Herbals Flashcards
(32 cards)
1
Q
CAM (4)
A
- Complementary and Alternative Medicine
- Complementary: used with conventional meds
- Alternative: used in place of conventional meds
- Integrative: conventional meds with evidence based safe and effective CAM therapies
2
Q
How does VE Tyler define herbal remedies? (2)
A
- Crude drugs of vegetable origin
- Utilized for treatment of disease states of chronic nature or to attain/maintain health
3
Q
How do US regulations define herbal remedies? (3)
A
- Products taken by mouth that contain a “dietary ingredient” intended to supplement the diet.
- May be vitamins, minerals, herbs, botanicals, AAs, enzymes, organ tissues and metabolites
- Tobacco is NOT an herbal remedy (TQ)
4
Q
Characteristics of pharmaceutical medicines (4)
A
- Active constituents are highly purified, single compounds
- Well-defined, specific activity
- Doses are precisely calibrated
- Potency is greater
5
Q
Characteristics of Herbs compared to Pharmaceutical meds (4)
A
- More dilute (ie caffeine in coffee) [TQ]
- Hundreds of related compounds (may have >1 active ingredients or no active ingredients)
- Concentrations vary with individual plants
- Mis-identification of plants at time of collection
6
Q
Forms of Herbals (5)
A
- Teas (dried herb, distributed in coarse cut form or tea bags)
- Extracts (concentrated preperations: fluids, powders, solids, volatile oils)
- Oil Macerations
- Fresh expressed juice
- Tinctures (herb + alcohol)
7
Q
5 Reasons Patients Use Herbals
A
- To control one’s own health
- To build resistance to disease (homeopathy)
- “Natural” must be better
- Disappointment/Fear with allopathic medicine
- Multicultural influences
8
Q
DSHEA (6)
A
- Dietary Supplement Health and Education Act - ‘94 (TQ)
1. Regulates dietary supplements as foods
2. Removes them from regulations as pharmaceuticals
3. Requires FDA to assess reasonable expectation of safety of new ingredients (although not prior to marketing)
4. There is no pre-approval review process
5. Proof of effectiveness is not required as long as there is no claim of curative or preventative use
6. Must state a disclaimer that it hasn’t been approved by FDA and is not intended to diagnose, treat or prevent any disease (TQ)
9
Q
GMP (5)
A
- Good Manufacturing Practices
- Described by FDA
- Requirements for quality control procedures, manufacturing plants, and testing of ingredients/products
- Requirements for record keeping and handling consumer product complaints
- Some manufacturers voluntarily follow drug GMPs which are more rigorous, and some organizations have created unofficial GMPs
10
Q
USP Certification (3)
A
- Dietary Supplement Verification Program (TQ)
- Tells consumer that product contains the stated ingredients, is pure and meets limits for contaminants (TQ)
- Assesses quality and conformity of ingredients
11
Q
Problems with Herbal Medications (3)
A
- Manufacturers: minimal financial incentive to conduct clinical studies since you can’t patent)
- Lack of assurance regarding safety and efficacy of products
- Long-term uses has been associated with increased risk of total mortality in older women
12
Q
Safety Issues with Herbals (13)
A
- Lack of clinical trials
- Unknown/Inconsistent dosage guidelines
- ADME questions
- Unknown consequences of long term therapy (TQ)
- Not for children under 3
- Sold by lay persons
- Lack of information available to patient
- No guidelines for what to do if remedy fails
- Contamination/Adulteration is possible and not detected (TQ)
- high levels of heavy metals (TQ)
- No standardization of active ingredients
- Nomenclature and chemical constituents vary
- May have drug interactions (TQ)
- ADRs are unknown/underreported
13
Q
Common Uses of Herbals (7)
A
- Cold/Flu
- Colic
- Dietary concerns
- Performance enhancement
- Psych issues (ADHD, depression)
- Sleep
- Superficial injuries (cuts, burns)
14
Q
Contamination/Adulteration of Herbals (3)
A
- High levels of heavy metals found in traditional Chinese/Indian herbals (TQ)
