Exam 5 Herbal Medicines Flashcards Preview

Pharm. II > Exam 5 Herbal Medicines > Flashcards

Flashcards in Exam 5 Herbal Medicines Deck (41):
1

What are the indications for garlic? (4)

1) Anti-lipidemic
2) Antimicrobial
3) Anti-asthmatic
4) Anti-inflammatory

2

What are the indications for Ginkgo? (3)

1) Prevent decreased cerebral function

2) Peripheral vascular insufficiency associated w/ Alzheimer’s disease or age-related dementia

3) Improve memory and cognition

3

What are the indications for Ginseng? (7)

1) Anti-cancer
2) Slows aging
3) Prevent heart attack
4) Improve digestion
5) Reduce hypertension
6) Strengthen immunity
7) CNS stimulant

4

What are the indications for Ginger? (3)

1) Relieve motion sickness and morning sickness

2) Decrease arthritis pain and inflammation

3) Relieve upset stomach

5

What are the indication for Feverfew?

1 ) Anti-inflammatory (rheumatoid arthritis)
2) Fever reduction
3) Preventative for migraine headache (prophylaxis)

4) Muscle soreness
--Abrupt discontinuation: rebound headaches, joint pain and stiffness, anxiety.

5) Active: sesquiterpene lactone, parthenolide

6

What are the indications for Fish Oils?

1) Skin disorders
2) Cardioprotection
3) Diabetes
4) Headache
5) Immune support
6) Memory
7) PMS
8) Ulcerative colitis

7

What are the indications for St. John's Wort?

1) Reduce mild to moderate depression
2) Most widely studied herb with demonstrated efficacy
3) Weed-like plant
4) Renders oral contraceptives ineffective in some users

8

Major active antidepressive constituents in St. John’s wort are________ and ___________.

Other biologically active constituents: ___________ and __________

-hyperforin
- hypericin

-flavonoids
- tannins

9

What is the mechanism for St. John's Wort?

-The exact mechanism = unclear

-Mechanism is believed to involve inhibition of serotonin (5-HT) reuptake

10

Hyperforin is the major constituent for St. John's Wort. It has been to _______ the uptake of _______, ________, _________ , __________ and _________

- inhibit
- 5-HT
- dopamine
-norepinephrine
- GABA
- glutamate

11

What are the indications for Vitamin E?

1) Use: fat soluble vitamin

2) Antioxidant
■ Prevents oxidation of vitamins A & C
■ Protects polyunsaturated fatty acids in membranes from free radical damage
■ Protects RBCs against hemolysis

12

What is the uses for Echinacea?
(dangers?)

■ common cold
■ cough
■ bronchitis

○ Limit use to 10 days
○ Hepatotoxic, when used with other hepatotoxic meds

13

What are the indications for Kava-Kava?

1) anxiety
2) stress relief; acts like a minor tranquilizer, skeletal muscle relaxant
-FDA monitoring for hepatotoxicity

14

What are the indications for ● Licorice (Glycyrrhiza glabra)?

1) Gastric disorders
2) Antitussive
3) Aphthous ulcers
4) Herpes simplex

15

What are the indications for Valerian ?

1) Mild sedative
2) Mild anxiolytic
3) Anxiety
4) Depression
5) Insomnia

16

When the "g" is followed by a __________ (ex: ginkgo) the herb is associated w/ a __________ effect
○ Includes: _______, _______, ginger, _______, and __________

- vowel
- bleeding
-feverfew,
-ginkgo biloba
-garlic
-ginseng

17

What are Garlic's components implicated w/ bleeding?

1) Ajoene
2) Allicin-strong odor and flavor; platelet effect is irreversible
3) Sulfur containing compounds

○Effect: Antiplatelet= inhibits production and/or release of chemical mediators:
■ Platelet activating factor
■ Adenosine (decreases platelet function)

18

What is Ginkgo's components implicated in bleeding?

1) Terpenoids
2) Potent antagonist of platelet activating facor
3) Long-lasting and rapid onset w/ oral dosing

--Effect: Antiplatelet= INCREASES prothrombin time and DECREASES platelet activity

○ Risk for severe spontaneous bleeding w/ concurrent use of aspirin + warfarin

19

What is Ginseng's components implicated in bleeding?

■ Ginsenosides

--Effect: Antiplatelet = inhibit PAF, platelet aggregation, thrombin and thromboplastin

20

What is Ginger's components implicated in bleeding?

