Herbals & Drugs Of Abuse

Front 1

When did the use of herbals decrease due to the era of "new" medicine?

Back 1

1900s

Front 2

There is increased use of herbals today, how many people are currently using?

Back 2

1 in 3 people have used

22-32% currently

Front 3

Reasons for increased use of herbal medications

Back 3

--Consumers interested in health andparticipation in their own health

--Increase availability of info (internet)

--knowledge and “self help”

--Prevention and Fitness

--The dietary supplement and herbal industryhave done serious marketing and promotion

--Dissatisfaction with traditional, “modernMedicine”

Front 4

DSHEA Act of 1994: Allows companies to market product w/out demonstrating ______ or ______ as long as product makes NO claim it can _______, _______, or ______ ________.

Back 4

Safety -or- efficacy

DIAGNOSE, CURE OR PREVENT DISEASE

Front 5

Vitamins, minerals, cofactors, herbals, and amino acids are not considered OTC drugs but...

Back 5

Dietary supplements

Front 6

Dietary supplements are not regulated by?

Back 6

FDA

Front 7

DSHEA 1994

Reduced what?

Back 7

Dietary Supplement & Health Education Act of 1994

Reduced FDA authority over these drugs

Front 8

DSHEA has allowed pharmacologically active substances to be sold w/out prescriptions. What is an example of a pharmacologically active substance sold without prescription?

Back 8

Ephedra

Front 9

However, the FDA does mandate what?

But, regulations are not adequate to ensure product ________, __________, and

__________ ____________.

Back 9

”Good Manufacturing Practice” stds

purity, potency and accurate identification

Front 10

CGMP stands for?

in manufacturing what?

Back 10

Current Good Manufacturing Practice

in manufacturing packaging for holding human food

Front 11

9 FDA enforced labeling practices

Back 11

1.Plant part and common name

2“Dietary OR Herbal Supplement”

3.Disclaimer Statement…

4.Ingredients list

5.Quantity

6.Total weight

7.Usage directions

8.Side effect warnings or contraindications

9.FDA disclaimer “Product not evaluated by the FDA”

Front 12

Herbals are often labeled as _________ substances, but _______ doesn't mean safe.

Back 12

Natural, natural

Front 13

Active ingredients are extracted from _____.

Back 13

plants

Front 14

Many supplements and herbals effect _____ values

Back 14

lab

Front 15

Supplements can act as stimulants or __________.

Back 15

or depressants

Front 16

Supplements can create ______ or ______ disturbances.

Back 16

fluid or electrolyte

Front 17

Supplements can effect how the CV system reacts to __________.

Back 17

anesthetics

Front 18

The ASA and AANA recommends herbals and supplements be DC’d ______ weeks prior to surgery

Back 18

2-3

Front 19

Chamomile taken how

Back 19

as tea or topically

Front 20

Chamomile uses

Back 20

-digestive aid

-anti-inflammatory

-antispasmodic

-anti-infective agent

-tx mouth sores (2 studies do support)

Front 21

What is a possible allergic rxn assoc. with chamomile?

Back 21

If pt sensitive to ragweed, chrysanthemum ordaisy family

Front 22

Echinachea use

Back 22

Immune system stimulation

Front 23

Human studies show ________ and __________ production with echinacea use.

Back 23

phagocytosis and macrocyte

Front 24

Echinacea should be avoided in what pt populations?

Examples (7)

Back 24

Immunocompromised pts

HIV, transplant pts, CA, MS, Lupus, RA, & pts taking immune enhancing drugs (TB)

Front 25

Echinacea may cause what problem with diabetics?

Back 25

Worsen control of BS

Front 26

Ephedra uses? (2)

what properties does it have?

Back 26

Dietary and asthma aid

(beta 2 agonist properties)

Front 27

Ephedra is a CNS ________ & _________ adrenergic agonist.

Back 27

stimulant; non-selective

Front 28

Ephedra SEs (3)

Major ones?

Back 28

hyperglycemia

headache

irritability

Major – seizures (lowers seizure threshold), stroke, PVCs, HTN, MI and death

Front 29

Ephedra was ________ in dietary and herbal supplements by the FDA in 2004.

-does not pertain to traditional ______ medicine

Back 29

banned

chinese

Front 30

What pt populations should avoid ephedra?

Back 30

CV disease, diabetics, thyroid conditions

Front 31

Ephedra has interactions with what 3 classes of medications?

Back 31

Anti-HTN, anti-depressants, caffiene

Front 32

Ephedras interaction with ______________ can result in life threatening hyperpyrexia, HTN and coma.

