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NURA-671-01 Advanced Pharmacology > Lecture 1: Herbal Medications & Anesthesia JL > Flashcards

Lecture 1: Herbal Medications & Anesthesia JL Flashcards

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1
Q

Complementary & Alternative Medicine

CAM Therapy

A

A broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs other than those intrinsic to the politically dominant health system of a particular society or culture.

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2
Q

CAM Therapies: Use
Adult = X%
Children = X%

A

Adult – 38.3%

Children – 11.8%

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3
Q 
CAM Therapies: Most Common
? - 17.7% 
? - 12.7% 
? - 9.4% 
? - 8.6% 
? - 8.3%
A 
Natural products - 17.7% 
Deep breathing – 12.7% 
Meditation – 9.4% 
Chiropractic -8.6% 
Massage -8.3%
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4
Q

CAM Therapies = __ billion/yr

Herbals = __ billion/yr

A

80

8-10

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5
Q

Herbal medicine

A
  • Plants, seeds, berries, roots, bark, and flowers***
  • Used long before recorded history
  • Traditional Chinese Medicine
  • Ayurveda
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6
Q

Bark of the Willow Tree ?
Papaver Somniferous ?
Penicillium ?

A

Bark of the Willow Tree - aspirin
Papaver Somniferous - opium
Penicillium – antibiotics

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7
Q

19th & 20th Centuries……

21st Century…….

A

19th & 20th Centuries……
• Scientists figured out the active compounds from plants
• Chemists manufactured them in the lab

21st Century…….
• Genomic era
• Automated assays enabling mass screening of compounds
• Gene manipulation
• Mixing or re-arranging of terminal groups

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8
Q

FDA Dietary Supplement Health and Education Act (1994)

A
  • Defines and regulates dietary supplements
  • A dietary supplement must contain one or more dietary ingredients including vitamins, minerals, herbs, amino acids, dietary substance, metabolite, constituent, extract, or combination of above.
  • Must be labeled as dietary supplement
  • Cannot be approved or authorized for investigation as new drug, antibiotic, or biologic unless labeled before investigation
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9
Q

Labeled as dietary supplement =

A

dont have to do anything

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10
Q 
Dietary Supplements:
• Manufacturers are not required to prove ?
• Not required to report ?
• Manufactured before 1994 = ? 
• After 1994 = ?
A
  • Manufacturers are not required to prove efficacy, safety, or quality of their products.
  • Not required to report any post-marketing adverse events to central agency.
  • Manufactured before 1994 = Grandfathered in
  • After 1994 = Reasonable evidence of their safety or reasonable expectations of their safety must be reviewed not approved.
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11
Q

FDA Good Manufacturing Practices (2007):

A
  • Tries to regulate production and manufacturing
  • NO real oversight
  • Variations in quality, harvesting, storage conditions, processing, purity, and efficacy of herbal
  • Herbal medications are not what they seem.
  • (2013) New York Times Article - 1/3 had outright substitutions - St. John’s Wort Product contained… ..- Rice - Alexandria senna (laxative)
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12
Q

National Institute of Health:

Office of Alternative Medicine (1988)

A

• Study and evaluation of complementary and alternative medicine practices to disseminate the results.

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13
Q

National Institute of Health:

National Center for Complementary & Alternative Medicine (1992)

A
  • Define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and the role in improving health and health care.
  • To produce scientific evidence to inform decision making by the public, health care professionals, and policy makers.
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14
Q

AANA/ASA Pre op Recommendations (for all) =

A

Discontinue 2 weeks before surgery (testing answer)….see slides for Hopkins clinical/practice recommendations!

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15
Q

Echinacea: Chemistry (just review)

A
  • Not a single compound

* Volatile oils, alkamides, polyalkenes, & caffeic acid derivatives

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16
Q

Echinacea: Pharmacology & Clinical Effects

A
  • Anti-inflammatory
  • Cancer
  • Immune modulation
  • URI Treatment
  • Recurrent URI preventions
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17
Q

Echinacea: Adverse Effects

A
  • Allergic reactions (1 case of anaphylaxis)
  • Caution in patients with liver dysfunction
  • Caution in antipsychotic and antidepressants
  • Poor wound healing
  • Decrease the effectiveness of exogenous steroids
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18
Q

Ephedra: Chemistry (just review)

A

• Alkaloids ephedrine, pseudoephedrine & methylephedrine

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19
Q

Ephedra: Pharmacology & Clinical Effects

A
  • Has both direct and indirect effects on α and β adrenergic receptors
  • CNS Stimulant
  • Weight loss supplement
  • Treatment of asthma
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20
Q

Ephedra: Adverse Effects

A
  • CV: palpitation, tachycardia, hypertension, & cardiomyopathy (chronic use)
  • Fatal arrhythmias & MI
  • Hemodynamic instability intraop
  • CNS: Seizure, stroke, psychosis
  • Other: Hepatitis
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21
Q

Ginseng: Chemistry (just review)

A
  • Ginsenosides (steroidal saponins)

* Like steroids

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22
Q

Ginseng: Pharmacology & Clinical Effects

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A
  • Memory enhancement
  • Physical enhancement
  • Lower blood sugar
  • Alter coagulation pathway/inhibits platelet aggregation
  • Immunomodulation
  • Aphrodisiac
23
Q

Ginseng: Adverse Effects

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A
  • Increased bleeding
  • Inhibit platelet (irreversible)
  • Hypoglycemia
  • Interacts adversely with monoamine oxidase inhibitors
24
Q