1) Pungent principles
2) Volatile oils
3) Proteolytic enzymes
--Effect: Antiplatelet= reduces platelet thromboxane, inhibits platelet aggregation

○ Mixed reports in literatiere
○ Most significant effects w/ raw ginger

21

What is Feverfew's components implicated in bleeding?

Effect: inhibits platelet aggregation

22

What is John's Wort components implicated in bleeding?

-hypericin
-Increases clotting and lowers the INR
- Decreased efficacy of anticoagulants

23

What is Vitamin E's components implicated in bleeding?

-May alter the effect of vitamin K on clotting factors

-Increases risk for spontaneous hemorrhage

24

What is Licorice's components implicated in bleeding?

May alter platelet aggregation

25

Fish Oils
Effects:
__________ platelet aggregation and________bleeding time
_________fibrinolysis
may ________ von Willebrand factor
________ fibrinogen
_______ factor V levels
_________ thrombin generation in plasma .

-Decrease
-prolong
-increase
- reduce
-reduce
-reduce
-reduce

26

Fish Oils:
Intake of _________ or greater of omega-3 fatty acids may ________ risk of bleeding

-Very large intakes of ______oil/omega-3 may ___________risk of hemorrhagic (bleeding) _________

High doses have also been associated with ______and blood in __________

- 3 grams/day
- increase risk of bleeding
- fish
-increase
-stroke
- nosebleed
- urine

27

Medications with a ______therapeutic range (ex: ______, _______) = ______ risk for adverse outcomes b/c of HDS-drug interactions

-Important for patients on _________ (warfarin) who concomitantly took ______ products that had ______ or __________effects

- narrow
-(warfarin, digoxin)
-greater
-anticoagulants (warfarin)
- HDS products
-antiplatelet
- anticoagulant

28

How does Ginkgo alter effect of Warfarin?

○ Antiplatelet = increases prothrombin time and decreases platelet activity

○ Risk for severe spontaneous bleeding w/ concurrent use of aspirin and warfarin

29

How does Ginseng alter effect of Warfarin?

○ Antiplatelet = inhibit PAF, platelet aggregation, thrombin and thromboplastin
○ Potentiates bleeding w/ aspirin, NSAIDs, warfarin, heparin

30

How does St. John's Wort alter effect of Warfarin?

1) Induces cytochrome P450 liver enzymes

2) Reduces anticoagulant effect of warfarin (increases clotting) and lowers INR

31

How does Vitamin E alter effect of Warfarin?

-Interacts with warfarin: increases -hypoprothrombinemia= delays clotting and increases risk for spontaneous hemorrhage

32

Dental considerations:

Synergistic drug effects w/ ______, _________: seek _________ analgesics
● Monitor patients on _______ for herbal use and ______ appropriately
● Cross-reference all herbal and prescription medications to _____ ___________________using a database (LexiComp for Dentistry)

-aspirin
NSAIDS
-alternative
-warfarin
-counsel
-ensure
- compatibility

33

What is the dental implication of
Echinacea?

May decrease effectiveness of corticosteroids

34

What is the dental implication of
Feverfew ?

○ Up to 15% of users may develop aphthous ulcers
○ May cause irritation of oral mucosa/tongue
○ Contraindicated in pregnancy
○ Increases risk for photosensitivity

35

What are the dental implication of
Feverfew ?

-Potentiates CNS effects of other CNS depressants: alcohol, BDZs, barbituates, sedatives, general anesthesia = caution w/ sedation dentistry

-Contraindicated in pregnancy lactation and Parkinson’s disease (may cause dopamine antagonism)

36

What are the dental implication of Licorice??

1) May cause hypertension: (monitor vital signs)

2) Contraindicated in pregnancy, lactation, liver or renal impairment

37

What are the dental implication of St. John's Wort??

○ General anesthetics= patient difficult to awaken

○ Increases photosensitivity or tetracyclines

○ Reduces effect of glucocorticoids

38

What are the dental implication of Valerian?

○ Causes drowsiness and sedation
○ Potentiates the effects of CNS depressants, including barbiturates

39

What are the dental implication o Vitamin E

○ May alter the effect of vitamin K on clotting factors
○ hypoprothrombinemia

40

What is the rationale for discontinuing herbal supplement use 2 weeks prior to surgical procedures?

● All herbal medicines should be discontinued for 14 days prior to surgery (including oral surgery)

● Common herbs: ginkgo, garlic, ginseng, ginger
-Antagonize platelet activating factor

41

Describe the rationale for discontinuing herbal supplement like John’s Wort?

1) DECREASES effects of many medications

2) Multiple drug interactions

3) General anesthetics= patient difficult to awaken

4) DECREASED efficacy of anticoagulants