Dshea
Dietary Suppliement Health & Education Act
1994
- increased phytochemicals for consumption
- distinguished dietary suppliment from food additiivies
- Limits FDA: allow exemption of premarket approval for supplements
View points of suppliment users
- increasing
- not consider herbal
- herbs contain active drugs
- dont link adverse health events
What percentage of patients revel the use suppliments
40%
Studies that serve as initial indicators of possible herb drug interactions but not establish cause
case report
studies that assess various effects of botanicals using human subject
prospective in vivo studies
Studies that show effects of phyochemicals on purified enzymes/transporters
in vitro screens
Area of the body where herbs can change drug metabolizing enzymes are found
small intestine and liver
herbs can modulate drug transport primarily found in what areas of the body
small intestin, bbb, liver
most important enzymes
cyp3A4, cyp2d6, cyp2c9, cyp 1A2
St. Johns Wort
Indication: Antidepressive
Efficacy good
drug interaction risk highg (render most drugs ineffective)
-effects transplants recieving cyclosporin
means other than conventional medicines to treat
alternative medicines
Herbs, essential oils, and neti pots to treat is example of
alternative medicines
using both conventional and other means to treat without recommendation of providers is called
complimentary medicines
Using prescribed antibiotics, along with essential oils and neti pot to treat is example of
complimentary medicine
prescribed use of conventional medicine along with other means for treatment is known as
integrative medicine
APRN prescribes antibiotics, AND essential oils with neti pot to treat is example of
integrative medicine
Benefits of Tai Chi
helps Parkinsons balance decrease osteoarthritis pain decrease back pain and fibromyalgia increase concentration decrease depression
benefits of yoga
improves lymphedema well being
Acupuncture benefits
alleviate abnormal blood flow (chee)
may help with N/V; hot flashes; pain, and psycho disorder
Mindfulness benefits
reduce stress
reduce cancer fatigue
weightloss
Essential oils benefits
symptom management
not FDA approved for cure of specific diagnosis
Describe Reiki
energy medicine; moving blocked energy from chakra center
identify hot and cold centers
Describe Sound centers
singing bowls used to open chakra
Describe crystal healing
crystals are used to open chakra centers
Describe Ayurveda
supplements high in heavy metals and arsenic and lead; mind body medicine living in tune with natures
side effects of use of ephedra
cardiovascular and central nervous system events
What is Ma-Huang
The ancient Chinese ephedra herb
catechins, xanthones, and tannins can be seen in caffeine natural sources to inhibit COMT and MAO to potentiate what activity
sympathomimetic
Ephedra and Caffeine can lower blood flow to
cerebral areas
The difference in herbal supplements in single vs multi-ingredient supplements
the multi ingredient suppliments can cause toxic reactions
Licorice root Interactions
Glycyrrhiza Glabra
Interaction mxn: sodium retention, K depleting
Interacts with: diuretics and antiarrhythmic
When herb induce cyp or P-gp what levels of drug are suspected in body
reduced
When herb inhibits cyp or P-GP what levels of durg are suspected in body
increased
Patient with recent renal transplant asks about restarting St. Johns Wart. The APRN suggests
can not restart St. John Wart due to interaction with cyclosporin and potential of organ failure
Chemical in St john wart responsible for interaction
hyperforin
stronger than rifampin in receptor affinity
Goldenseal information
Cold, URTI, mask urine RX screens
Efficacy: poor
high interaction risk inhibits cyp3A4 and cyp2D6
How can Goldenseal increase the efficacy of a smaller dose of quinine
quinine is a substrate of CYP 3A4, goldenseal binds to 3A4
MDP containing botanicals can interfere with which cyp
CYP3A4
how does MDP contiaining Schizandra has what effect on tacrolimus? where can Schizandra be found
increases absorption
weight-loss supplement
Resveratrol effects what cyp450
decrease cyp2C9 activity
resveratrol has what effect on diclofenac
diclofenac levels increase
Green tea has what effect on nadolol
catechins in green tea decreases effects absorption
what is a liposome
artificial vesicles composed of phospholipid membranes surrounding an aqueous core.
can greatly improve oral bioavailability
what is a phytosomes
improve stability and shelf life, and improve bioavailability can be improved 2 to 6 fold
