Herbal Medicine Exam 1

Front 1

Phytomedicines

Back 1

A medicinal product containing as active ingredients only plants, parts of plants or plant materials, or combinations thereof, whether in the crude or processed state

Front 2

Rational phytotherapy

Back 2

Therapeutic system of science-based medicine

Cure

Dose-effect relationships usually apply: a larger dose will usually have a more powerful effect

Clinical and pharmacological evidence of efficacy is AVAILABLE

Front 3

Traditional phytotherapy

Back 3

A therapeutic system derived from the traditional use of plants

"support, improvement, alleviation..."

Dose-effect relationships usually apply: a larger dose will usually have a more powerful effect

Clinical and pharmacological evidence of efficacy is usually LACKING

Front 4

Homeopathy

Back 4

A therapeutic system with its own concepts, not scientifically based

"Cure, support, alleviation, improvement..."

The strength of the effect increases with increasing dilution (so-called "dynamisation")

Scanty clinical and pharmacological evidence of efficacy

Front 5

Principles of homeopathy

Back 5

A system of medicine based on the principle of "like cures like"

Uses the smallest dose possible to produce a response

Front 6

Basis of homeopathy treatment

Back 6

Homeopathy works with the body's response to illness and remedies are prescribed according to the symptoms

One remedy can be used to treat several ailments

One ailment may need to be treated with different remedies in different patients

Front 7

Homeopathy: preparation of remedies

Back 7

1. whole plant is macerated in alcohol = mother tincture

2. if insoluble, it is finely ground and pulverized in similar proportions with powdered lactose (milk sugar)

3. 1 mL added to 9mL or 99mL of solution results in 1X or 1C potency

4. Shake vigorously in between dilutions

5. standard dilutions: 6X-30X but products of 30C or more are marketed

X = 10-fold, C = 100-fold

Front 8

Limit to the Dilution in Remedy preparation

Back 8

Limit = 6.023 x 10^23 which equals homeopathic concentrations of 12C or 24X (1 part in 10^24)

Front 9

Cort.

Back 9

full name (Latin) = cortex
full name (English) = bark

Front 10

Fol.

Back 10

Full name (Latin) = folium, folia
Full name (English) = leaf, leaves

Front 11

Frct.

Back 11

Full name (Latin) = fructus
Full name (English) = fruits

Front 12

Pericarp.

Back 12

Full name (Latin) = pericarpium
Full name (English) = peel

Front 13

Rad.

Back 13

Full name (Latin) = radix
Full name (English) = root

Front 14

Rhiz.

Back 14

Full name (Latin) = rhizome
Full name (English) = rhizome

Front 15

Sem.

Back 15

Full name (Latin) = semen
Full name (English) = seed

Front 16

Flor.

Back 16

Full name (Latin) = flores
Full name (English) = flowers

Front 17

Components of scientific name

Back 17

Genus species (in italics)

Front 18

St. John's Wort

Back 18

Hypericum perforatum

Front 19

Cranberries

Back 19

Vaccinium macrocarpon

Front 20

Most important chemical found in grapefruit juice that contributes to drug-drug interactions

Back 20

6',7'-dihydroxybergamottin

Front 21

Marker substances

Back 21

chemically defined constituents of herbal drugs of interest for control purposes only (may be independent of whether they have any therapeutic activity or not)

when constituents responsible for therapeutic activity unknown, assays of other determinants required (appropriateness of marker substance should be justified)

Front 22

Standardization

Back 22

Defined as all measures during manufacturing process and quality control to yield reproducibility

this includes adjusting herbal drug or derived preparation to a defined content of a constituent or a group of substances with known therapeutic activity (ex = add excipients, mix herbal drugs or derived preparations)

Front 23

Control of Starting Materials (plants)