Ginger: Chemistry

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A

• Shogaol, gingerol, and galanolactone (just review)

  • • Antagonizes serotonin (5HT3 receptors) = ?
  • • Inhibits prostaglandin = inhibit vasodilation, platelet aggregation and inflammation
  • • Inhibits thromboxane synthetase = inhibits clot formation
25
Ginger: Pharmacology & Clinical Application
* GI discomfort * Anti-inflammatory * Nausea/motion * Respiratory problems * Sore throat * ***Increased bleeding time***
26
Ginger: Adverse Effects
* Increased bleeding * Hyperglycemia * Pregnancy – possibly safe? * Large doses may alter fetal sex hormones
27
Garlic: Chemistry
Sulfur containing compounds – alliin or ajoene • Potent antibiotic properties • HMG-CoA reductase Cysteine • ***Alters arachidonic acid metabolism***
28
Garlic: Pharmacology & Clinical Application
* Decrease blood pressure * Decrease atherosclerosis (Decrease lipids/cholesterol) * ***Inhibits platelet aggregation*** * Anti-tussive/expectorant
29
Garlic :Adverse Effects
* Bleeding – 1 case report of spontaneous epidural hematoma * Smell-bad breath * GI upset (N/V/D)
30
Kava: Chemistry
• Kavalactones (May potentiate GABA) -> increased inhibition of NTs = higher affinity to receptors....sedation!
31
Kava: Pharmacology & Clinical Applications
* ***Anxiolytic*** * ***Sedative***...... Addiction/tolerance * Antiepileptic * Neuroprotective
32
Kava: Adverse Effects
* Addiction/tolerance * Withdrawal * Inhibits cytochrome P450 and 2E1 * Glutathione depletion – acetaminophen induced cytotoxicity
33
Valerian: Chemistry
Sesquiterpines • Modulation of GABA neurotransmitters • Inhibit GABA breakdown or re-uptake = longer effect
34
Valerian: Pharmacology & Clinical Applications
* ***Insomnia*** * Sedation * ***Anxiety***
35
Valerian | • Adverse Effects
* ***Stopping after long term use may result in withdrawal*** * Interactions with alcohol and sedatives * Hepatotoxicity with long term use * *Abuse
36
Ginkgo biloba: Chemistry
Flavonids, terpenoids, & organic acids • Free radical scavenger • Modulation of neurotransmitters • ***Inhibits platelet activating factor***
37
Ginkgo biloba: Pharmacology & Clinical Applications
* ***Dementia – Alzheimer’s*** * Age related macular degeneration * Peripheral vascular disease * Vertigo
38
Ginkgo biloba: Adverse reactions
* Spontaneous intracranial bleeding * ***Postoperative bleeding risk*** * Nausea/vomiting * Stomach pain * Interactions with SSRI or MAOI’s
39
St. John’s Wort (Hypericum perforatum): Chemistry (just review)
Hypericin and hyperforin | • Inhibits re-uptake of serotonin, norepinephrine, and dopamine
40
St. John’s Wort (Hypericum perforatum): Pharmacology & Clinical Applications
* ***Mild to moderate depression*** * Insomnia * OCD * ADHD
41
St. John’s Wort (Hypericum perforatum): Adverse Reactions
Induces cytochrome P450 enzymes (3A4 & 2C9) = LIVER • Alfenta, midazolam, lidocaine, CCB, serotonin receptor antagonists • Warfarin and NSAIDS • Cyclosporin (49% reduction) ***Serotonin syndrome*** Fatigue Sedation
42
Hoodia gordonii: Chemistry
* Molecule P57 – neuroactive steroid * Has effect on hypothalamus (May look like glucose and trick brain into thinking your full) * Multiple companies have tried to bring to market without success
43
Hoodia gordonii: Pharmacology & Clinical Application
Appetite suppressant | • Used in Africa for thousands of years
44
Hoodia gordonii: Adverse Reactions
* Nausea & vomiting * Dizziness * ***Increased blood pressure and heart rate*** * Altered skin sensations * Abuse potential
45
Feverfew: Chemistry
Parthedolide • Inhibits Nf-KB –> anti-inflammatory • Inhibits prostaglandin synthetase
46
Feverfew: Pharmacology & Clinical Application
* Prevent migraines * Reducing headache symptoms (pain & sensitivity to light) * Rheumatoid arthritis
47
Feverfew: Adverse Reactions
* Nausea, vomiting, & diarrhea * Nervousness & dizziness * ***Pregnancy - potential abortifacient, d/t increase blood flow * ***Induce liver enzymes – altering drug metabolism * ***Increase risk of bleeding (Especially if already on platelet altering medications)
48
``` Summary: Herbal Products FDA NIH AANA/ASA ```
Herbal Products • Commonly used • Always ask about use FDA • Dietary Supplement Health and Education Act (1994) • Good Manufacturing Practices (2007) • "Relative" efficacy & safety NIH • Study efficacy of products AANA/ASA • Both recommend holding medications for up to two weeks • No specific guidelines…..
49
Bleeding
* Ginseng * Ginger * Garlic * Ginkgo * Feverfew
50
Sedation (gaba)
* Kava * Valerian * St. John’s Wort
51
Sympathetic stimulation (dietary)
* Ephedra | * Hoodia?
52
Liver
* Echinacea * St. John’s Wort * Feverfew
53
Pregnancy
* Feverfew | * Ginger?

NURA-671-01 Advanced Pharmacology (18 decks)

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