II Pharm V Flashcards by Tim Agee

T/F

70% of consumers DON’T report using herbal medicines to healthcare providers

True

How well did you know this?

Not at all

Perfectly

What is important to determine if you are assessing a pts use of herbal remedies?

If using as Replacement or Supplement

instead of or adjunct to

How well did you know this?

Not at all

Perfectly

What % of americans have used “natural products” in the last 12 months?

*dietary supplements other than vitamins and minerals

17.7%

How well did you know this?

Not at all

Perfectly

The 5 most popular products used in the last 30 days (used for health reasons):

fish oil (37%)

glucosamine (20%)

echinacea (20%)

flaxseed oils/pills (16%)

ginseng (14%)

How well did you know this?

Not at all

Perfectly

What % of americans have used a supplement in the last 30 days?

52%

How well did you know this?

Not at all

Perfectly

4 most common supplements used in last 30 days:

as opposed to “product”

multivitamins/multiminerals (35%)

vitamins E and C (12%)

calcium (10%)

B vitamins (5%)

How well did you know this?

Not at all

Perfectly

In the study of 130 participants (mean age 71.4 years) what was the prevalence of polypharmacy?

Polyherbacy?

% at risk for DDI?

***% at risk for drub/herbal supplement interaction?

***31.5%

How well did you know this?

Not at all

Perfectly

In the study a total of 90 different herbs and supplements were used by participants, the most common of which were:
Glucosamine/chondroitin, Garlic, Echinacea, Ginko, Herbal tea, cod liver oil, st. John’s wort, ginseng, saw palmetto

True

How well did you know this?

Not at all

Perfectly

The most common reasons people take dietary supplements: Improve general ________

Help manage _______

Help prevent/manage _______

Improve _______

Wellness

Arthritis

Colds

Memory

How well did you know this?

Not at all

Perfectly

About ___% of cancer pts take anti-oxidants, which counteract cancer fighting drugs

50%

How well did you know this?

Not at all

Perfectly

What drug causes the MOST interactions with herbs?

Coumadin

How well did you know this?

Not at all

Perfectly

Systematic lit review identified 1491 pairs of Herbal Drug Supplement - Drug interactions, what 5 herbs/supplements had the most interactions?

St. Johns wort

Magnesium

Calcium

Iron

Ginkgo

How well did you know this?

Not at all

Perfectly

509 drugs studied for interaction w/ herbs/supplements (100 CNS, 90 CV, 75 systemic anti-infectives) - What were the top 5 Drugs w/ interactions?

Warfarin

Insulin

Aspirin

Digoxin (cardiac glycoside)

Ticlopidine (anti-platelet)

How well did you know this?

Not at all

Perfectly

Vitamins, minerals, and dietary supplements have more interactions/contraindications with Drugs than Herbs

False

*herbs have more

How well did you know this?

Not at all

Perfectly

Patients using medications with a _________ have a greater risk for adverse outcomes b/c of HDS-drug interactions

Narrow Therapeutic Index

How well did you know this?

Not at all

Perfectly

Pts using what class of drugs must be especially careful with Herbal Dietary Supplement products?

Anticoagulants

Warfarin

How well did you know this?

Not at all

Perfectly

HDS (herbal dietary supplements) are used by what % of cancer pts?

50%

How well did you know this?

Not at all

Perfectly

Many herbs act as ______ or _______ medications

Anti-platelet

Anti-coagulant

How well did you know this?

Not at all

Perfectly

The antiplatelet or anticoagulant effects of herbs may be ________ with aspirin, ibuprofen, warfarin, etc.

Pts tend to be ______ of these effects

Additive

Unaware

How well did you know this?

Not at all

Perfectly

T/F

Many products contain multiple hers and pts often don’t know what is in them

True

How well did you know this?

Not at all

Perfectly

There is limited evidence supporting bleeding effects of herbal meds, however ginkgo, garlic, ginseng, and ginger antagonize what?

Platelet activating factor

How well did you know this?

Not at all

Perfectly

Discontinue all herbal meds ______ days before surgery.

14 days

How well did you know this?

Not at all

Perfectly

For herbs and bleeding, if the “g” is followed by a vowel - what is the rule?

If the “g” is followed by a consonant?

g + vowel = bleeding

g + consonant = not a concern

ginkgo, ginger, garlic, ginseng - bleeding
green tea - no bleeding

How well did you know this?

Not at all

Perfectly

4 reasons people take garlic:

Anti-lipidemic

Antimicrobial

Anti-asthmatic

Anti-inflammatory

How well did you know this?

Not at all

Perfectly

Garlic is associated with what side effect?

Bleeding

What are 3 components in Garlic that are implicated in bleeding?

Ajoene Allicin Sulfur compounds

The Ajoene, Allicin, and Sulfur compounds found in garlic have what kind of effect? What 2 chemical mediators do these components to Garlic inhibit?

Anti-platelet Platelet activating factor, Adenosine

People take Ginkgo to protect brain function, improve memory/cognition, and ____________

Alzheimers/dementia caused peripheral vascular insufficiency

Ginkgo, in 3 randomized controlled studies, doesn't do anything for the brain, but it does cause _______

Bleeding

What component in Ginkgo is implicated in bleeding? This component is a potent antagonist of what?

Terpenoids Platelet activating factor

Terpenoids acting as an antagonist to Platelet Activating Factor causing bleeding in Ginkgo has what effect? There is a risk for spontaneous bleeding with Ginkgo and concurrent use of what 2 drugs?

Antiplatelet Aspirin Warfarin

People take Ginseng for the following reasons: Anti-cancer, slows aging, prevents heart attack, improves digestion, reduces HTN, strengthen immunity, and CNS stimulant

True

What components of Ginseng are implicated in bleeding effects? The antiplatelet effect inhibits ______, platelet aggregation, ______ and ______

Gensenosides PAF, thrombin, thromboplastin

Ginseng antagonizes the effect of what?

Warfarin

Ginseng Potentiates bleeding with what 4 drugs?

Aspirin NSAIDS warfarin heparin

People take ginger to relieve motion sickness, morning sickness, decrease arthritis pain/inflammation, and relieve upset stomach.

True

3 components implicated in Ginger's antiplatelet effect?

Pungent principles Volatile Oils Proteolytic enzymes

Pungent principles, Volatile Oils, and Proteolytic enzymes of Ginger reduce platelet _____ and inhibits _______

thromboxane platelet aggregation

T/F | Literature on ginger is mixed and the most significant effects are if ginger is cooked

False ***raw

3 effects of Feverfew | or why people take it

Anti-inflammatory (RA) Preventive for Migraine Headache Muscle soreness

The net effect of Feverfew is that it inhibits _______ What are the 2 active chemicals in Feverfew?

Platelet Aggregation Sesquiterpene lactone, parthenolide

What dental consequence is there to taking Feverfew? | remember, it inhibits platelet aggregation

Irritation of Oral mucosa and tongue

Feverfew also increases the risk for what?

photosensitivity

Fish oils are used for skin disorders, cardioprotection, diabetes, headache, immune support, memory, PMS, ulcerative colitis, and many others....

True

What is the main side effect of Fish Oil | has many mechanisms

Bleeding complications

Taking more than how many grams of fish oil/day increases the chance of bleeding?

3 grams

Very larg intakes of Fish Oil increases the chance of what?

hemmorrhagic stroke

High doses of Fish Oil have been associated with _____ and _____

nosebleed blood in urine

What weed-like plant is the most widely studied herb with demonstrated efficacy to reduce mild to moderate depression?

St Johns Wort

T/F | The exact mechanism of St Johns Wort is unclear

True

St. Johns Wort may work by inhibiting the reuptake of what?

Serotonin (5-HT)

What are the 2 major antidepressive components of St Johns Wort (or what they're thought to be) What are 2 other biologically active constituents to this weed?

Hyperforin, Hypericin Flavonoids, tannins

What is the major biologically active constituent of St Johns Wort?

Hyperforin

Hyperforin (in St Johns Wort) has been shown to inhibit the uptake of what 5 neurotransmitters?

5-HT dopamine norepinepherine GABA glutamate

What is the main component in St Johns Wort implicated in bleeding? Works how?

Hypericin induces cytochrome P450 liver enzymes

St Johns Wort is a classic ______, which means it breaks down drugs faster b/c it kickstarts certain enzyme pathways.

Inducer

Even though the Hypericin in St Johns Wort is implicated in bleeding, it has what effect on Warfarin? This does what to the INR?

Reduces anticoagulant effect (increases clotting) Lowers INR

A high INR means what? Low INR?

No clotting clotting

T/F When used in combo w/ other antidepressants, St Johns Wort can produce Serotonin Syndrome - and the pt looks like they're having an MI or a seizure

True

St John's Wort is equal to Zoloft in the treatment of what?