Back 23

1. controlled wild collection

2. controlled post collection

3. controlled transport and storage

4. propagation for cultivation

5. cultivation

6. processing

Front 24

Parameters influencing extract composition: herb material

Back 24

extractive concentration, water content, drug particle size, powder fraction

Front 25

Parameters influencing extract composition: manufacturing procedure

Back 25

extraction mode, extraction time, extraction pressure, batch size

Front 26

Parameters influencing extract composition: solvent effects

Back 26

solvent type, modifier concentration, solvent amount, flow-through rate

Front 27

Parameters influencing extract composition: manufacturing plant

Back 27

filling amount, filling height (density), static pressure

Front 28

Coffee

Back 28

Coffea arabica

Front 29

Dietary Substance Health Education Act (DSHEA)

Back 29

herbs are "dietary supplements." not drugs

Front 30

DSHEA Ramifications

Back 30

1. food safety division of the FDA regulates these products, not the drug division

2. no safety or efficacy tests required, but manufacturer is responsible for safety

3. no adverse event reporting to FDA necessary

4. no treatment claims, but "structure-function" claims are acceptable

5. to halt sales or distribution, FDA must prove that the product is "unsafe"

Front 31

2007 FDA Good Manufacturing Practice (GMP) requirements for dietary supplements

Back 31

GMP ensures that all dietary supplements are manufactured consistently with respect to identity, purity, strength, and composition

Requirements include:
1. design and construction of physical maintenance plants
2. proper manufacturing operations
3. quality-control procedures
4. testing final products
5. handling customer complaints

Front 32

USP Certification Program

Back 32

1. totally voluntary
2. certify ingredients
3. certify quantity of ingredients
4. will disintegrate or dissolve effectively to release nutrients for absorption into your body
5. product screened for harmful contaminants such as pesticides, bacteria, and heavy metals
6. product is manufactured using safe, sanitary and well-controlled procedures

Front 33

Selecting herbal supplements

Back 33

1. look for standardized herbal supplements

2. buy only single herb products

3. beware of claims that sound too good to be true

4. be extremely cautious about herbal supplements manufactured outside the US (except most European manufacturers)

Front 34

Saw palmetto

Back 34

Serenoa repens

part used: berries

unique compound: steroids = beta-sitosterol, campesterol, stigmasterol

Front 35

Saw palmetto uses

Back 35

1. benefit the urinary tract

2. relieve strain from painful bladder problems

3. tone the bladder by improving urinary flow

4. for treatment of BPH symptoms

Front 36

Saw palmetto MOA

Back 36

BPH probably involves 5-alpha-dihydrotestosterone (DHT)

ACTS TO INHIBIT 5-alpha-reductase

Front 37

Isoforms of 5-alpha-reductase

Back 37

1. 5-alpha-reductase - 1 (liver, non-genital skin, brain)

2. 5-alpha-reductase - 2 (liver, urogenital tract)

Front 38

Potency of DHT

Back 38

DHT (dihydrotestosterone) is 10 times more potent than testosterone!

Front 39

Saw palmetto conclusions

Back 39

Saw palmetto provides mild to moderate improvement in urinary symptoms, flow measures

Relative to finasteride, improvements in urinary symptoms and flow measure are comparable, but fewer side effects and lower cost with saw palmetto

Front 40

Saw palmetto drug interactions

Back 40

1. Androgenic drugs: therapy may decrease the effectiveness of therapeutic androgens

2. Anti-androgenic drugs: additive effects may occur with anti-androgen drugs such as finasteride

3. Anticoagulants, anti-platelets, NSAIDs: not confirmed so far

Front 41

Saw palmetto dose

Back 41

1-2 grams of ground, dried, or whole berries daily

**teas prepared from saw palmetto berries are potentially ineffective because the purported active constituents are water insoluble**

extract: 320 mg daily in one dose or two divided doses (160mg BID) = recommended by German expert panel, the Commission E

DER (drug extract ratio): 9-12:1

Front 42

DER (drug extract ratio)

Back 42

the ratio of herbal substance to the herbal preparation

one of the most important criteria to approve the therapeutic equivalence of different herbal preparations

increased DER = hard to extract compound!!

