomach

What are the 3 components of Ginger implicated in BLEEDING?

1.Pungent principles 2.Volatile oils 3.Proteolytic enzymes

What are the 2 ways Ginger has an antiPlatelet effect?

1.Reduces platelet THROMBOXANE 2.inhibits platelet aggregation

Ginger has _____ reports in the literature.

mixed

What preparation of ginger has the most significant effects?

RAW ginger (sorry Max, not the ginger candy)

What are the 3 benefits of FEVERFEW?

1.Anti-inflammatory (rheumatoid arthritis) 2.Preventative for migrane headache 3.muscle soreness

What are the 2 active components that inhibit platelet aggregation in Feverfew??

1. Ses-quit-er-pene Lactione 2.Parth-en-olide

What is the herbal medication that MAY CAUSE IRRITATION to the ORAL MUCOSA and TONGUE???

FeverFew!!

Feverfew also increases risk for ________!!

photosensitivity

YOU READY FOR THIS?? HOW BAD DO YOU WANT IT??? What are the 8 benefits of Fish Oil?

1.skin disorders 2.cardioprotection 3.diabetes 4.headache 5.immune support 6.memory 7. PMS :) 8.Ulcerative colitis

Daaaaang Fish oil has 7 effects on bleeding....what are they?

1.decrease platelet aggregation 2.prolong bleeding time 3.increase fibrinolysis 4.reduce Von Willebrand factor 5.reduce fibrinogen 6.reduce factor V levels 7. reduce Thrombin generation in plasma

Intake of ___ grams per day or greater of omega-3 fatty acids may increase the risk of bleeding

3 grams

Very large intakes of fish oil/omega-3 fatty acids may increase the risk of ____________

hemorrhagic (bleeding) stroke

High doses of fish oil/omega-3 FA's have also been associated with ________ and ____________.

nosebleed and blood in the urine

What is the main indication of St. John's Wort?

reduce mild to moderate depression

St. John's Wort is a _____-like plant

weed-like plant

What is the MOST widely studied herb with demonstrated efficiency?

St. John's Wort

While the The exact mechanism of St. John's Wort is _______, it is believed to involve inhibition of ________

unclear...serotonin (5-HT) reuptake

What are the 2 MAJOR active anti depressive constituents in St. John's Wort? what are the 2 'other'/minor biologically active constituents?

1.Hyper-forin(really THE major constituent) 2.Hypericin (others: 3.flavon-oids 4.tannins)

What is the MAJOR constituent of St. John's Wort?

HyperForin

Holy Crap: the major constituent HyperForin in St. Johns Wort has been shown to inhibit 5 freaking neurotransmitters....WHICH ONES?

1.5-HT (seratonin) 2.dopamine 3. norepi 4.GABA 5.Glutamate

Since the Hyperforin in St. John's Wort is blocking all those neurotransmitters, what is the main component involved in bleeding? How does it work?

hypericin...it INDUCES some cytochrome P450 liver enzymes

hypericin in St. John’s Wort ______ the anticoagulant effect of warfarin (increases _______) and lowers the ___

REDUCES, so it increases clotting...lowers INR

St. John's Wort ______ effects of MANY medications and has MULTIPLE drug _________

decreases....interactions

St. John's Wort: Renders _________ ineffective in | some users

ORAL CONTRACEPTIVES

Which herbal med has an effect on general anesthetics making the patient difficult to awaken?

St. John's Wort!

St. John's Wort increases PHOTOSENSITIVITY of _________

tetracyclines...so random!

What happens to the effect of GLUCOCORTICOIDS while on St. John's Wort?

Effect of glucocorticoids is reduced

St. Johns Wort: ________ efficacy of anticoagulants

decreased

REMBER: Discontinue all herbs ____ days prior to surgery

14 days

Vitamin E is a ____ soluble vitamin that acts mainly as an ________

FAT...antioxidant

Vitamin E as an anti-oxidant: prevents oxidation of Vitamins __ and ___

A and C

Vitamin E as an anti-oxidant: Protects ___________ in MEMBRANES from free radical damage

polyunsaturated fatty acids

Vitamin E as an anti-oxidant: Protects _____ against hemolysis

RBCs

Which herbal med may alter the effect of vitamin K on | clotting factors

Vitamin E

Which drug does Vitamin E interact with?

