Pharm Exam 4 Summer 2023 - Herbal.pdf

DRUG NAME: MOA: • Increases production of IL and NK cell activity (immune suppressant) PROPOSED USE: • Marketed to reduce duration of the common cold if started w/in 24 hrs of onset of sx • CV - lowers total cholesterol and LDL cholesterol; may inhibit plt aggregation; reduces SBP and DBP Garli...

DRUG NAME: MOA: • Increases production of IL and NK cell activity (immune suppressant) PROPOSED USE: • Marketed to reduce duration of the common cold if started w/in 24 hrs of onset of sx • CV - lowers total cholesterol and LDL cholesterol; may inhibit plt aggregation; reduces SBP and DBP Garlic • CV MOA - inhibits HMGCoA reductase and antioxidant properties DRUG INTERACTIONS: NOTES: immunosuppressant meds • avoid in immune def disorders or autoimmune disorders; ppl taking immunosuppressant meds • URTI prevention: risk ratio 0.78; 10• Unpleasant taste, GI upset, 20% risk reduction; duration not or allergic reactions (eg, rash) affected Echinacea • Demonstrated weak abx/antiviral/antifungal effects ADVERSE EFFECTS: • antimicrobial, antiviral, immuneenhancing - reduces total # of colds, but evidence not strong • Short-term use (eg, 10–14 days) is probs safe • anticlotting meds (warfarin, nausea, hypotension, allergy, ASA) - increases risk of postop bleeding, spinal bleeding epidural hematoma, breath and body odor, contact • protease inhibitors - reduces dermatits w/ raw garlic bioavailability of saquinavir • antineoplastic use being studied Gingko biloba increases blood flow, reduces blood viscosity, promotes vasodilation • CV - enhances tissue perfusion, increases blood flow, reduces viscosity, and promotes vasodilation - mild/mod vascular occlusive disease • dementia and memory - possibly an add-on to conventional dementia therapies (not for prevention) • schizophrenia n/d, HA, GI upset, allergy, anxiety, insomnia, bleeding complications, seizures warfarin, ASA need to monitor INR more frequently if pt wants to begin using any of these while taking warfarin - all can elevate INR need to monitor INR more frequently if pt wants to begin using any of these while taking warfarin - all can elevate INR DRUG NAME: MOA: PROPOSED USE: • improve mental performance and increase energy • cold prevention • lower postprandial glucose Ginseng ADVERSE EFFECTS: DRUG INTERACTIONS: NOTES: • P ginseng - CNS stimulation and htn • vaginal bleeding, mastalgia, and gynecomastia in an adolescent male - case report --> suggests estrogen effect warfarin • nonspecific cancer prevention and • caution w/ alleviating cancer-related fatigue - may immunocompromised, ppl benefit when combo w/ chemo in taking immune stimulants, ppl certian types of cancers w/ autoimmune disorders Glucosamine/chondroitin • glucosamine - derived from chitin - stimulates manufacturing of substances essential for proper joint function/joint repair stimulation • chondroitin - dervied from bovine/shark cartilage - acts as chondroprotectant • serotonin derivative produced by pineal gland Melatonin • regulates sleep/wake cycle • release coincides w/ darkness, release is suppressed by daylight • mild-moderate knee OA - best evidence • general OA - less evidence n/v/d, abd cramps, HA, possible asthma exacs w/ chondroitin warfarin - increased INR • chondroitin - for urinary incontinence and destrusor instability • jet lag - when traveling across 5+ time zones (strongest data) - take dose close to target bedtime @ new destination and 1-3 nights after arrival • insomnia - taken at desired bedtime rare - reports of next day w/ lights off - improves morning drowsiness, vivid dreams, alertness and quality of sleep HA; increased and decreased BP - monitor pts w/ HTN • pre/postop anxiety • +/- improves quality of oocytes & embryos during ovulation induction and egg retrieval N/A contraindication shellfish allergy DRUG NAME: MOA: PROPOSED USE: Saw Palmetto