Front 43

Pygeum (extract of bark of an evergreen tree found in Africa)

Back 43

Pygeum africana

part used: bark extract

products should be standardized to contain 14% triterpenes and 0.5% docosanol

Front 44

Pygeum MOA

Back 44

possible MOA: pygeum might inhibit growth factors

NO special safety concerns

Front 45

Pygeum Dose

Back 45

75-200 mg standardized lipophilic extract (14% tripterpenes, 0.5% n-docosanol) per day has been used

some research suggests daily or BID dosing is equally effective

Front 46

Pygeum adverse effects

Back 46

general: Pygeum has been well tolerated in most studies, with adverse effects similar to placebo

GI: some people may experience abdominal discomfort, including diarrhea, constipation, stomach pain, or nausea

Front 47

Pumpkin

Back 47

Cucurbita pepo, Cucurbita moschata (2 different plants)

Active part: seeds (whole or crushed), seed extract oil, tablets, tea

Front 48

Pumpkin use

Back 48

BPH

Proposed dose: 480mg per day (pumpkin seed extract) in 3 divided doses in combo with saw palmetto and other herbs

Front 49

Pumpkin adverse effects

Back 49

electrolyte imbalance (from mild diuretic actions)

drug interactions: diuretics (potentiation of fluid loss and electrolyte imbalance)

Front 50

Stinging nettle

Back 50

Urtica dioica

Parts of plant used: root

Hairs that cover the plant contain acetylcholine, histamine, serotonin, leukotrienes

Front 51

Stinging Nettle other uses

Back 51

adjuvant in the symptomatic treatment of arthritis, arthroses, and/or rheumatic conditions

also used as a diuretic, in inflammatory complaints of the lower urinary tract

BPH

Front 52

Stinging nettle precaution/side effects

Back 52

Use with caution in patients taking anti-inflammatory agents

Use with caution in patients with hyponatremia as nettle has a synergistic diuretic effect

Front 53

Cranberry

Back 53

Vaccinium macrocarpon

For prevention and treatment of UTI (diuretic, antiseptic, urinary deodorizer)

**rich in anthocyanins --> antioxidant, anti-inflammatory

Front 54

Cranberry MOA and dose

Back 54

MOA thought previously to be urine acidification, now MOA through adhesion inhibitors

Need about 8-16 oz (240-480 mL) of pure juice (NOT DRINK OR COCKTAIL)

Front 55

Cranberry tablets caution

Back 55

Dietary supplementation with cranberry concentrate tablets may increase the risk of nephrolithiasis (calcium oxalate increased)

Front 56

Cranberry possible drug interaction

Back 56

cranberry-warfarin

Front 57

Cranberry dose

Back 57

>8 oz/day of JUICE

(caution in diabetics due to sugar content)

Front 58

Bearberry

Back 58

Arctostaphylos uva-ursi

part of plant used: leaves (as diuretic, astringent, antiseptic, and treatment for UTIs)

Front 59

Bearberry key compounds

Back 59

ARBUTIN is the active ingredient in bearberry present in fairly high amounts (up to 10%)

HYDROXYQUINONE is a very powerful anti-microbial agent and seems to be responsible for bearberry's ability to treat UTIs

Front 60

Bearberry Medicinal Use

Back 60

UTIs including cystitis, nephritis, urethritis, yeast infection, early stage of genital herpes

Front 61

Bearberry Side Effects

Back 61

nausea, vomiting (due to high tannin content)

Front 62

Bearberry Dose

Back 62

cold water infusions of the dried leaf (3g per day) correspond to 400-800 mg arbutin per day

