EXAM #4: HERBAL

Question 1

What advice should you give patients on how to choose nutrient supplements?

Answer 1

Select supplements that:

1) Have been studied in clinical trials
2) Independently tested e.g.
- USP
3) Standardized

Question 2

What are two evidence-based resources to use in evaluating supplements?

Answer 2

1) Natural medicines

2) NIH Office of Dietary Supplements

Question 3

Why are there conflicting results regarding many supplements?

Answer 3

• Lack of large clinical randomized trials

- Varying drug doses and formulations

Question 4

What is the intended clinical use of Echinacea?

Answer 4

Decrease duration and intensity of cold

Question 5

What is the MOA of Echinacea in reducing the duration and intensity of a cold?

Answer 5

1) Increases cytokine production
2) Anti-inflammatory by inhibiting COX
3) Increased immunological blood cells produced

Question 6

What supplement increased immune system activity?

Answer 6

Echinacea

Thus, patients that are being immunosuppressed should NOT take this medication

Question 7

What are the intended clinical uses of Ginkgo biloba?

Answer 7

1) Improve memory
2) Treat/prevent AD
3) Treat/prevent PVD

Question 8

What is the mechanism by which Gingko biloba prevents cognitive decline?

Answer 8

• Increases density of 5-HT1A receptors

- Increased receptor density may lead to increased cognitive function

Question 9

What harmful side effect is associated with Gingko Biloba?

Answer 9

1) Anti-platelet effects/ bleeding
2) Uncooked seeds can INDUCE SEIZURES

Patients that are seizure prone should avoid Gingko

Question 10

What is the intended clinical uses of garlic?

Answer 10

1) Atherosclerosis
2) High cholesterol
3) HTN

Question 11

What is the MOA of garlic in lowering blood pressure?

Answer 11

1) ACE inhibitor
2) Increased NO bioavailbility
3) Increased H2S production

Decrease vasoconstriction and enhance vasodilation

Question 12

What adverse reaction is associated with garlic?

Answer 12

Increased bleeding

D/c garlic 7x days prior to elective surgery

Question 13

What is the intended clinical use of Ginseng?

Answer 13

Boost overall health/stamina and immune performance

E.g. treatment of fatigue in cancer

Question 14

What major side effect is associated with Ginseng?

Answer 14

• CNS stimulation i.e. should be avoided in:
  1) Seizure prone patients
  2) Patients prone to MANIA
• Anti-platelet effects

Question 15

What is the intended clinical use of Milk Thistle (Silymarin)?

Answer 15

Prevention/ treatment of liver disease

Question 16

What is the intended clinical use of St. John’s Wort?

Answer 16

Antidepressant

Question 17

What is the MOA of St. John’s Wort as an antidepressant?

Answer 17

Inhibits the reuptake of DA, NE, and 5-HT

Generally, it acts like a SSRI

Question 18

What major side effect is associated with St. John’s Wort?

Answer 18

CYP induction that decreases the serum concentrations of other drugs

Question 19

What is the intended clinical use of Saw Palmetto?

Answer 19

Treatment of BPH

Question 20

What is the MOA of Saw Palmetto in the treatment of BPH?

Answer 20

• Inhibits 5-a reductase
• Prevents Testosterone conversion to DHT
• Blocks DHT induced growth of the prostate

Question 21

What is the intended clinical use of Glucosamine and Chondroitin?

Answer 21

Osteoarthritis

Question 22

What drug-drug interaction is associated with Glucosamine and Chondroitin?

Answer 22

Enhanced anticoagulant effects of Warfarin

Question 23

What is the intended clinical use of Melatonin?

Answer 23

Sleep-aid/ treatment of insomnia

Question 24

What is Ramelteon?

Answer 24

Rx melatonin receptor agonist

Question 25

What major adverse effect is associated with Melatonin?

Answer 25

Depress reproductive system function

• Reduced sperm quality
• Decreased LH levels

Question 26

What is the intended clinical use of Butterbur?

Answer 26

Migraines

Question 27

What is the intended clinical use of Feverfew?

Answer 27

Migraines

Question 28

What are the intended clinical uses of CoQ10?

Answer 28

1) Reduction of statin-induced myopathy
2) HTN
3) CAD
4) Neurodegenerative Disease
5) Migraines

Question 29

List the supplements that increase the risk of bleeding in patients on warfarin.

Answer 29

• Ginkgo biloba
• Garlic
• Ginseng
• Glucosamine and Chondrioitin
• Feverfew
• CoQ10

Question 30

What drugs should NOT be used in patients on immune suppressants?

Answer 30

Echinacea

Ginseng