Back 32

MAO inhibitors

Front 33

What drug is similar to ephedra and sold OTC in cold remedies?

Back 33

Pseudoephedrine

Front 34

Long term use of ephedra can result in _______________, which is?

Back 34

Tachyphylaxis - depletion of catecholamines

Front 35

Anesthesia concern with fever few and willow bark

Back 35

Bleeding (can have additive effects with other anti-coagulats)

*may increase bleeding time

Front 36

Fever few and willow bark uses (3)

Back 36

Treatment of fevers, pain, and headaches

Front 37

Fever few and willow bark may suppress (2 things) and inhibit what (1)?

Back 37

1. suppress prostaglandin (contributes to pain + inflammation)

2. suppress thrombaxaneA2 production

3. inhibit release of serotonin from platelets (like ASA - so pts not a. activated or b.aggregated)

Front 38

Garlic uses (2)

Back 38

treatment of hypercholesterolemia and HTN (5-7mmhg)

Front 39

How does garlic work to reduce cholesterol?

Back 39

Inhibit HMG-CoA reductase

Front 40

How much do recent studies show that garlic reduces cholesterol?

Back 40

<5%

*Numbers are obsolete when low cholesterol diets are followed

Front 41

Anesthesia considerations with garlic (2)

Back 41

Bleeding and hypoglycemia

Front 42

How does garlic cause bleeding?

Back 42

May inhibit thromboxane A2 (a concern if other anti-coagulants are used)

Front 43

What is a bad (minor) SE of garlic?

Back 43

breath odor

Front 44

Ginger uses

Back 44

N/V (esp due to motion sickness)

Digestive Aid

menstural cramps

Front 45

Ginger anesthesia concern

Back 45

Bleeding

Front 46

Ginko Baloba Uses

Back 46

Improvement in blood circulation (PVD),improved memory, Reynaud’s, vertigo, tinnitus

Front 47

Ginko Baloba has been shown to improve ______ ______ and reduce ______ _______ by inhibiting _______ ________.

Back 47

blood flow; blood viscosity; platelet activity

Front 48

Anesthesia concern with ginko baloba

Back 48

Bleeding

Front 49

Avoid ginko baloba in what pt population?

Back 49

Seizure disorders bc it has epileptogenic properties

Front 50

Ginseng Uses (3)

Back 50

increased stamina, mental concentration, lowers cholesterol

Front 51

If you mix ginseng with an antidepressant what can result?

Back 51

Mania

Front 52

Ginseng has mild estrogenic properties and can cause?

Back 52

vaginal bleeding (mild)

Front 53

Ginseng is an enzyme ________ and ________ digoxin levels.

And causes resistance with what meds?

Back 53

inducer; decreases

diuretics

Front 54

Milk thistle uses (3)

Back 54

hepatitis, alcoholic liver, and Tylenol induced liver damage

Front 55

What does milk thistle do in animal studies? (2)

Back 55

may reduce tumor initiation & interfere with inflammatory signaling

Front 56

Kava uses (4)

Back 56

anxiolytic

muscle relaxant

anticonvulsant

sleep aid for insomniacs

*like a benzo

Front 57

Kava prolongs _____ anesthetics.

Back 57

sedative

Front 58

Kava increases effects of some __________ drugs.

Back 58

antiseizure

Front 59

Kava enhances the effects of __________ and _________.

Back 59

Alcohol and CNS depressants

Front 60

Saw palmetto uses (2)

Back 60

Urinary S/S

BPH (has anti-androgenic properties)

*has few SEs or drug interactions

Front 61

St. Johns Wort Uses (3)

Back 61

Anti-inflammatory

Anti-depressant

Anti-viral

* Trials indicate SJW is effective in improving the symptoms of mild to moderate depression

Front 62

St Johns Wart may interfere with reuptake of various ______ __________.

Back 62

amine transmitters

Front 63

St Johns Wart response to SNS __________ may be unpredictable.

Back 63

agonist

*ephedrine indirect agonist

*so unknown how SJW with react with our vasopressors

Front 64

St Johns Wart should not be taken with ______, ______, or _____.

Back 64

Ephedra, MAOI, or SSRI

Front 65

St Johns Wart has interactions with ________ and ___________.

Back 65

HIV & immunosuppressants

Front 66

St Johns wart prolongs some ______ agents.

Back 66

anesthesia

Front 67

Co-Q 10 may slow progression of _________.

Back 67

Parkinson's

Front 68

Co-Q 10 is similar to Vit K so it shouldn't be used with __________.