Front 63

Bearberry duration

Back 63

until complete disappearance of symptoms, maximum of 12 weeks

Front 64

Bearberry drug interactions

Back 64

corticosteroids: may potentiate the effects of prednisolone and dexamethasone

diuretic drugs: may increase urine flow

NSAIDs: may increase the anti-inflammatory activity of indomethacin

Front 65

Chasteberry

Back 65

Vitex agnus

Part used: dried, ripe berries

Front 66

Chasteberry indication

Back 66

menstrual irregularities including dysmenorrhea, secondary amenorrhea, oligomenorrhea, and polymenorrhea

symptoms of menopause

PMS

treating female infertility, increasing lactation, and treating fibrocystic breasts

Front 67

Chasteberry key compounds

Back 67

vitexilactone, casticin (may also be used for standardization), rotundifuran, agnuside (usual standardized ingredient)

Front 68

Standardization of chasteberry

Back 68

many extracts are standardized to contain 0.5% agnuside or 0.6% aucubin (may be standardized to casticin content)

Front 69

Chasteberry MOA

Back 69

works similar to dopamine molecule by acting at dopamine receptor to block conversion of ATP to cAMP and therefore INHIBITING prolactin secretion

Front 70

Chasteberry Dose

Back 70

single dose each morning before breakfast throughout cycle

extract: 30-40mg/day

powdered berries: 3 x per day at 500mg/dose (total 1500mg/day)

0.15-0.2mL daily of tincture (1:5 g/mL)

long-term use acceptable within recommended therapeutic range

Front 71

Chasteberry Contraindications

Back 71

DO NOT take with dopamine receptor antagonist/agonist

Avoid using in women undergoing in vitro fertilization

use during pregnancy and lactation should be avoided

Front 72

Black cohosh

Back 72

Cimifuga racemosa

Part used: root

Front 73

Black cohosh use

Back 73

premenstrual complaints and dysmenorrhea as well as neurovegetative conditions related to menopause

Front 74

Black cohosh key compounds

Back 74

deoxyactein, caffeic acid, salicylic acid, formononetin

Front 75

Black cohosh standardization

Back 75

based on content of triterpenes, calculated as 27-deoxyactein

1mg of 27-deoxyactein per 20mg tablet

Front 76

Black cohosh MOA

Back 76

have selective estrogen receptor modulating (SERM) effects

(estrogenic and anti-estrogenic effects)

Front 77

Estrogen receptors/locations

Back 77

ER-alpha: uterus, breast, ovary, testis, kidney, and adrenal gland

ER-beta: brain, prostate, lung, bladder, intestine, bone

Front 78

SERMs

Back 78

designed to act in specific ways at each of the estrogen receptor sites in different tissues

SERMs preferentially bind to ER-beta, potentially activating cardioprotective and bone-stabilizing metabolic processes

SERMs down-regulate activity of ER-alpha, found in breast and uterus, and may help prevent cancer in these tissues

Front 79

Traditional Black cohosh dose

Back 79

40-200mg dried rhizome daily in divided doses

Front 80

Modern/recommended black cohosh dose

Back 80

ethanol extract: equivalent to 40mg of dried rhizome/root/day

Remifemin: standardized extract where each 20mg tablet contains 1 mg triterpene glycosides, 40mg/day (2 tabs per day)

Front 81

Black cohosh adverse reactions

Back 81

might cause liver disease

Front 82

Black cohosh contraindications and warnings

Back 82

contraindicated in pregnancy

anti-HTN medications

allergy to aspirin

in patients with known estrogen sensitive conditions

interactions: atorvastatin

Front 83

Soybeans

Back 83

Glycine max

observations of Asian populations: generally a diet higher in soy than America (but must start eating soy at a young age for protective effect)

Front 84

Beneficial components of soy

Back 84

fatty acids:

mainly unsaturated fat
minimal saturated fat
plant source of omega-3 fatty acid, linoleic acid

Front 85

Omega ratio

Back 85

omega-6 to omega-3 ratio should be 2:1

omega-6 family: thrombotic, inflammatory

omega-3 family: less thrombotic, less inflammatory

Front 86

Plant derived estrogens (phytoestrogens)

