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Flashcards in herbel Deck (84):
1

To be labeled a supplement

The herbal product must make no claims to treat, prevent or cure a disease

2

Impact of Dietary Supplement Health Education Act

Restricted FDA ability to control the safe and manufacturing of herbal products

3

Why herbals initially regulated in 1920s

Presence of natural drugs like cocaine and opium

4

Common Problem with Herbal Medicines

Active Ingredient is unknown therfore saftey/side effects/drug interactions cannot be fully understood.

5

Why herbal symptoms occur (broad)

(1) lack of standardization (2) different purities (3) variations in plant conditions and parts

6

Two tested treatments for usage of Ginko

(1) Cerebrovascular insufficeny symptoms (2) Dementia

7

Tested Treatment for St. John's Warts

Depression

8

Six Popular Herbal Supplements (Focus of the Lecture)

(1) St. John's Wort (2) Ginko (3) Kava (4) Ephedrine (5) Omega-3-Fatty Acid (6) Turmeric./Curcumin

9

Active Ingredient St. John's Wort

Hypericin

10

Prescribed use of St. John's Wort

Anxiety, Depression, Insomnia (only in Germany)

11

Pharmokinetics of St. John's Wort: Admin, Peak Blood LEvel, Half Life, Steady State

(1) Administered Orally (2) Peak Blood Levels at 5 hours after (3) Half Life of 25 hours (4) Steady State of 4-6 days

12

Pharmodynamics of St. John's Wort (reduce reuptake of 3 NT, binds to 3 types of receptors, has on chemical neuronal influence)

(1) Reduced Reuptake of 5HT, NE, DA (2) Bind at GABA Receptors (3) Bind at Benzodiazepine Receptors (4) Blind to glutamatergic NMDA-type receptors (5) Antioxadtive

13

Clinical efficacy of St. John's WOrt

Now just seend as effective in treatment of mild to moderate depression

14

What St. John's Wort inhibits

(1) CYP-2D6/CYP-2C9 are inhibited by Hyperforin (2) CYP-1A2 is inhibited by Quercitin

15

In SJW inhibits CYP1A2

Quercitin

16

In SJW inhibits CYP2D6 and CYP2C9

Hyperforin

17

SJW influence on COdeine

SJW decreases effectiveness of codeine due to a inhibition of CYP2D6 which converts codeine into mmorphine

18

SJW influence on caffeine, tricyclics, antipsychotics

INcreased blood level of all three

19

SJW influence on CYP-3A4

Increased activivty... causing reduced levels of drugs that are cardiac and anti-inlammatory

20

Side effects of SJW

Mild: Sedation/Lethargy/Upset GI..... ALso photosensativity, hypomania, seotonin syndrome when combined with SSRIs (agitation, diarrhea, increased heart rate, hallucinations. nasuea, vomitting)

21

Ginko extract

EGb-760

22

Benefit of Ginko flavonoids and terpenoids

(1) Reduce free radicals implicated in the cell damage that cuases Alzheimer's disease (2)Ginkogolide B inhibits platelet aggregation and slows blood clotting

23

Harms of GInko flavonoids and Terpenoids

Increased tendency to bleed and potentiate action of blood thinners.... also ainhibit CYP-1A2

24

Pharmokinetics of Ginko (Absorbtion, Peak PLasma, Half life)

(1) Taken orally (2) Peak plasma in 2-3 hours (3) Half life of 5 hours

25

Pharmodynamics of Ginko (homeostatic impact and brain function)

Egb-761 extract may act on processes involved in homeostasis of inflammation and oxidative stress ,,, (resulting in membrane protection and neurotransmission modulation)...EEG studies show increased ALPHA wave activity

26

Clinical Efficencey of Ginko

Ginko modestly improves cognitive functioning associated with cerebrovascular impairments but does not prevent the icidence of AD

27

Side Effects of GInko

(1) Mild GI upset (2) Mild Headaches [most common complaint] (3) Exacerbate bleeding problems and interacts with aspirin and other anticoagulants (4) Unknown saftey in pregnancy and lactation

28

Kava similar to

Ethyl alcohol--induces relaxation, improved social interaction & sleep

29

Kava inhibits

CYP450 liver enzyme

30

Kava most active ingredient

Kava Lactone

31

Kava anesthetic-like effect

Blocking sodium channels

32

Kava Clinical Effects

Seen as a short term remedy for moderate anxiety...depressive and GAD symptoms also can be improved with Kava

33

Kava Side Effects

(1) Drowsiness, nasea, muscle weakness, blurred vision, yellow skin, sedative effects (2) DO NOT combine with alcohol, benzoids, barbiturates, THC or CNS (3) Can result in hepatotoxcitity

34

Ephedrine course

Release catecholamine neurotransmitters (NE, DA, EP)

35

Epedrine benefits

Reduce appetite, stimulate cardiac function and pyscho-stimulant

36

Epderine harms

Release of adrenaline can increase blood pressure, heart rate, and force of cardiac contraction/cardiac output..... FATAL CARDIAC ARRYTHMIAS RESULTS

