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PHAR154 > Herbals > Flashcards

Herbals Flashcards

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1
Q

What is the biggest question we will probably always get asked about herbals?

A

“is this good for _____?”
-probably wont ever have someone ask you about side effects,
what dose to use, or drug interactions

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2
Q

If decide to go the route of giving a herbal a try, what are some questions to ask the patient or things to keep in mind?

A

what has been tried so far?
have they tried the standard therapies?
what is the risk this will delay MD input?
patient frustration level

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3
Q

How do we control the risk of herbal use?

A

does the dose seem reasonable?
-often unknown, we are stuck with the label dosing
if not better in [days/weeks/months] get help
-need to have a time frame
is the patient under MD care?
-especially for osteoarthritis, insomnia, menopause,
depression

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4
Q

Which drug requires us to always search up drug interactions with herbals?

A

warfarin
also DOACs

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5
Q

When there’s a tv sign off with statements like “take ginger daily” or “add cinnamon to your water, its good for blood sugar”, what is never mentioned on these sign offs?

A

how much?
how long?
better than other measures?
any downside?
value vs effort/cost?
indication?

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6
Q

True or false: dark chocolate is fairly low calories and full of antioxidants

A

true
tv ads wont tell you that it has to be dark chocolate, they will just say “chocolate is full of antioxidants”

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7
Q

During a herbal consult, what must we always keep in mind?

A

has this person tried standard therapy for this situation
ex: premarin for menopause or celecoxib for arthritis

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8
Q

Differentiate between rheumatoid arthritis and osteoarthritis.

A

rheumatoid arthritis:
-more severe than OA
-immune system attacking the body
-people of any age, most commonly between age 20-60
-symptoms felt throughout entire body
-affects women more than men
-morning stiffness >1hr
osteoarthritis:
-generally less severe than RA
-caused by wear and tear on the body
-generally affects people over age 40
-usually only affects the joints
-commonly in both genders
-morning stiffness <1hr, returns at end of the day

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9
Q

What do the joints of an osteoarthritis sufferer look like? What about the joints of a rheumatoid arthritis sufferer?

A

osteoarthritis: bone ends rubbing together, thinned cartilage
rheumatoid arthritis: swollen inflamed synovial membrane,
bone erosion

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10
Q

What are the common sites for osteoarthritis?

A

neck
shoulder
lower back/SPINE
elbow
HIP
base of thumb
tips of fingers
KNEE
ankle
base of big toe

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11
Q

What is a location of joint pain that worries us and requires referral?

A

neck

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12
Q

What is the main use of glucosamine and chondroitin?

A

osteoarthritis

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13
Q

Describe the progression of osteoarthritis.

A

wear and tear–>loss of cartilage–>friction between bones–>pain/swelling/less ROM

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14
Q

What can contribute to the development of osteoarthritis?

A

age
obesity
genetics

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15
Q

What is the MOA of glucosamine and chondroitin?

A

normal component of cartilage matrix and synovial fluid
may prevent joint-space narrowing

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16
Q

What are glycosaminoglycans?

A

normal component of cartilage/connective tissue
water sticks to GAGs (cushioning action)

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17
Q

What is the dosage regimen for glucosamine?

A

try for 3-6 months
500mg TID
-can be 750mg BID or all 3 caps at once

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18
Q

What are the patient expectations for glucosamine?

A

dont stop other meds
will take 4-8 weeks (if it even works)

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19
Q

Describe the efficacy of glucosamine.

A

likely not good for arthritis of low back pain
if it works, likely still need NSAID for flare-ups

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20
Q

Why is glucosamine not good for back pain?

A

glucosamine tries to fix the interface between joints
these interfaces are not really present in the back
more likely to work on somewhere like a knee joint

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21
Q

Describe the efficacy of chondroitin.

A

little benefit (alone or with glucosamine)
beneficial effect on joint space (at 2 years)
can help, but less than glucosamine
AGAIN, LOTS OF BACK AND FORTH
mainly an add-on to glucosamine

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22
Q

What is MSM?

A

found in humans (and foods) but NOT a normal component of joints

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23
Q

True or false: MSM has great value

A

false
questionable value

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24
Q

What is the dosing of chondroitin?

