Flashcards in Exam 5 Herbal Medicines Deck (41):
What are the indications for garlic? (4)
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
What are the indications for Ginseng? (7)
2) Slows aging
3) Prevent heart attack
4) Improve digestion
5) Reduce hypertension
6) Strengthen immunity
7) CNS stimulant
What are the indications for Ginger? (3)
1) Relieve motion sickness and morning sickness
2) Decrease arthritis pain and inflammation
3) Relieve upset stomach
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
What are the indications for Fish Oils?
1) Skin disorders
5) Immune support
8) Ulcerative colitis
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
Major active antidepressive constituents in St. John’s wort are________ and ___________.
Other biologically active constituents: ___________ and __________
What is the mechanism for St. John's Wort?
-The exact mechanism = unclear
-Mechanism is believed to involve inhibition of serotonin (5-HT) reuptake
Hyperforin is the major constituent for St. John's Wort. It has been to _______ the uptake of _______, ________, _________ , __________ and _________
What are the indications for Vitamin E?
1) Use: fat soluble vitamin
■ Prevents oxidation of vitamins A & C
■ Protects polyunsaturated fatty acids in membranes from free radical damage
■ Protects RBCs against hemolysis
What is the uses for Echinacea?
■ common cold
○ Limit use to 10 days
○ Hepatotoxic, when used with other hepatotoxic meds
What are the indications for Kava-Kava?
2) stress relief; acts like a minor tranquilizer, skeletal muscle relaxant
-FDA monitoring for hepatotoxicity
What are the indications for ● Licorice (Glycyrrhiza glabra)?
1) Gastric disorders
3) Aphthous ulcers
4) Herpes simplex
What are the indications for Valerian ?
1) Mild sedative
2) Mild anxiolytic
When the "g" is followed by a __________ (ex: ginkgo) the herb is associated w/ a __________ effect
○ Includes: _______, _______, ginger, _______, and __________
What are Garlic's components implicated w/ bleeding?
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)
What is Ginkgo's components implicated in bleeding?
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
What is Ginseng's components implicated in bleeding?
--Effect: Antiplatelet = inhibit PAF, platelet aggregation, thrombin and thromboplastin
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
What is Feverfew's components implicated in bleeding?
Effect: inhibits platelet aggregation
What is John's Wort components implicated in bleeding?
-Increases clotting and lowers the INR
- Decreased efficacy of anticoagulants
What is Vitamin E's components implicated in bleeding?
-May alter the effect of vitamin K on clotting factors
-Increases risk for spontaneous hemorrhage
What is Licorice's components implicated in bleeding?
May alter platelet aggregation
__________ platelet aggregation and________bleeding time
may ________ von Willebrand factor
_______ factor V levels
_________ thrombin generation in plasma .
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
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
- HDS products
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
How does Ginseng alter effect of Warfarin?
○ Antiplatelet = inhibit PAF, platelet aggregation, thrombin and thromboplastin
○ Potentiates bleeding w/ aspirin, NSAIDs, warfarin, heparin
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
How does Vitamin E alter effect of Warfarin?
-Interacts with warfarin: increases -hypoprothrombinemia= delays clotting and increases risk for spontaneous hemorrhage
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)
What is the dental implication of
May decrease effectiveness of corticosteroids
What is the dental implication of
○ Up to 15% of users may develop aphthous ulcers
○ May cause irritation of oral mucosa/tongue
○ Contraindicated in pregnancy
○ Increases risk for photosensitivity
What are the dental implication of
-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)
What are the dental implication of Licorice??
1) May cause hypertension: (monitor vital signs)
2) Contraindicated in pregnancy, lactation, liver or renal impairment
What are the dental implication of St. John's Wort??
○ General anesthetics= patient difficult to awaken
○ Increases photosensitivity or tetracyclines
○ Reduces effect of glucocorticoids
What are the dental implication of Valerian?
○ Causes drowsiness and sedation
○ Potentiates the effects of CNS depressants, including barbiturates
What are the dental implication o Vitamin E
○ May alter the effect of vitamin K on clotting factors
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