37

Doping substance of herbals

ephedrine

38

Caffeine and Ephedrine

Toxic combination because caffine increases the cardiovascular toxcity of ephedrine

39

Psuedoephedrine

A synthetic steroisomer to the ephedrine molecule ... must sign for it because it can be converted into methamphetamine in large doses

40

Two Major Omega-3-FA

EPA/DHA

41

Omega-3-Fatty Acids Found In

Wild Fish, Flax Seeds, Olive Oil, Walnuts, Dark Leafy Veggies

42

Where EPA/DHA most deficent

(1) Western Diets (2) During Pregnancy (3) Normal Brain maturations

43

EPA/DHA deficencies cause

Mood disorders, chronic pain syndromes

44

EPA/DHA antidepressant

Useful in treatment of depression and BP

45

ADHD link to Omega-3-FA

Children with ADHD consumed 50% less omega-3-FA rich food

46

Normal Course of Omega-6-FA

Omega-6-Fatty Acids activate Aracidonic Acid which can in turn activate prostaglandins which cause inflamation

47

How Omega-3-Fatty Acids impact Omega-6-Fatty Acids

Omega-3-Fatty Acids Inhibits the Arachidonic Acid (more specifically they inhibit the COX enzyme which converts arachidonic acid to prostagladins

48

Current Westen Ratio of Omega 3 to OMega 6

1:8

49

Ideal Ratio of Omega 3 to Omega 6

1:1

50

OMega 3 link to Dementis

DHA can reduce cognitive decline

51

Omega-3-Index

% of EPA + DHA in red blood cells... low index may mean risk for sudden cardiac death

52

Recommended dose during pregnanct

200 mg/daty

53

Suggested way of consuming DHA/EPA

Not through fish due to mercury but instead consider using supplements

54

Benefits of Omega-3-FA in pregnancy

Requires for normal fetal development and optimal maternal outcome...necessary for development of neural/retinal tissues,,,, may reduce allergy susceptibility,,,, may treat depressive symptoms in pregnant females

55

Benefits of Turmeric and Curcumin

Impact: Inflammation, cardiovascular, cancer, digestive system, anti-bacterial, anti-fungal, alzheimers, memory

56

NSAIDS

Nonnarcotic (non-steroidal) anti-inflammatory analgesics

57

Acute pain

Suddenly, usually self limited (opiods best)

58

Chornic Pain

Represents a disease by itself..presists over time... leads to loss of independence, loss of interpersonal relationships, work issues, anxiety, depression

59

Chronic Pain Treatment Options

(1) NSAIDS (2) Antidepressants with NE potentiating action (3) Mood stabilizing anticonvulsants (4) Opiod Analgesics

60

NSAID impact on tissue injury

Reduce inflammation and reduce transmission of pain impulses

61

NSAID euphoria

Does not produce

62

NSAID course of action

Work by inhibiting synthesis and release of prostaglandins (body hormones that produce the local inflammatory resposne)

63

Prostaglandins

Body hormone that produce inflammatory resposne

64

NSAIDS chemical relation

nONE

65

NSAID COX influence

NSAID block the COX. THey are known as COX inhibitors...

66

COX role

Convert arachidonic acid to prostaglandins

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Cox ENzymes

COx 1 and COx2

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COX 1- ENzyme

Mediates production of prostaglandins that protect the GI tract and allow for normal platlet functioning in blood clotting

69

Inhibition of COX1

Loss of protection for GI cells which cause ulcers ...ALso Loss of platlet function which reduces ability of blood to clot... GOOD because it reduces risk of stroeks and heart attacks BAD because it causes excessive bleeding

70

COX 2 Enzyme

INDUCED in response to inflamations. LEads to the production of prostaglandins to mediate inflammation and pain

71

Asprin

Good for low intensity pain

72

Antipyretic effect

(reduction of fever) due to inhibition of prostaglandin synthesis in the hypothalamus

73

Key parts of aspring

Carboxylic acid and an ester

74

Examples of nonselective COX inhibitors

Aspring, acetaminophen, ibuprofen

75

Nonselective COX inhibitors impact

(1) Anti-inflammatory (2) anti-pyretic (3) Analgesic (4) inhibition of platlet aggregation (5) adverse effects on GI tract

76

Asprin Benefits

Can bind to an inhibit blood platelets (prevent blood clotting)

77

Apsring Harms

Gastric Upset...also if given when someone has flu can cause Rye syndrome

78

Tylenol difference than Asprin

Does not inhibit platlet function, does not cause Rye syndrome, cause less GI distress

79

Adverse effect of acetaminophen

Liver damage, hypertension in females

80

Advil compared to tylenol and asprin

Advil is better tolerated than aspin.. but it does inhibit platlet aggregation like aspring

81

Selective COX 2 inhibit benefit

Reduce risk of cancer, and reduce rate of gastric ulcers while providing same benefits as aspring

82

Example of COX2 inhibitor

Celebrex

83

Celebrex impact

Does not inhibit platlet aggregation so might increase incidence of heart attack BUT it reduces pain and inflammation with less GI distress

84

Nitroasprins

Nitric oxide bound to an NSAID via an ester linkage