A

400mg TID

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25
What are the side effects of glucosamine?
excellent safety record maybe GI or derm
26
What are the drug interactions with glucosamine?
very minimal warfarin interference is possible but unlikely blood glucose impact unlikely
27
When you have the choice between glucosamine, chondroitin, MSM, or a combo product, which would you choose?
SKIP MSM JT goes glucosamine and skips the combo cant really find chondroitin alone, left with solo glucosamine or the combo chondroitin may be additive
28
What do we make of SierraSil and bromelain?
hot trash
29
Differentiate between curcumin and turmeric.
curcumin is a naturally occurring chemical compound found in turmeric turmeric is the yellow powder and curcumin is found within the powder
30
What is the dose of curcumin used for relief of pain in arthritis?
2g
31
How much turmeric is needed to achieve the beneficial dose of curcumin?
1stp=3g turmeric=200mg curcumin therefore: 10tsp=30g turmeric=2g curcumin
32
What is arnica often advertised for?
bruising, inflammation, soreness GARBAGE often seen in homeopathic preps and food additives
33
What are the essential fatty acids?
omega-3 omega-6
34
Name sources of the following omega-3 fatty acids: ALA, EPA, DHA
ALA: canola, soybeans, walnuts, flaxseed EPA: oily fishes such as cod liver, herring, mackerel, salmon, sardines DHA: oily fishes " ", also from algal fermentation
35
True or false: ALA can be converted by humans into EPA/DHA
true but only minimally thus ingesting a marine source is key
36
Name sources of the following omega-6 fatty acids: LA (linoleic acid), AA (arachidonic acid)
LA: soybean oil, corn oil, safflower oil, sunflower oil AA: peanut oil, meat, eggs, and dairy products
37
What can an excess of omega-6 lead to?
promotion of inflammation which can contribute to development of diseases such as coronary heart disease, cancer, and arthritis
38
What does a healthy balance of omega-6 to omega-3 look like?
2-4x more omega-6 than omega-3 the average diet today is 11-30x more omega-6 than omega-3 which is contributing to the rise of inflammatory diseases
39
Describe omega-9.
unsaturated fats found in vegetable and animal fats also known as oleic acids or monounsaturated fats sources: canola, sunflower, olive, and nut oils *produced by the body*
40
What are the effects of DHA/EPA?
anti-inflammatory less platelet adhesion
41
What are the effects of ALA?
5% converted to DHA/EPA (thus get DHA/EPA from diet) used for cell membranes and hormones
42
What are the effects of omega-6 fatty acids?
energy production undesirable PGs inflammation
43
What are the main uses of omega-3 fatty acids?
cardiovascular: -1 prevention (prevent 1st MI) -2 prevention (prevent 2nd MI) -high TGs *REPORTS NOW SHOWING THAT THE VALUE IS PROBABLY NOT GREAT* (flashcard coming up on its efficacy)
44
Describe the efficacy of omega-3 fatty acids in regards to its main uses.
modest or no benefit from supplements -more hope for secondary prevention than primary -likely less helpful if taking full MI medicine regimen helpful for elevated TGs
45
What is the best source of omega-3 fatty acids?
fish
46
What are the side effects of omega-3 supplements?
fishy taste (only se that JT mentions) unlikely risk of bleeding
47
Is there a concern of drug interaction between omega-3 supplements and agents with risk of bleeding?
no sir
48
What is the recommendations for omega-3 intake for patients without documented cardiovascular heart disease?
eat a variety of fish 2x per week include oils and foods rich in ALA
49
What is the recommendations for omega-3 intake for patients with documented cardiovascular heart disease?
1g of EPA+DHA per day, preferably from fatty fish EPA+DHA supps can could be considered in consultation with a physician
50
What is the recommendations for omega-3 intake for patients who need to lower TGs?
2-4g of EPA+DHA per day provided as capsules under a physicians care
51
What is the recommended amount of EPA/DHA per day or per week?
500mg a day or 3500mg a week "two small servings" for primary prevention
52
What is the dosing of EPA/DHA supplements for primary prevention?
2 servings/wk of specific fish or 500mg supp (EPA/DHA) daily