Antiandrogenic, antiproliferative, and anti-inflammatory properties BPH - improves frequent urination, painful urination, hesitancy, urgency ADVERSE EFFECTS: DRUG INTERACTIONS: NOTES: less likely to affect sexual function compared to tamsulosin and finasteride dizziness, n/v/c/d • photosensitivity • mild-mod MDD - equivalent to prescription tx w/ fewer side effects St. John's Wort • PMDD, climacteric complaints, inhibits reuptake of serotonin, norepi, dopamine somatoform disorders, anxiety - need more studies • +/- reduce hot flashes • mild GI sx, fatigue, sedation, restlessness, dizziness, HA, dry mouth - less than Rx antidepressants • serotonin syndrome alone or w/ other drugs that increase serotonin; mania, hypomania • htn crisis w/ tyraminecontaining foods • CYP450/3A4 inducer reduces levels of amitriptyline/nortriptyline, midazolam/alprazolam, cyclosporine/tacrolimus, indinavir/nevirapine, imatinib/irinotecan, dig, methadone, omeprazole, OCP, simvastatin, warfarin, verapamil, theophylline allow for 14 day washout period after tx with MAOI before starting • abortifacient - do not use during pregnancy • abd pain, n/v/d, indigestion, flatulence Feverfew inhibit plt aggregation, serotonin release, leukotrienes, prostaglandin synthesis migraine prophylaxis - reduces frequency; less severe sx of pain, n/v, photophobia, hyperacusis • swelling of lips, tongue, oral mucosa (less w/ capsule form) warfarin • abortifacient - avoid in pregnancy Co-Q10 affects mitochrondrial function - anti oxidant • Co-Q10 def, ischemic heart dz likely effective • HF, htn - less evidence well tolerated; GI in < 1% of pts • taper to prevent withdrawal - post feverfew syndrome --> fatigue, anxiety, HA, insomnia, arthralgias, muscle/joint stiffnss • do not use if allergic to ragweed or related plants warfarin - structure similar to vit K DRUG NAME: MOA: PROPOSED USE: ADVERSE EFFECTS: DRUG INTERACTIONS: NOTES: • stimulatory effect on bile for cholestasis - need trials Milk Thistle increases RNA polymerase activity in nonmalignant hepatocytes but not in malignant cell lines • Amanita phalloides mushroom poisoning (IV) • GI upset, HA, derm • high doses - laxative effect • hepatic fibrosis • anti-inflammatory • Made from methionine, an amino acid found in foods S-adenosylmethionine (SAMe) • Increases dopamine & norepi levels • OA - likely effective • depression - possibly effective n/v/d, constipation, anorexia, dizziness, dry mouth, HA, flatulence, insomnia, sweating, nervousness • Anti-inflammatory and analgesic effects may have additive effect on drugs that increase serotonin levels (Pt edu - do not combine SAMe w/ other antidepressants) • animal studies - show analgesic effects and reduced neoplasm rates Methylsulfonylmethane (MSM) • OA - conflicting data little data little data added to products containing glucosamine/chondroitin for added pain relief • pain relief Black cohosh relief of hot flashes Soy relief of hot flashes hepatotoxic avoid w/ estrogen receptor positive breast cancer • HA, dizziness, nausea Apoaequorin (Prevagen) VD3 + apoaequorin "improve cognition clarity" - delayed recall only modestly improved pt edu - don't take if hx or fam hx of breast cancer • post market - htn, hypotension, chest pain, irregular HR, sz, CVA DRUG NAME: MOA: PROPOSED USE: ADVERSE EFFECTS: Vitamin B3 (in skin cancer) may reduce risk in pts who already have non-melanoma skin cancer Iodine (in pregnancy) give w/ pregnancy/breastfeeding - 1/3 of US women mildly iodine deficient avoid doses > 1000 mcg/day can inhibit thyroid synthesis in mom/baby Comfrey inflammatory disorders abnormal liver function/damage - irreversible Kava Kava anxiety/stress abnormal liver function/damage - deaths reported Yohimbine impotence BP changes, arrhythmias, resp depression, MI - deaths reported Ephedra (Ma Huang) CNS and cardiac tox - avoid in htn, risk for CVA, MI, sz DRUG INTERACTIONS: NOTES: