Medicinal Herbs 2023 with verified questions and answers

Herbal usage were used in medieval times for (6) amputations analgesia antiseptics depression pregnancy preparation for burial What is current usage of herbal medications? 1 in 5 (has increased 300%) What is in an herb? any form of plant or plant product root, stem, seeds, etc. How can the plants be sold? raw or as extract Herbal medications can contain what 6 things? fatty acids sterols alkaloids flavonoids glycosides saphanoids Give an example of a flavonoid: grapefruit juice What do flavonoids do to p450? suppress it Which medications have a prolonged clearance & metabolite elimination when taken with flavavoids (d/t suppression of p450) (6)? ABx Anti-seizure CCB Coumadin Cyclosporins HIV meds Why do we care about herbal meds? they are NOT controlled by FDA like Rx drugs in 1994, the dietary supplements health & education act (DSHEA) set "guidelines" for herbal medications, list 4: 1. content list 2. cannot be used to diagnose, treat, cure or prevent dz 3. quantity, & weight 4. directions for intended use Does the FDA evaluate herbal drugs? No Are additives listed? may or may not be List 6 possible additives: diuretic heavy metals hormones pesticides steroids tranquilizers Herbs from where have a higher incidence of tampered components? Asia, specifically China Investigators have found more what than herbs in the some supplements? saw dust Two consumer report studies have found what? wide variations of amount/ingredients present Some studies have shown that positive effect of drugs what not from herb but from? additive The American Herbal Products Association has four classes of herbs, what are they? 1. safe when used appropriately 2. restrictions 3. needs to be used only under supervision in an expert qualified in appropriate use of medication 4. insufficient data What are the 4 types of restrictions? external only not used in pregnancy not used while nursing other restrictions as noted List 6 dangerous & unsafe herbs: comfrey & colts foot chaparral ephedra licorice lobelia sassafras Dangerous/unsafe: comfrey & colts foot carcinogenic & hepatotoxic Dangerous/unsafe: Chaparral renal toxicity Dangerous/unsafe: ephedra mania, arrhythmias, HTN, dependence Dangerous/unsafe: Licorice pseudoaldosteronism Dangerous/unsafe: lobelia seizures/coma w/ OD Dangerous/unsafe: sassafras procarcinogen for liver What are the 8 most used herbal supplements? Echinacea Ephedra Garlic Ginko Ginseng Kava St. John's wort Valerian What is garlic primarily used for? antioxidant effects What does garlic produce? decrease in hyperlipidemia What properties does garlic have? antimicrobial antiplatelet fibrinolytic Garlic is beneficial for what conditions? CV dz DM tumor infection Garlic (especially in presence of other herbs) may increase? bleeding What might garlic do to BP? decrease it What does garlic do to peristalsis? enhance it What does garlic do to glucose levels? decrease it Caution using garlic with which drugs? NSAIDS ASA thrombolytic DM What is ephedra used for? diet aid energy enhancer diseases of respiratory tract What 5 things might ephedra contain? alkaloids ephedrine norephrdrine pseudoephedrine methylephedrine Ephedra has direct agonist effects on? alpha beta Ephedra can indirectly increase the release of? norepinephrine from pre-synaptic neurons What is ephedra also called? squawtea herbal ectasy Ma Huang Cloud 9 What can ephedra cause? arrhythmias HTN MI angina myocarditis CVA SAH Seizures (especially when taken w/ caffeine) mania psychosis dependence When taking ephedra w/ which type of medication can cause complications/interactions? MAOIs Which drug is involved in 100 times more reports to the US poison control center than any other herb? ephedra Combining ephedra w/ anesthesia can cause what? arrhythmias HTN Hyperthermia Long term use of ephedra may deplete what? endogenous catecholamines With depleted endogenous catecholamines - what can happen intraop? CV instability tachyphylaxis to other sympathomimetic drugs What should you give to a patient if they are a chronic user of ehedra w/ depleted catecholamine stores and require BP tx? a direct acting sympathomimetic Ephedra was banned, now products use what? citrus aurantium (bitter orange) Which herbal supplement is taken to increase resistance to stress and restore homeostasis? Ginseng Ginseng increases which cells? t-lymphocytes cytotoxic & natural killer cells What is the major concern with Ginseng? irreversible platelet inhibition Which 2 medications might Ginseng interfere with? Coumadin decreases effectiveness of analgesics What does Ginseng do to INR? decrease it What might Ginseng do to CV? HTN tachycardia What does Ginseng do to the CNS? stimulate it What does Ginseng