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Flashcards in II Pharm V Deck (90):
1

T/F
70% of consumers DON'T report using herbal medicines to healthcare providers

True

2

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)

3

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

*dietary supplements other than vitamins and minerals

17.7%

4

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%)

5

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

52%

6

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%)

7

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?

72.3%

16.2%

46.2%

***31.5%

8

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

9

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

Help manage _______

Help prevent/manage _______

Improve _______

Wellness

Arthritis

Colds

Memory

10

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

50%

11

What drug causes the MOST interactions with herbs?

Coumadin

12

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

13

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)

14

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

False

*herbs have more

15

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

Narrow Therapeutic Index

16

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

Anticoagulants

(Warfarin)

17

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

50%

18

Many herbs act as ______ or _______ medications

Anti-platelet

Anti-coagulant

19

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

Pts tend to be ______ of these effects

Additive

Unaware

20

T/F
Many products contain multiple hers and pts often don't know what is in them

True

21

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

Platelet activating factor

22

Discontinue all herbal meds ______ days before surgery.

14 days

23

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

24

4 reasons people take garlic:

Anti-lipidemic

Antimicrobial

Anti-asthmatic

Anti-inflammatory

25

Garlic is associated with what side effect?

Bleeding

26

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

Ajoene

Allicin

Sulfur compounds

27

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

28

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

Alzheimers/dementia caused peripheral vascular insufficiency

29

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

Bleeding

30

What component in Ginkgo is implicated in bleeding?

This component is a potent antagonist of what?

Terpenoids

Platelet activating factor

31

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

32

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

True

33

What components of Ginseng are implicated in bleeding effects?

The antiplatelet effect inhibits ______, platelet aggregation, ______ and ______

Gensenosides

PAF, thrombin, thromboplastin

34

Ginseng antagonizes the effect of what?

Warfarin

35

Ginseng Potentiates bleeding with what 4 drugs?

Aspirin

NSAIDS

warfarin

heparin

36

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

True

37

3 components implicated in Ginger's antiplatelet effect?

Pungent principles

Volatile Oils

Proteolytic enzymes

38

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

thromboxane

platelet aggregation

39

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

False

***raw

40

3 effects of Feverfew

(or why people take it)

Anti-inflammatory (RA)

Preventive for Migraine Headache

Muscle soreness

41

The net effect of Feverfew is that it inhibits _______

What are the 2 active chemicals in Feverfew?

Platelet Aggregation

Sesquiterpene lactone, parthenolide

42

What dental consequence is there to taking Feverfew?

(remember, it inhibits platelet aggregation)

Irritation of Oral mucosa and tongue

43

Feverfew also increases the risk for what?

photosensitivity

44

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

True

45

What is the main side effect of Fish Oil

(has many mechanisms)

Bleeding complications

46

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

3 grams

47

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

hemmorrhagic stroke

48

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

nosebleed

blood in urine

49

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

St Johns Wort

50

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

True

51

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

Serotonin (5-HT)

52

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

53

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

Hyperforin

54

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

5-HT

dopamine

norepinepherine

GABA

glutamate

55

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

Works how?

Hypericin

induces cytochrome P450 liver enzymes

56

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

Inducer

57

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

58

A high INR means what?

Low INR?

No clotting

clotting

59

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

60

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

Mild to Moderate depression

61

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

62

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

14

63

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

Antioxidant

64

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

65

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

Vitamin K

66

Vitamin K + Warfarin =

hypoprothrombinemia

*delays clotting further (increases INR)

**increases risk for spontaneous hemorrhage

67

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

68

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

Corticosteroids

69

Abrupt discontinuation of taking Feverfew will have what 4 consequences?

rebound headaches

joint pain

stiffness

anxiety

70

Feverfew inhibits what?

Up to ___% of users develop _____

Causes irritation of what?

Contraindication?

platelet activity

15%, aphthous ulcers

Oral mucosa/tongue

Pregnancy

71

Kava Kava acts like what class of drugs?

(is on watchlists)

BDZ

*anxiety, muscle relaxant, additive for other depressants

72

Kava Kava is used for what?

anxiety, stress

(minor tranquilizer, skeletal muscle relaxant)

73

Kava Kava potentiates what?

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

CNS effects of other depressants

sedation

74

FDA is monitoring Kava Kava for what?

hepatotoxicity

*europe - cirrhosis, hepatitis, liver failure)

75

3 contraindications for Kava Kava:

pregnancy

lactation

Parkinson's

76

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

77

Valerian acts like what?

BDZ

*mild sedative

78

Valerian ______ the effects of CNS ______

potentiates

depressants

(barbiturates, etc)

79

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

alternative analgesics

80

Monitor pts on _____ for herbal use and counsel appropriately

warfarin

81

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

compatibility

82

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)

83

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

diphenhydramine (Benadryl)

choropheniramine (Chlor-Trimeton)

84

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)

85

Level 3 rescue drugs:

Advanced cardiac life-support drugs

86

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

87

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)

88

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

atropine

89

Two types of Antidotes (Level 4):

What are they?

Benzodiazepine antagonist, flumazenil

Opioid antagonist, naloxone (Narcan), naltrexone

90

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

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