Back 86

soy or red clover--> soy (ISP) or clover isolate --> isoflavone concentrate --> genistein, daidzein, glycitin (all have weak estrogenic effects)

Front 87

Phytoestrogens in human health

Back 87

cancer preventative
post-menopausal supplement
prevention of osteoporosis
cardiovascular health

Front 88

Soy dose

Back 88

soy protein 20-60 grams providing 34-76 mg of isoflavones daily

concentrated soy isoflavone extracts providing 35-120 mg of isoflavones daily

osteoporosis: 80-90mg, in 40 grams of soy protein

Front 89

Red clover

Back 89

Trifolium pratense

part used: flowering top

Front 90

Red clover key compounds

Back 90

isoflavones

coumestrol (similar in structure to warfarin, increase bleeding risk)

Front 91

Red clover use

Back 91

orally, red clover is used for menopausal symptoms and hot flashes (evidence is poor)

Front 92

Red clover dose

Back 92

menopausal symptoms: 40, 80, or 160mg of red clover isoflavones/day

HRT: 40-80mg of red clover isoflavones/day

cholesterol: 28.5, 57, or 85.5mg of red clover isoflavones/day

osteoporosis: 40mg of red clover isoflavones/day

Front 93

Dong quai

Back 93

Angelica sinensis

part used: root

Front 94

Dong quai use

Back 94

dysmenorrhea, PMS, and menopausal symptoms

(no phytoestrogens, coumarin derivatives)

Front 95

Dong quai dose

Back 95

4.5 grams of powdered dong quai has been used daily

interactions: warfarin

Front 96

Wild yam

Back 96

Disocorea species

part used: all parts grown underground

Front 97

Wild yam uses

Back 97

menopausal complaints

osteoporosis

precursor for commercial chemical synthesis of human steroidal hormomes

Front 98

Wild yam active ingredient

Back 98

diosgenin --> progesterone

NOTE: this conversion happens synthetically but NOT in the body

some products are spiked with progesterone!!

Front 99

Wild yam effectiveness

Back 99

applied topically appears to be no better than placebo for reliving vasomotor symptoms

dosage: not known
interactions: not known
adverse effects: vomiting

Front 100

Garlic

Back 100

Allium sativum

part used: bulb

(all garlic for commercial use is cultivated)

Front 101

Modern use of garlic

Back 101

anti-HTN

antimicrobial

fibrinolytic

**anti-atherogenic

antithrombotic

**lipid-lowering

Front 102

RLS of synthesis of cholesterol

Back 102

conversion of HMG-CoA to mevalonic acid through HMG-CoA reductase

Front 103

Garlic key compounds

Back 103

Alliin: chemically stable, odorless, little physiological activity

Allicin: chemically unstable, typical garlic odor, physiologically active (RELEASED BY CRUSHING THE GARLIC)

Front 104

Garlic odor...why does your breath and skin stink after eating garlic?

Back 104

The sulfur molecules that are created when garlic is smashed or chewed are absorbed into the bloodstream and lungs and escape through exhaled air and perspiration

Front 105

Garlic MOA

Back 105

inhibit HMG-CoA reductase (primary)

inhibit squalene epoxidase (in conversion of squalene to lanosterol)

Front 106

Garlic product formulation

Back 106

product needs to be enteric coated to be effective!!