Warfarin

Vitamin E interacts with warfarin: increases _______________ = ______ clotting and ________ risk for spontaneous hemorrhage

hypoprothombinemia....DELAYS clotting and INCREASES risk

Herbs that alter Bleeding: 2 A's

ARN-ICA and ASTRA-GALUS

Herbs that alter Bleeding: 4 B's

BARberry, BILberry,BladderWrack, BRO-mel-ain

Herbs that alter Bleeding: 2 C's

Cat's Claw and Coenzyme Q10

Herbs that alter Bleeding: 2 D's

Devil's claw and DONG QUAI

Herbs that alter Bleeding: 1 E

Evening Primrose

Herbs that alter Bleeding: 3 F's

Fennel, FeverFew, Fish Oils

Herbs that alter Bleeding: 6 G's

1.Garlic 2.Ginger 3.Ginkgo bil-oba 4.Ginseng 5.Grape Seed 6.Green Tea

Herbs that alter Bleeding: 1 H

Horse Chestnut

Herbs that alter Bleeding: 1 K

Kudzu

Herbs that alter Bleeding: 2 P's

Poli-co-sanol and Pyc-no-genol

Herbs that alter Bleeding: 1 T

Turmeric

What are the 3 usual uses for Echinacea?

common cold, cough, bronchitis

What's the main systemic consequence of Echinacea? When is it especially bad?

its Hepatotoxic...esp with other hepatotoxic meds

Limit your use of Echinacea to ____ days

10 days

What two drugs decrease the effectiveness of corticosteroids?

1.St. John's Wort 2.Echinacea

What happens if you suddenly stop taking FeverFew?

1. Rebound Headaches 2.Joint Pain 3.Stiffness 4.Anxiety

Feverfew Inhibits ______ activity

patelet

Up to 15% of FeverFew users may develop _________

aphthous ulcers

Which 3 herbal meds are CONTRAINDICATED in pregnancy???

1.FeverFew 2.Kava-Kava 3.Licorice

What were the two herbal meds associated with photosensitivity?

st johns wort with tetracyclines and FeverFew with general photosen.

What are the 4 indications for KAVA-KAVA use?

1.Anxiety 2.Stress Relief 3.Minor tranquilizer 4.Skeletal muscle relaxant

Which herbal med potentiates CNS effects of other CNS depressants (EtOH, BDZ's, barbiturates, sedatives, general anesthesia)?

Kava-Kava

Which two herbals have adverse associations with anesthetics?

Kava-Kava and St. John's Wort

The FDA is currently monitoring KAVA-KAVA for _________ problems

hepatoToxicity

Kava-Kava is contraindicated in pregnancy, lactation AND ________.. WHY?

Parkinson's Disease...may cause dopamine antagonism)

What do people use Licorice to treat (4)?

1.Gastric disorders 2.AntiTussive (cough) 3.Apthous Ulcers 4.Herpes Simplex

Monitor vital signs when on LICORICE! Why?

Can cause Hypertension!

Licorice may alter ______ aggregation

platelet

Licorice is contraindicated in pregnancy, lactation, and can cause _____ or _____ impairment

liver or renal

Wait, what are the (7) platelet altering herbs?

1.Garlic 2.Ginkgo 3.Ginseng 4.Ginger 5.FeverFew 6.Fish Oils 7.Licorice

What is Valerian used for? (5)

1.mild sedative 2.mild anxiolytic 3.anxiety 4.depression 5.insomnia

Valerian causes ________ and sedation

drowsiness

Valerian potentiates the effects of CNS depressants, including _________

barbiturates

Which two herbals potentiate the effects of CNS depressants?

kaVA-kaVA and VAlerian

Dental Considerations: Synergistic drug effects with ______, ______: seek alternative analgesics

aspirin NSAIDS

Dental Considerations: Monitor patients on ______ for herbal use and counsel appropriately

warfarin

Dental Considerations: Cross-reference all herbal and prescription medications prior to prescribing to ensure _________...Like what resource?

compatibility...Lexicomp

E5: Herbie Hancock-Herbal Drugs Flashcards

(118 cards)