53
What is the dosing of EPA/DHA supplements for secondary prevention?
1000mg fish oil (to deliver 180/120mg EPA/DHA) TID
54
What is the dosing of EPA/DHA supplements for hyper-TGs?
2-4g of EPA/DHA
55
How much EPA/DHA is in 1000mg of wild salmon fish oil supplements?
300mg
56
We know that omega-3 has a fish aftertaste that is not desired by patients. There are liquid versions of omega-3 that try to mask the taste, what do we make of these products?
don't recommend, they are super expensive just tell the patient to take the omega-3 with food
57
True or false: Neptune Krill Oil is super good for MI prevention
false
58
What form must flaxseed be in to be absorbed?
ground up must also be packaged airtight
59
What are the other uses of omega-3?
rheumatoid arthritis: beneficial osteoarthritis: less benefit than RA depression: mixed reports, less so on the radar screen -doesnt look good dry eyes: maybe, leap of faith -evidence is uncertain ADHD: has promise
60
What are some cholesterol lowering agents other than statins?
Metamucil -10g/day (3 tsp TID), drop by 5% omega-3s -2-4g EPA/DHA to lower TGs only plant sterols/stanols -2g, drop by 10% soy -25g soy protein (4 cups soy milk), drops by 5%
61
How does Metamucil lower cholesterol?
bile acids get trapped in the Metamucil gel and eliminated, the body then has to make more bile acids which uses up cholesterol to do that
62
What is CoQ-10?
aka ubiquinone vitamin-like present in all cells antioxidant EXPENSIVE some in meats/seafood
63
What is the link between CoQ-10 and statins?
statins reduce the amount of CoQ-10 in the body -maybe the reason for myopathy from statins?? JT goes 3-4mo of statins, if muscle pain shows up can try adding CoQ-10 as a supp, dont have to add it from the start
64
What are the uses of CoQ-10?
possibly effective: -congestive heart failure: treatment -hypertension: treatment -heart attack: prevention -migraines: prevention not sure yet: -angina -melanoma -diabetes likely ineffective: -alzheimers *statin-induced muscle pain=worth a try*
65
What are the side effects of CoQ-10?
no major side effects occasional stomach upset
66
What is the recommended dose of CoQ-10 for supplementation?
30-200mg OD
67
What is the difference between ubiquinone and ubiquinol?
ubiquinone gets converted to the active form, ubiquinol in the body ubiquinol may yield a bit more active compound in your body
68
What percent of the population experiences chronic insomnia?
10%
69
What is JTs mindset when it comes to OTC products and insomnia?
attempt to curb OTC product use and shift their focus to getting medical care
70
What is first line therapy for insomnia?
cognitive behavioural therapy -for insomnia, the primary goal is to recognize and change irrational thoughts and beliefs about sleep that elevate stress and anxiety and thus cause or exacerbate sleeplessness
71
True or false: turkey contains more tryptophan than other meats and is therefore more sedating
false its just the volume of food
72
Whats the verdict on chamomile and sleep?
highly unlikely to be helpful try if you wish
73
Whats the verdict on lavender and sleep?
not gonna help you sleep
74
Whats the verdict on valerian and sleep?
not gonna help you sleep
75
What is an important line extension of Nytol to watch out for?
the one that contains valerian rather than dph
76
How sedating is diphenhydramine?
not much, a little bit drowsy probably more psychological than therapeutic
77
Does tolerance develop to diphenhydramine?
yes ex: someone taking QD x 30d will see effectiveness drop around week 3-4
78
What are the side effects of diphenhydramine?
dry mouth constipating urinary retention *on the BEERS List*
79
What stimulates melatonin production?
stimulated by darkness, inhibited by light
80
What part of the brain produces melatonin?
pineal gland
81
Describe melatonin.
hormone produced from tryptophan ties into our circadian rhythms (seasonal/daily) increased levels at night levels drop as we age humans have MT1 and MT2 receptors
82
What is the main use of melatonin?
insomnia others include: depression, jet lag, CV, GERD, antioxidant, cancer (but does it really work for these???)
83
