Flashcards in II Pharm V Deck (90):
70% of consumers DON'T report using herbal medicines to healthcare providers
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)
What % of americans have used "natural products" in the last 12 months?
*dietary supplements other than vitamins and minerals
The 5 most popular products used in the last 30 days (used for health reasons):
fish oil (37%)
flaxseed oils/pills (16%)
What % of americans have used a supplement in the last 30 days?
4 most common supplements used in last 30 days:
(as opposed to "product")
vitamins E and C (12%)
B vitamins (5%)
In the study of 130 participants (mean age 71.4 years) what was the prevalence of polypharmacy?
% at risk for DDI?
***% at risk for drub/herbal supplement interaction?
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
The most common reasons people take dietary supplements: Improve general ________
Help manage _______
Help prevent/manage _______
About ___% of cancer pts take anti-oxidants, which counteract cancer fighting drugs
What drug causes the MOST interactions with herbs?
Systematic lit review identified 1491 pairs of Herbal Drug Supplement - Drug interactions, what 5 herbs/supplements had the most interactions?
St. Johns wort
509 drugs studied for interaction w/ herbs/supplements (100 CNS, 90 CV, 75 systemic anti-infectives) - What were the top 5 Drugs w/ interactions?
Digoxin (cardiac glycoside)
Vitamins, minerals, and dietary supplements have more interactions/contraindications with Drugs than Herbs
*herbs have more
Patients using medications with a _________ have a greater risk for adverse outcomes b/c of HDS-drug interactions
Narrow Therapeutic Index
Pts using what class of drugs must be especially careful with Herbal Dietary Supplement products?
HDS (herbal dietary supplements) are used by what % of cancer pts?
Many herbs act as ______ or _______ medications
The antiplatelet or anticoagulant effects of herbs may be ________ with aspirin, ibuprofen, warfarin, etc.
Pts tend to be ______ of these effects
Many products contain multiple hers and pts often don't know what is in them
There is limited evidence supporting bleeding effects of herbal meds, however ginkgo, garlic, ginseng, and ginger antagonize what?
Platelet activating factor
Discontinue all herbal meds ______ days before surgery.
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
4 reasons people take garlic:
Garlic is associated with what side effect?
What are 3 components in Garlic that are implicated in bleeding?
The Ajoene, Allicin, and Sulfur compounds found in garlic have what kind of effect?
What 2 chemical mediators do these components to Garlic inhibit?
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 _______
What component in Ginkgo is implicated in bleeding?
This component is a potent antagonist of what?
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?
People take Ginseng for the following reasons: Anti-cancer, slows aging, prevents heart attack, improves digestion, reduces HTN, strengthen immunity, and CNS stimulant
What components of Ginseng are implicated in bleeding effects?
The antiplatelet effect inhibits ______, platelet aggregation, ______ and ______
PAF, thrombin, thromboplastin
Ginseng antagonizes the effect of what?
Ginseng Potentiates bleeding with what 4 drugs?
People take ginger to relieve motion sickness, morning sickness, decrease arthritis pain/inflammation, and relieve upset stomach.
3 components implicated in Ginger's antiplatelet effect?
Pungent principles, Volatile Oils, and Proteolytic enzymes of Ginger reduce platelet _____ and inhibits _______
Literature on ginger is mixed and the most significant effects are if ginger is cooked
3 effects of Feverfew
(or why people take it)
Preventive for Migraine Headache
The net effect of Feverfew is that it inhibits _______
What are the 2 active chemicals in Feverfew?
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?
Fish oils are used for skin disorders, cardioprotection, diabetes, headache, immune support, memory, PMS, ulcerative colitis, and many others....
What is the main side effect of Fish Oil
(has many mechanisms)
Taking more than how many grams of fish oil/day increases the chance of bleeding?
Very larg intakes of Fish Oil increases the chance of what?
High doses of Fish Oil have been associated with _____ and _____
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
The exact mechanism of St Johns Wort is unclear
St. Johns Wort may work by inhibiting the reuptake of what?
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?
What is the major biologically active constituent of St Johns Wort?
Hyperforin (in St Johns Wort) has been shown to inhibit the uptake of what 5 neurotransmitters?
What is the main component in St Johns Wort implicated in bleeding?
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.
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)
A high INR means what?
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
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?
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 + Warfarin =
*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?
*esp with other hepatotoxic meds
Echinacea is definitely hepatotoxic, and probably decreases the effectiveness of what?
Abrupt discontinuation of taking Feverfew will have what 4 consequences?
Feverfew inhibits what?
Up to ___% of users develop _____
Causes irritation of what?
15%, aphthous ulcers
Kava Kava acts like what class of drugs?
(is on watchlists)
*anxiety, muscle relaxant, additive for other depressants
Kava Kava is used for what?
(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
FDA is monitoring Kava Kava for what?
*europe - cirrhosis, hepatitis, liver failure)
3 contraindications for Kava Kava:
Licorice is used for GI, antitussive, aphthous ulcers, and herpes, but may cause what?
pregnancy, lactation, liver/renal impairment
Valerian acts like what?
Valerian ______ the effects of CNS ______
A lot of these herbs have synergistic effects with aspirin and NSAIDS, what should be done?
Monitor pts on _____ for herbal use and counsel appropriately
Cross reference all herbal and prescription meds prior to prescribing to ensure _____
The 7 Level 1 drugs (basic critical)
Endogenous catecholamine (epi 1:1000)
Histamine blocker (diphenhydramine, chloropheniramine)
fibrinolytic (chewable aspirin)
2 histamine blockers used as a Level 1 drug (basic critical)
9 Level 2 rescue drugs:
Respiratory stimulant (aromatic ammonia)
Histamine blocker (diphenhydramine)
Analgesic (morphine sulfate)
Anti-hypertensive (beta blockers)
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)
An Anti-dysrhythmics used for advanced cardiac life-support (Level 3)
***the drug of shoice for suppression of ventricular tachycardia and ventricular fibrillation
What is the Level 3 anti-cholinergic/anti-dysrhythmic?
Two types of Antidotes (Level 4):
What are they?
Benzodiazepine antagonist, flumazenil
Opioid antagonist, naloxone (Narcan), naltrexone