Questions and Answers
What percentage of adults with liver disease used CAM therapies in the prior year, according to a specific study?
What is a primary reason why patients with liver disease use CAM therapies?
What is a potential risk associated with using herbal supplements in hepatology?
What is a key learning outcome for students regarding phytotherapies with hepatoprotective properties?
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What is a common mechanism through which drug interactions occur with CAM interventions?
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Why is it essential to discuss the phytochemical profile of grapefruit and St John's Wort in the context of drug interactions?
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According to the provided information, what is the most common herb used for 'liver detoxification' in Ireland?
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The passage mentions that milk thistle is often used to treat which condition?
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What is the primary constituent of milk thistle responsible for its purported antihepatotoxic effects?
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Which of the following is NOT a proposed mechanism of action for milk thistle's antihepatotoxic effects?
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According to the Cochrane hepato-biliary group review, what is the efficacy of milk thistle for various liver disorders?
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What is the typical daily treatment dose of milk thistle for liver conditions?
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Based on the text, what is a valid clinical outcome for assessing the efficacy of milk thistle treatment?
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Which of the following statements accurately reflects the evidence base for milk thistle's effectiveness in treating liver disorders?
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What is the primary concern regarding the findings about milk thistle's effectiveness for liver diseases?
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Which component in artichoke leaf is recognized as anti-hepatotoxic?
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What traditional medicinal use is associated with gentian root?
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Which substance makes up a significant portion of dandelion's constituents?
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What is the primary action attributed to turmeric in traditional medicine?
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Which of the following is NOT a recognized traditional use of bitters like artichoke leaf and gentian?
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What major flaw is noted about the traditional uses of herbs for liver disorders?
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Which bitter receptor stimulation is linked to appetite stimulation?
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Which component of grapefruit is primarily concentrated in the peel and is known to activate furanocoumarins?
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What is the primary effect of furanocoumarins on CYP apoprotein?
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Which of the following drugs is least likely to be affected by grapefruit juice based on the provided information?
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What is the range of bergamottin concentration found in different brands of grapefruit juice?
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Which of the following flavonoids is now considered less significant in the context of grapefruit's drug interaction mechanisms?
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Which intermediate is formed during the metabolic activation of furanocoumarins?
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What common characteristic do the drugs amiodarone and rivaroxaban share in relation to grapefruit juice?
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What is the possible implication of grapefruit juice on drug exposure levels?
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Which of the following statements accurately describes the potential interaction between curcumin and conventional medications, based on the provided content?
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Based on the provided information, which of the following patient groups is NOT specifically identified as being at higher risk for drug interactions with herbal products like curcumin?
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What is a potential implication of curcumin's ability to inhibit several transcription factors?
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Which of the following is a key message regarding the evaluation of evidence-based drug-herbal interactions?
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Based on the information provided, what is the main rationale behind the statement that drug-herbal interactions need to be considered as carefully as conventional drug-drug interactions?
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Which of the following is NOT listed as a potential application of curcumin in traditional medicine?
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Which of the following statements best describes the reason for recommending caution with curcumin use in patients at either end of the age spectrum?
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Which of the following resources is mentioned as a valuable resource for information on drug-herb interactions?
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Study Notes
CAM Therapies in Hepatology
- CAM therapies are used by 41% of patients with liver disease, commonly for anxiety, depression, fatigue, and substance use
- Herbs and supplements are the most common modalities encountered, but some are potentially hepatotoxic
- Many patients are on multi-drug regimens, making CAM interactions possible
Milk Thistle
- Originates from Silybum marianum
- Constituents: mixture of flavonolignans, including silybin
- Claimed mode of action: antihepatotoxic effect, inhibition of toxin binding and activation, and enhanced glutathione and protein synthesis
- Applications: mild hypolipidaemic effect, treatment of hepatitis and cirrhosis at a dose of 400mg daily
- Efficacy: Cochrane review (2005) found it to be ineffective for various liver disorders, but safe and well-tolerated
- Commission E considers it safe and effective for toxic liver damage and supportive treatment in chronic inflammatory liver disease and hepatic cirrhosis
Liver Disorders: Use of Bitters
- Traditional use, largely unsupported by evidence-base
- Examples:
- Artichoke Leaf: anti-hepatotoxic, cholagogue, and cholesterol-lowering effects
- Gentian: stimulates bitter receptors, promoting salivation and appetite
- Dandelion: hepatic stimulant, diuretic, tonic, and anti-rheumatic
- Turmeric: antihepatotoxic, anti-inflammatory, antispasmodic, hypoglycaemic, and hypocholesterolaemic
Overview of Drug Interactions
- Mechanisms of interaction:
- Pharmacodynamic (PD): altering the concentration-dependent activity of a therapeutic molecule at the site of action
- Pharmacokinetic (PK): altering the ADME of a conventional drug
- Interactions between herbal and conventional medicines need to be considered as carefully as those between conventional drugs
Particular Risk Groups for Drug Interactions
- Patients with chronic disease, who use multiple medications—particularly those with a narrow therapeutic range
- Patients with genetic variance in drug metabolism
- Patients with impaired organ function
- Patients at either end of the age spectrum
Evidence-Based Drug-Herbal Interactions
- Sources:
- Known or suspected pharmacologic activity
- Data derived from in vitro or animal studies
- Isolated case reports lacking full information
- Grapefruit components:
- Furanocoumarins (bergamottin and 6',7'-dihydroxybergamottin)
- Flavonoids (naringin and naringenin)
- FC activation: irreversibly binds to CYP apoprotein, eliminating enzymatic activity
- Variability in juices: naringin, bergamottin, and 6',7'-dihydroxybergamottin concentrations vary across brands
- Grapefruit juice affects >80 drugs, increasing their levels, including anticoagulants, antiarrhythmics, and statins.
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Description
Explore the use of Complementary and Alternative Medicine (CAM) therapies in Hepatology, including herbs and supplements, for patients with liver disease.