What is the impact of melatonin on sleep latency and total sleep time?
decreased sleep latency by 7.1 minutes increased total sleep time by 8.3 minutes
84
What is the dosing of melatonin?
1-2mg HS x 2 wks, then 5mg HS x 2wks; re-assess 1-2 hours before bedtime
85
Describe the efficacy of melatonin.
may not be dose-dependent (more is not better) no signs of tolerance (at 1-3 years) no signs of negative effects on sleep
86
What are the side effects of melatonin?
mild GI additive drowsiness to any other sedating agent headache *safety seen over several years (up to 5mg)*
87
What should be your focus with a patient during a melatonin consult?
seen a doctor? how long has this been a problem? (years=refer) any link to an event? (melatonin wont cure it) affecting quality of life? (physician care) tips on better sleep shift people away from Nytol to melatonin set out a time frame of reasonable use
88
What are ten tips for a better sleep?
maintain a consistent schedule reduce daily caffeine intake turn off the computer or TV dont go to bed on a full stomach dont go to bed on an empty stomach engage in regular exercise limit beverage consumption before bed keep your bedroom dark and quiet invest in a comfortable mattress, pillow, and bedding go to sleep and wake up using your internal alarm clock
89
Is melatonin safe for kids?
yes but not our call
90
What is Circadin?
melatonin in a tablet that is Rx in Europe 2mg SR tablet approved for 3 months use takes few weeks (maybe 21d) for full effect
91
What are the so called "uses" of flaxseed?
cardiovascular (omega 3 precursor as it has ALA but remember little ALA is converted to omega-3 in the body) =likely not constipation (soluble fiber) =sure menopause (contains lignans which is an estrogenic compound) =maybe
92
What form must flaxseed be in to be absorbed?
ground up
93
How much flaxseed is the right amount?
we have no idea reported that ~50g is the therapeutic serving for menopause
94
True or false: echinacea is great for the cold
false
95
Is garlic great for the cold?
not at all
96
Which herbal is contained within ColdFx?
ginseng
97
What is the active ingredient within St Johns Wort?
0.3% hypericin
98
True or false: St Johns Wort has the greatest risk of any herbal we have looked at
true potential for plenty of drug interactions
99
Describe the main uses and efficacy of St Johns Wort.
mild-moderate depression -as effective AND safe as SSRIs major depression -less proof of value
100
Is St Johns Wort an area for self-care?
not really almost exclusively an area of MD care
101
How do SSRIs work?
prevents re-uptake of serotonin
102
What is the MOA of St Johns Wort?
natural SSRI-like abilities
103
What are the side effects of St John Wort?
well tolerated (remember this) -better than TCAs -good as (or better) than SSRIs GI, rash, photosensitivity, sedation, anxiety, dizziness, headache, dry mouth (JT never remembers these)
104
How many drugs are known to interact with St Johns Wort?
100
105
What are some key drug interactions with St Johns Wort?
induces CYP P450 and P glycoprotein -decreases alprazolam levels -decreases simvastatin levels -decrease birth control pill levels (BIG ONE) -decreases warfarin levels other antidepressants-->serotonin syndrome
106
What is the dosing for St Johns Wort?
300mg TID
107
True or false: serotonin syndrome is quite common
false
108
How many drugs that increase serotonin are usually involved in serotonin syndrome?
2 drugs
109
What is the thought for an MOA of cranberry use in UTIs?
prevent E coli adhesion onto urinary tract does not appear to acidify urine (need 4L for that) may need 1-2 months for effect
110
Is treatment of UTIs with cranberry likely? What about prevention?
treatment: unlikely to help once the UTI occurs prevention: possibly effective
111
What is the definition of recurrent UTIs?
3 or more culture-positive infections in 1 year -approach is antibiotic use daily for weeks/months
112
What is the issue with cranberry juice for UTIs?
the delivery system, lots of sugar assuming 2 cups cranberry juice daily and the most positive data, for a 1 in 12 chance pf avoiding a UTI over 6 months=$180 + 45000 calories

PHAR154 (18 decks)

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