Herbal

Question 1

Echinacea

Answer 1

Cold symptoms

Question 2

Echinacea MoA

Answer 2

Inhibition of pro-inflammatory cytokines
Bactericidal and Virucidal

Question 3

Echinacea Cautions

Answer 3

NOT FOR PREGNANT WOMEN
Unpleasant taste & GI effects
High alcohol content (caution in alcoholics)
No reported drug interactions
Avoid in immunocompromised patients

Question 4

Garlic

Answer 4

Cholesterol and hypertension

Question 5

Garlic MoA

Answer 5

Allicin inhibits HMG-CoA reductase which synthesizes cholesterol and exhibits antioxidant properties
Antiplatelet via ↑ nitric oxide
- Significant reduction in total cholesterol
- Significant reduction in SBP & DBP

Question 6

Garlic Cautions

Answer 6

Nausea, hypotension, and allergic reactions may occur
Breath and body odor (20-40%)
Hypotension + Anti-platelet = do not take

Question 7

Ginkgo

Answer 7

Intermittent claudication & Dementia

Question 8

Ginkgo MoA

Answer 8

Intermittent Claudication: ↑ Blood flow, ↑ Vasodilation
↓Blood Viscosity

CNS Effects: ↑ Serum Acetylcholine & Norepinephrine

Question 9

Ginkgo Cautions

Answer 9

GI effects, anxiety, insomnia, and headache.
Possible anti-platelet action
May be epileptogenic - avoid with hx of seizures

Question 10

Ginseng

Answer 10

Improvement of Serum Glucose & Mental Performance

Question 11

Ginseng MoA

Answer 11

Induces activated B and T cells, NK Cells & Macrophages
CNS: ↑Ach ↑Serotonin ↑Norepi ↑Dopamine

Question 12

Ginseng Cautions

Answer 12

Estrogenic: Mastalgia & Vaginal Bleeding
Insomnia, Nervousness, and HTN
Use cation with anticoagulation, hypoglycemics, antihypertensives, and psych meds.

Question 13

Milk Thistle

Answer 13

Hepatic Injury & Antidote for Amanita Mushroom

Question 14

Milk Thistle MoA

Answer 14

Scavenges free radicals & works as Antioxidant
Reduces lipid peroxidation

Question 15

Milk Thistle Cautions

Answer 15

Loose Stools
No significant toxicity
No reports of drug interactions

Question 16

St. John’s Wort

Answer 16

Mild to Moderate Depression

Question 17

St. John’s Wort MoA

Answer 17

Inhibition of nerve terminal re-uptake of:
Serotonin, Norepi, and Dopamine
- Effective Substance

Question 18

St. John’s Wort Cautions

Answer 18

Photosensitivity & GI effects
Avoid with SSRIs or MAO-Is –> Serotonin Syndrome
Induces formation of CYP450 and P-glycoprotein
↓ Effectiveness of birth control pills

Question 19

Saw Palmetto

Answer 19

Improvement of Benign Prostatic Hyperplasia (BPH)

Question 20

Saw Palmetto MoA

Answer 20

Noncompetitive inhibition of 5α-reductase and antagonist of DHT at androgen receptors

Question 21

Saw Palmetto Cautions

Answer 21

GI Distress, ↓ Libido
No Effect on prostate-specific antigen (PSA) marker

Question 22

Black Cohosh

Answer 22

Relief of Premenstrual & Menopause Symptoms

Question 23

Black Cohosh MoA

Answer 23

Selective Estrogen Receptor Modulator
Suppresses nitric oxide production in brain microglial cell
- Effective Substance

Question 24

Black Cohosh Cautions

Answer 24

Rash & Headache
Possible hepatic toxicity

Question 25

Valerian Root

Answer 25

Anxiety and Insomnia

Question 26

Valerian Root MoA

Answer 26

↑ GABA in the brain

Question 27

Valerian Root Cautions

Answer 27

Vivid Dreams Hangover Effect

Question 28

Coenzyme Q10

Answer 28

CHF, HTN, Statin-induced myopathy Parkinson's Disease

Question 29

Coenzyme Q10 MoA

Answer 29

Benzoquinone serves as important antioxidant Significant ↓ in SBP & DBP ↑ Ejection Fraction ↓ Statin-induced myopathy - Effective Substance

Question 30

CoQ10 Cautions

Answer 30

GI disturbance (most common) Headache & Dizziness Structurally similar to Vitamin K and can ↓ effects of Warfarin

Question 31

Glucosamine

Answer 31

↓ pain from Osteoarthritis

Question 32

Glucosamine MoA

Answer 32

Precursor of glycosaminoglycans (part of connective tissue such as joints and cartilage)

Question 33

Glucosamine Cautions

Answer 33

GI Effects Caution with shellfish allergies May increase INR with Warfarin (slow blood clotting)

Question 34

Melatonin

Answer 34

Sleep Aid & ↓ Jet Lag

Question 35

Melatonin MoA

Answer 35

Serotonin (5-HT) derivative Release coincides with darkness Regulates sleep cycles

Question 36

Melatonin Cautions

Answer 36

Sedation and Drowsiness DO NOT USE IN PREGNANCY Do NOT use while nursing Metabolized by P-450 & can ↑ drug interactions

Question 37

Fish Oil (Omega 3 Fatty Acid)

Answer 37

↓ Triglycerides ↓ Inflammation ↓ Heart Disease

Question 38

Fish Oil MoA

Answer 38

Contains DHA and EPA DHA & EPA block active side of enzyme stopping free fatty acids formation

Question 39

Fish Oil Cautions

Answer 39

↑ LDL GI side effects Fishy burps ↑ Risk of bleeding