do to BS? decrease it What is Ginkgo Biloba do? (5) 1. protect vascular walls & nerve cells 2. increase uptake & utilization of O2 & glucose 3. modulates neurotransmitters 4. stabilizes Ca+ membranes 5. decreases blood viscosity & improves blood flow to tissues What condition might Ginko Biloba be used for? cerebral vascular disease PVD What does Ginko cause? (6) vasodilation nausea vomiting diarrhea seizures inhibits PLT aggregation Caution should be used when using Ginko with what other medications? ASA NSAIDS Coagulation drugs Ginko may decrease the effects of? barbituates Which medication is herbal valium, used for it's anxiolytic & sedative properties? Kava Kava potentiates what? gaba transmission Kava acts as? muscle relaxant Kava increases effect of? Barbs Benzos How quickly does Kava cause sedation? 2 hours May see what with heavy Kava use? loss of coordination sluggish motor reflexes dilated pupils Kava has synergistics effects with? sedatives What organ might Kava effect? liver - hepatotoxicity If pt. takes Kava - what might happen to anesthetic requirements? reduced What is St. John's Wort used for? antidepressant and mood disorders anxiety cramps chest congestion What is St. John's wort sometimes called? natures prozac St. John's Wort if a nonspecific reuptake inhibitor of what 3 neurotransmitters? Serotonin Dopamine Norepinephrine What are the 2 active ingredients in St. John's wort? hypercin hyperforin St. John's wort has an efficacy equivalent to? TCAs What is St. John's wort effect on p450? potent inducer St. John's Wort is a potent sedative - this will do what to anesthetic agents? potentiate or prolong effects What medications can St. John's wort not be given with? MAOIs SSRIs *Can lead to serotonin syndrome What medication might St. John's wort interact with? vasoactive drugs St. John's Wort might decrease digoxin levels by how much? 25-30% Valerian is given for? insomnia - used as a sedative anxiety All sleep aids contain what? Valerian How does valerian work? GABA modulation - inhibits GABA breakdown & reuptake Use caution when taking Valerian with which other medications? benzos narcotics barbituates What can occur with Valerian? acute withdrawl What should you prior to surgery if taking Valerian? taper dose weeks before Valerian will do what to MAC? decrease it What will Valerian do to emergence? delay it What is the most popular herbal in the US & UK? Echinacea What is Echinacea taken for? immune system stimulant antiviral activity promotes release of tumor necrosis factor Which patients is Echinacea contraindicated for? AIDS MS TB Echinacea might do what to the effect of immunosuppressant drugs? counteract them Extended use of how long can cause immunosuppression? 8 weeks Which medication if taken for/as an aphrodisiac, stimulant, erectile dysfunction, alpha-2 antagonist? Yohimbe What is another name for Yohimbe? Natural Viagra Cautious use in Yohimbe with which medications? TCAs MAOIs SSRIs Which medications should you not give with Yohimbe? sympathomimetics Which foods should you avoid with Yohimbe? Tyramine What CV changes might be seen with Yohimbe? HTN tachycardia negative inotrope What might you see with Yohimbe OD? cardiac conduction abnormalities cholinergic effects (GI evacuation) midriasis Which herbs affect PLT aggregation? Ginko Biloba Ginseng Garlic Ginger Fish Oil Feverfew Black Widow Bark Jamaican Dogwood Bark Which herbs affect CV status? Ephedrine Caffeine Why does ephedrine effect CV status? depresses alpha & beta receptor response causes cardiomyopathy Which drugs affect metabolism? St. Johns Wort Flavonoids Which drug induces cytochrome p450 (causes decreased blood levels)? St. Johns Wort Which drug suppresses cytochrome p450 (causes increased blood levels)? Flavonoids When does the ASA recommend stopping herbal medications prior to surgery? 2 weeks When should you stop taking Echinacea? ASAP When should you stop taking Ephedra? at least 24 hours When should you stop taking Garlic? at least 7 days When should you stop taking Ginko? 36 hours When should you stop taking Ginseng? 7 days When should you stop taking St. John's Wort? 5 days Which medication may have acute withdrawal symptoms? Kava Which medication potentiates barbiturate effects & may prolong sleep time? Ginger Which med may decrease effects of IV barbituates? Ginkgo Which medication may prolong sedative effects of anesthesia? St. Johns wort Which medication may enhance benzo activity? Melatonin Which medication may potentiate barbs & benzos, leading to excessive sedation? Kava Which medication is synergistic with barbituates, narcotics, hypnotics, and benzos; sedative effects of narcs are unpredictable, may decrease MAC, and may have delayed emergence w/ delirium? Valerian