Front 107

Aged garlic-A potent antioxidant

Back 107

extracts of fresh garlic that are aged over a prolonged period to produce aged garlic extract (AGE) that contains antioxidant phytochemicals that prevent oxidant damage

Front 108

Formation of free radicals

Back 108

UV light
ionizing radiation
smoking
air pollution
inflammation
metabolism

Front 109

AGE MOA

Back 109

AGE exerts antioxidant action by scavenging reactive oxygen species (ROS)

It protects DNA against free radical-mediated damage and mutations

Front 110

Garlic clinical considerations

Back 110

side effects: odor and GI upset

active component allicin is odiferous; reduced in many products to decrease odor

Front 111

Garlic dose

Back 111

tablets or capsules: 600-900mg (10mg allicin) daily

odorless formulations other than enteric-coated may be less effective!!

fresh garlic: 2-5g/day (5-20 cloves)

must be taken for 6 weeks - 2 months for maximal effect

Front 112

Garlic drug interactions

Back 112

Norvir (ritonavir): cases of GI toxic effects

Fortovase/Invirase (saquinavir): combination results in decreased effectiveness of saquinavir

warfarin: prolongs the time for blood to clot, increased risk for bleeding

Front 113

Red yeast rice

Back 113

Monascus purpureus

Front 114

Red yeast rice key compounds

Back 114

major compound: monacolin K = mevinolin (similar in structure to statin)

Front 115

Red yeast rice MOA

Back 115

inhibits the action of HMG-CoA reductase

Front 116

Red yeast rice dose

Back 116

traditional: 6-9 grams/day
recommended: 1.2 grams/day

Front 117

Red yeast rice contraindications

Back 117

patients who are hypersensitive or allergic to rice or yeast

Front 118

Red yeast rice drug interactions

Back 118

cholesterol-lowering medications = additive effects

grapefruit juice - HMG-CoA reductase inhibition

Front 119

Red yeast rice side effects

Back 119

only mild effects have been reported: heartburn, flatulence, dizziness

Front 120

Oats

Back 120

Avena sativa

part used: seeds or oat bran (milled)

Front 121

Oat uses (orally)

Back 121

hypercholesterolemia

diabetes

lowering uric acid levels

Front 122

Oat uses (topically)

Back 122

seborrhea

dry and itchy skin

Front 123

Oat key compound

Back 123

beta-glucans --> in the bran of grasses

Front 124

Oats MOA

Back 124

(beta-glucan)

1. binds with bile acids in the gut and increasing fecal bile acid excretion

2. decreases cholesterol absorption

3. increases the viscosity of food

Front 125

Oats dose

Back 125

for hypercholesterinaemia:

56-150 grams of whole oat products such as oatmeal containing 3.6-10 grams of beta-glucan

Front 126

Oats and FDA regulation

Back 126

health claim: product may reduce the risk of heart disease if they contain at least 750mg of soluble fiber per serving

approximately 3 grams soluble fiber taken daily

Front 127

Artichoke

Back 127

Cynara scolymus

part used: leaves of the STEM

Front 128

Artichoke key compounds

Back 128

Caffeoylquinic acids

Flavonoids (eg luteolin-7-O-glycoside)

Sesquiterpene lactones

luteolin (most prominent), chlorogenic acid, cynarin

Front 129

Artichoke therapeutic indications

Back 129

adjuvant to a low fat diet in the treatment of mild to moderate hyperlipidemia

Front 130

Artichoke dose

Back 130

320-640mg artichoke leaf extract three times daily

Front 131

Artichoke MOA

Back 131

indirect inhibition of HMG-CoA reductase

Front 132

Artichoke side effects

Back 132

mild GI disturbances, allergic reactions (in individuals sensitive to Asteracease/Compositae family plant)

also allergic contact dermatitis

Front 133

Artichoke safety

Back 133

interactions with other medications: none

overdose: no toxic effects reported

duration of treatment: no restriction

GRAS

Front 134

Hawthorn

Back 134

Crataegus species
(C. monogyna, C. laevigata)

part used: leaves and flowers

Front 135

Hawthorn key compounds

Back 135

Flavonoids (vitexin-4'-rhamnoside, rutin, quercetin, hyperoside)

flowers and leaves: high in flavonoids, fruits contain lowest amount

Front 136

Hawthorn standardization

Back 136

range from 0.6-1.5% flavonoids, typically calculated as hyperoside

Front 137

Hawthorn key compound

Back 137

Proanthocyanidins

OPCs = oligomeric proanthocyandins

Front 138

Hawthorn therapeutic indications

Back 138

preparations based on hydroalcoholic extracts: declining cardiac performance (NYHA class I or II)

herbal teas and other preparations: nervous heart complaints, support of cardiac and circulatory function

Front 139

Hawthorn side effects

Back 139

GI complaints
vertigo
headache
sleeplessness
in general, very well tolerated

Front 140

Hawthorn special warning

Back 140

Self-medication is inappropriate among patients with heart failure!!

