Valentovic - Herbal Products Flashcards
(36 cards)
Herbal Agents that became drugs
Drug Natural Agent Clinical Purpose
Aspirin ____________ _____________
Digitalis ____________ _____________
Morphine . ____________ . ______________
Placlitaxel . _____________ ______________
Eribuline ____________ ______________
True or False: Herbal products are included in government regulation by the US Food, Drug and Cosmetic Act.
False - excluded!!
No standard for efficacy, safety, validation!
Fact: Herbals…
- cannot claim for cure or treatment of disease
- CAN SAY they improve, support, promotes, etc…
Fact: Complexity of Herbal Preps
- Herbs are not uniform in nature
- Active ingredient varies with climate, soil and fertilization
- Herbs contain a complex of ingredients
- Herb product activity dependent on family of compounds
- Multiple components may have synergistic effect
What herb?
- marketed for Cardiovascular action
- lowering cholesterol
- preventing heart attack
- contains allin converted to allicin by allinase in plant and GI tract
- crushing releases ____________ (found in garlic capsules, chopped garlic and cold extracted garlic in vegetable oil)
- heat volatilizes thiosulfinate compound and diallyl sulfides releasing in to air
Garlic
Allinase
Effects of what Herb?
- lowers cholesterol (6-12%) –> comparable to Cholestyramine
- 900 mg/day powder or 1 clove
- HMG CoA reductase inhibitor*
- *-inhibits Platelet aggregation** –> similar to Ibuprofen (reversible inhibitor)
- ingredients: ajoene (allicin metabolism) and diallyl trisulfiide
- inhibit platelet COX**
- reduces platelet TXA2 generation**
Garlic
When utilizing high doses (4 cloves/day) Garlic herbal supplements, it is important to be cautious of using in combination with __________ drugs.
Chopped garlic in oil needs to be stored in refrigerator. Why?
antiplatelet drugs
Clostridium infection
What herbal supplement?
- marketed to improve vasculature (decrease leg fatigue and pain)
- -> Varicose Veins (Venostat)
-Activity attributed to Saponins
Good Herb: Escin - decreases capillary edema/pain
Bad Herb: Aesculin - adverse effects, similar to Warfarin, potential for bleeding; anti-coagulant
Horse Chestnut
Horse Chestnut
Good Herb: __________ (standardized to 16.7%)
- reduces leg pain (4x) and swelling (p<0.05)
- decreases vascular permeability of venous capillaries
Bad Herb: __________
- anticoagulant
- similar to hydroxycoumarin (Warfarin)
- bleeding gums, nose, etc.
Escin
Aesculin
What are contraindications for Horse Chestnut?
1.
2.
3.
- Anticoagulants (Warfarin), NSAIDS –> increased bleeding
- Pregnancy (Category X)
- Breast Feeding
What herbal supplement?
- sharpens mental focus
- improves cerebral circulation
- improves peripheral circulation (perfusion of capillaries)
- standardized for ginkgo flavonglycosides (active ingredients: quercetin, kaempferol, isorhamnetine)
Ginko
Effects of ________
Cardiovascular: improves blood flow in skin (brain?)
CNS
-Kaempferol
-anti-oxidant reduces free radical damage, may slow aging and improve
mental focus
-improves utilization of ATP and glucose in brain
-slows cancer cells in Ovarian cancer
-Kaempferol & Apigenin: inhibitors of MAO-A and MAO-B
Ginki
What is the major adverse effect of Ginko?
Bleeding (bleeding times can double)
Adverse Effects of what Herb?
-Major adverse effect is bleeding (Bleeding times can double)
-Drug Interactions with increased risk of bleeding*****
◦ Inhibits platelet activating factor
◦ Aspirin, NSAIDs (inhibit platelet function)
◦ Warfarin and heparin
◦ Platelet IIb/IIIa receptor antagonists (Clopidogrel)
-Lethal Ingestion of ginko seeds (contain ginkotoxin) results in seizures and death –> neurotoxin
◦ ginkotoxin (4’-O-Methylpyridoxine) - antimetabolite
◦ Anti-vitamin B6 interferes with amino acid metabolism
Ginko
What Herbal Supplement?
- Improving Mood (Depression)
- Sleep Disorders
- Weight Loss
- Standardized for Hypericin and Hyperforin (active components)
St. John’s Wort
What Herb?
-mediated by multiple mechanisms d/t neurotransmitters are altered
- Serotonin re-uptake inhibitor –> mood benefit
- dependent on Hyperforin
- MAO inhibition
- Hypericin and Hyperforin
- SSRI > MAO inhibitor
- Activation of GABA
- inhibited by Flumazenil (given for BZD overdose)
St. John’s Wort
Fact: St. John’s Wort
- *Alcohol Extract is best for anti-depressant action**
- minimum of 3% hyperforin and/or .3% hypericin (FYI)
Effective for Mild Depression ONLY
Side Effects of what herb?
-Side effects
◦ Headache and loss of appetite
-Should not be taken with
◦ MAO inhibitors
◦ Selective serotonin re-uptake inhibitors (SSRIs)
-Induces P450 isozyme Cyp 3A4********
◦ May need to increase dose of oral contraceptives, theophylline, warfarin
St. John’s Wort
What Herbal supplement?
for INSOMIA
Active ingredients: Valerenic Acid, Valtrate, Glutamine
- binds to GABA-A receptor (similar to BZD)
- GABA opens the Cl- channel, hyperpolization and decreased neuronal activity
Major Side Effect: Sedation
Valerian
What Herbal Supplement?
- Capsules, tablets, tea alcohol extracts
- lessens symptoms of colds, flu and infections
- stimulates phagocytosis and chemotaxis
- alcohol extract better than water extract
- action on the immune system
- Arabinogalactan releases IL-1 and TNFa
- Heteroxylan stimulates PMN phagocytosis
Echinacea
True or False: Echinacea prevents colds.
FALSE!! Does NOT prevent colds, but people say they felt better during colds (less congestion, lethargy and cough)
Side Effects of what Herb?
- avoid use if allergic to plants in the daisy or ragweed family
- avoid use with IMMUNOSUPPRESSANTS (Azathioprine, Corticosteroids, Cyclosporine)
Echinacea
What Herbal supplement?
- improve health of prostate
- diuretic effect
- active component in berries
- inhibitor of 5alpha-reductase
- inhibits conversion of testosterone –> dihydrotestosterone (active test molecule in the body)
-may block the translocation of the cytosol androgen receptor when bound to DHT in to the nucleus
Saw Palmetto
What drug is used in comparison to Saw Palmetto?
Finasteride (5alpha-reductase inhibitor)