Mild to Moderate depression

St. Johns Wort has many DI's - 5 major ones:

Oral contraception doesn't work (some people) Pt difficult to awaken from general aneshtesia Photosensitivity of Tetracyclines increased Glucocorticoid effects decreased Anticoagulant efficacy decreased

You should discontinue all herbs (esp St Johns Wort) how many days prior to surgery?

Vitamin E is a fat soluble vitamin that most people use as what?

Antioxidant

What are 3 antioxidant effects of Vitamin E?

Prevents oxidation of Vitamins A and C Protects polyunsaturated FA's in membranes Protects RBC's against hemolysis

Vitamin E may alter the effect of what on clotting factors?

Vitamin K

Vitamin K + Warfarin =

hypoprothrombinemia *delays clotting further (increases INR) **increases risk for spontaneous hemorrhage

Echinacea is used for the common cold, cough, and bronchitis, and must be limited to 10 days use why?

Hepatotoxicity *esp with other hepatotoxic meds

Echinacea is definitely hepatotoxic, and probably decreases the effectiveness of what?

Corticosteroids

Abrupt discontinuation of taking Feverfew will have what 4 consequences?

rebound headaches joint pain stiffness anxiety

Feverfew inhibits what? Up to ___% of users develop _____ Causes irritation of what? Contraindication?

platelet activity 15%, aphthous ulcers Oral mucosa/tongue Pregnancy

Kava Kava acts like what class of drugs? | is on watchlists

BDZ *anxiety, muscle relaxant, additive for other depressants

Kava Kava is used for what?

anxiety, stress | minor tranquilizer, skeletal muscle relaxant

Kava Kava potentiates what? For this reason must use with caution if doing what in dentistry?

CNS effects of other depressants sedation

FDA is monitoring Kava Kava for what?

hepatotoxicity *europe - cirrhosis, hepatitis, liver failure)

3 contraindications for Kava Kava:

pregnancy lactation Parkinson's

Licorice is used for GI, antitussive, aphthous ulcers, and herpes, but may cause what? May alter... 3 contraindications:

HTN platelet aggregation pregnancy, lactation, liver/renal impairment

Valerian acts like what?

BDZ *mild sedative

Valerian ______ the effects of CNS ______

potentiates depressants (barbiturates, etc)

A lot of these herbs have synergistic effects with aspirin and NSAIDS, what should be done?

alternative analgesics

Monitor pts on _____ for herbal use and counsel appropriately

warfarin

Cross reference all herbal and prescription meds prior to prescribing to ensure _____

compatibility

The 7 Level 1 drugs (basic critical)

Endogenous catecholamine (epi 1:1000) Histamine blocker (diphenhydramine, chloropheniramine) Oxygen Vasodilator (nitro) Bronchodilator (albuterol) anti-hypoglycemic fibrinolytic (chewable aspirin)

2 histamine blockers used as a Level 1 drug (basic critical)

diphenhydramine (Benadryl) choropheniramine (Chlor-Trimeton)

9 Level 2 rescue drugs:

Respiratory stimulant (aromatic ammonia) Histamine blocker (diphenhydramine) Analgesic (morphine sulfate) Anticonvulsant (diazepam/Valium) Anti-hypertensive (beta blockers) Anti-hypoglycemic Glucocorticoid (hydrocortisone) Vasoconstrictor (methoxamine) Anticholinergic (atropine)

Level 3 rescue drugs:

Advanced cardiac life-support drugs

6 level 3 drugs (advanced cardiac life-support)

Alkalinizing agent (sodium bicarbonate - not used much) Analgesic (morphine sulfate) Anti-dysrhythmic Anti-cholinergic/anti-dysrhythmic Calcium salt Endogenous catecholamine

An Anti-dysrhythmics used for advanced cardiac life-support (Level 3) ***the drug of shoice for suppression of ventricular tachycardia and ventricular fibrillation

lidocaine (Xylocaine)

What is the Level 3 anti-cholinergic/anti-dysrhythmic?

atropine

Two types of Antidotes (Level 4): What are they?

Benzodiazepine antagonist, flumazenil Opioid antagonist, naloxone (Narcan), naltrexone

What level 2 drug is used to restore heart rate and arterial pressure when vagal stimulation causes sudden decrease in pulse rate and cardiac action (this overcomes severe bradycardia/syncope)

atropine

II Pharm V Flashcards

(90 cards)