- Some products have been adulterated with drugs (may contain sibutramine, niacin, sildenafil, glyburide, etc)
- May contain pesticides, molds, microbes
15
Q
Increased Risk for Toxicity (4)
A
- Unborn, babies, breast-feeding babies
- Elderly
- Herb consumption: high dose, multiple compounds, long-term use
- Herb/Drug interactions
16
Q
Herbs Unsafe in Anyone (9)
A
- Chaparral
- Comfrey
- Ephedra (Ma-Huang)
- Hyndrangea
- Kava
- Pennyroyal (I miss Pennnnnny)
- Poke root
- Sassafrass
- Yohimbine
(PYP CHECKS)
17
Q
Encourage Patients To: (9)
A
- Do some research
- Use standardized and dated extracts
- Buy same brand each time
- Store properly (away from moisture and light)
- Only use for minor ailments (avoid miracle cures)
- Limit dosage, number and length of use
- Avoid during pregnancy and lactation
- Check dosage
- Keep in childproof container
18
Q
Herbals for Cold and Flu (3 Main, 9 alternatives)
A
- Echinacea
- Zinc
- Airborne Herbal
- Bee Pollen
- Chicken soup
- Garlic
- Vitamin C
- Elderberry
- Goldenseal
- Larch
- Slippery Elm
- White Willow
19
Q
Herbals for Depression (1)
A
-St. John’s Wort
20
Q
Herbals for Lipid Lowering/Cardioprotection (2)
A
- Fish Oil/Omega-3
- Ginseng
21
Q
Herbals for Performance Enhancement (6)
A
- Ephedra
- Chromium Picolinate
- Creatine
- Ginseng
- Kola Nut
- Tribulus Terrestris
22
Q
Herbals for Colic and Stomach Ailments (2)
A
- Chamomile
- Ginger
23
Q
Echinacea (8)
A
- Uses: cold and flu
- Strains: Purpurea, Augustifolia and Pallida
- Forms: tincture, fresh extract, capsules
- PO (and IV in Europe)
- MOA: immunostimulant (TQ) when used short term, anti-inflammatory, mild antibiotic
- Interactions: immunosuppressors, grapefruit juice
- Not for: children, HIV patients
- ADRs: >10 days becomes immunosuppressant
24
Q
Zinc (5)
A
- Uses: cold and flu (shortens length of misery)
- Lozenge, dissolved in mouth
- Must be taken every couple hours
- MOA: interrupts viral replication and cell attachment mechanisms
- ADRs: bad taste (metallic), nausea (if swallowed)
25
Airborne Herbal (4)
- Uses: cold and flu
- Created by 2nd grade teacher
- Contains: Vitamin A, Vitamin C, Vitamin E, Zinc, Selenium
- Herbal extracts: lonicera, forsythia, schizonepeta, ginger, chinese vitex, isatis root, echinacea)
26
What 2 alternatives for cold and flu contain salicylates?
1. Slippery Elm (TQ)
2. White Willow (TQ)
- These reduce fever but can cause Reye's syndrome in children
27
St. John's Wort (5)
- Uses: mild to moderate depression
- Dosing: TID (300 mg)
- MOA: MAOI and SSRI properties, may bind to GABA receptor
- Interactions: induces CYP3A4, inhibits CYP1A2, other antidepressants (precipitates serotonin syndrome [TQ])
- ADRs: fatigue, weight gain, pruritis, photosensitivity
28
Fish Oil/Omega-3 (4)
- Uses: lipid lowering/cardioprotection
- EPA and DHA in fish oil
- ALA in plant sources (walnuts, almonds)
- MOA: reduction in BP and triglycerides, significance in heart disease is inconsistent
29
Ginseng (5)
- Uses: cardiovascular conditions, reduce hyperglycemia, enhance immune system, Type II diabetes
- Active ingredient: ginsengosides (different types: panax is active component)
- Overall performance booster
- Big sales annually in U.S.
- Harvested from wild (so may be contaminated)
30
Ephedra (4)
- Uses: metabolic stimulant, increases thermogenesis for modest weight loss
- ADRs: vasospasm, arrhythmias, MI, HTN, seizures
- Removed from market due to abuse potential and cardiac risk (TQ)
- China has used for centuries as a CNS stimulant
31
Chamomile (4)
- Uses: colic and stomach ailments
- Relatively safe for infants
- Colic affects 20% of babies regardless if they are breast or bottle fed, has to do with more low iron formula than with iron fortified
- ADRs: weight loss (because baby has to exchange a fraction of breast milk for chamomile)
32
Ginger
- Uses: seasickness and motion sickness (TQ)
- Given to babies as an herbal tea
- Interactions: may affect 5HT-3 receptors
- ADRs: can increase bleeding time