Front 141

Hawthorn MOA

Back 141

increasing force of contraction and lengthening refractory period

increasing coronary blood flow and cardiac output, and reducing oxygen consumption

cardiotrophic properties: increased membrane permeability for calcium, and phosphodiesterase inhibition (intracellular cAMP increased)

increased cAMP = increased coronary blood flow, vasodilation, and positive inotropic effects

Front 142

Hawthorn dose

Back 142

160-900mg extract per day in 2-3 divided doses

powdered drug: 2-5 grams daily

tincture: 20 drops 2-3x day

herbal teas: 1-1.5 grams of drug as an infusion

Front 143

Hawthorn duration of treatment

Back 143

Should be used for 4-8 weeks to determine benefit

Front 144

Hawthorn interactions

Back 144

conventional CV drug therapy

not reported

Front 145

Hawthorn safety

Back 145

safe, when used short term

pregnancy and lactation: avoid using

overdose: NO toxic effects reported

Front 146

Fish oil

Back 146

omega-3 EPA and DHA

Front 147

EPA

Back 147

eicosapentaenoic acid (primarily from fish)

Front 148

DHA

Back 148

docosahexaenoic acid (primarily from fish)

Front 149

ALA

Back 149

alpha-linolenic (primarily from flax)

Front 150

1 gram fish oil = ?

Back 150

150 mg EPA/DHA

Front 151

1 gram flax seed oil = ?

Back 151

19.6 mg EPA/DHA

Front 152

Desired omega-6 to omega-3 ratio

Back 152

2:1

Front 153

Goal omega-3 EPA/DHA consumption

Back 153

500-650 mg per day

Front 154

EPA/DHA dose

Back 154

eat two 4 oz. servings of fatty fish per week:

providing 3500 mg EPA + DHA per week OR 496 mg of EPA + DHA per day

Front 155

Fish oil safety concerns

Back 155

contamination with toxins (mercury)

Front 156

EPA/DHA benefits

Back 156

heart health
brain development
brain function
asthma
visual acuity
immune function
arthritis
skin and hair health

Front 157

Horse chestnut

Back 157

Aesculus hippocastanum

Front 158

Horse chestnut key compounds

Back 158

terpenoid compounds:

escin (also aescin) = complex mixture of various, chemically similar triterpene glycosides **major prominent compound

fatty acids

coumarin derivatives (aesculin)

Front 159

Horse chestnut standardization

Back 159

horse chestnut seed extract (HCSE)

16-20% triterpene glycosides calculated as aescin

Front 160

Horse chestnut therapeutic applications

Back 160

treatment of chronic venous insufficiency, treatment of inflammatory conditions, skin care products, treatment of hemorrhoids

Front 161

Phases of compression therapy

Back 161

Phase I: reduction of edema and/or ulcer healing, achieved by applying non-elastic compression

Phase II: maintenance of compression, elastic compression

Front 162

Horse chestnut dose

Back 162

drug or hydroalcoholic extracts = 300 to 900 mg of a 16% extract

2 or 3 x daily

**in all cases, patient must continue physician-prescribed treatments including the use of supportive elastic stockings

Front 163

Horse chestnut safety profile

Back 163

FDA status: unsafe herb

toxicity: attributed to the glycoside aesculin (dilation of pupils, diarrhea, vomiting, paralysis)

interactions: none reported
theoretically: anticoagulants