Back 68

warfarin

Front 69

Co-Q 10 showed improvement of _____ in older trials but newer trials show no improvement.

Back 69

CHF

Front 70

Co-Q 10 shows improved end points following _____.

Decreased _____, _____, _____, & _____.

Back 70

MI

Decreased lipids, cholesterol, angina, death

Front 71

Melatonin is derived from _____. Produced from _____ gland.

Back 71

serotonin

pineal

Front 72

Melatonin regulates the ___________ cycle.

When is the production/release of melatonin increased?

Back 72

Sleep-wake

*Increased production/release in darkness

Front 73

Melatonin uses (2)

Back 73

1. Sleep (improves sleep onset, duration, and quality, increases REM sleep)

2. Relief of Jet Lag

Front 74

Withdrawal s/s denote ____________.

Back 74

dependence

Front 75

Most addictive drugs activate the ___________-_________ system

Back 75

mesolimbic dopamine

Front 76

Compulsive, relapsing use despite negative consequences denotes _____________.

Back 76

addiction

Front 77

Marijuana causes disinhibition of __________ neurons.

Back 77

dopamine

Front 78

Marijuana effects

...with higher doses can cause? (2)

Back 78

euphoria, relaxation, loss of time, altered memory, visual hallucinations, increased appetite, reduced IOP, relief of pain.

With higher doses can cause psychotic episodes and de-personalization

Front 79

What is the THC analog that is approved by the FDA?

Back 79

Dronabinol

Front 80

Marijuana

Onset?

Peak?

1/2 life?

Back 80

Onset: w/in mins following inhalation

Peak: 1-2H

1/2 life: 4H

Front 81

The metabolism of GABA yields _________.

Back 81

Gamma Hydroxybutyric Acid (GHB)

GABA to GHB

Front 82

GHB fist introduced as a _______ ___________ (sedation, coma and amnesia).

What caused it to be removed from the market? (2)

Back 82

general anesthetic

Narrow safety margin and highly addictive profile

Front 83

The main SE of GHB is _________, but prior to sedation there is ___________ and _________________________.

Back 83

Sedation

euphoria & a feeling of closeness

THEN sedation & amnesia

Front 84

GHB is used for date rapes bc it is _________ and ______ and undetectable when placed in liquid.

Back 84

colorless; odorless

Front 85

Inhalants: following numerous exposures there is damage to the _______ _______ in the brain.

Back 85

white matter

Front 86

Cocaine is a water soluble alkaloid found in the leaves of the _____ _______.

Back 86

cocoa shrub

*can be injected, snorted, or heated in an alkaline solution (crack) and then smoked.

Front 87

Cocaine MOA (3)

Back 87

1. inhibits fast Na+ channels (LA properties)

2. blocks reuptake of amineneurotransmitters (dopamine, serotonin, epi, norepi)

3. NMDA Receptor agonist

Front 88

What explains the high and "reward" effect associated with cocaine?

and what s/s does this cause?

Back 88

Blocking of the reuptake of catecholamines (so they build up)

tachycardia, hypertension and ventricular arrhythmias (especially with volatiles)

Front 89

Cocaine lethal effects

Back 89

stroke, coronary vasospasm (tx = ntg),MI, V-Tach and V-Fib

Front 90

Cocaine OD can lead to

Back 90

hyperthermia, seizures, coma, and death

Front 91

Amphetamines MOA

Back 91

cause the release of endogenous NTMs

(interfere with vesicle transport mechanism –once inside cell they deplete neurotransmitter in vesicle itself)

Front 92

When amphetamines have been used, what vasopressors will not work, and why?

Back 92

***Indirect, due to depleted NE in vesicles

Front 93

Amphetamine effects (4)

similar to?

Back 93

(similar to cocaine) increased awareness, reduced sleep, flushed skin, vasoconstriction

Front 94

Unlike cocaine, amphetamines are ________.

Back 94

neurotoxic

Front 95

Ecstacy: MDMA MOA

Back 95

Like amphetamines - interferes with transport mechanism of neurotransmitters but more selectively interferes with serotonin

Front 96

Ecstacy: MDMA

following 1 dose- profound release of ________ followed by a huge depletion that can last 24 hrs

Back 96

Serotonin

Front 97

Ecstacy: MDMA

after several sequential doses depletion can be ___________. Researchers feel can produce irreversible damage – neurotoxicity.

Back 97

Permanent

Front 98

Ecstacy: MDMA has serious SEs such as what syndrome?

Back 98

Serotonin Syndrome

Front 99

Serotonin syndrome consists of ________, which makes it look like ________ ________.

It also can have what other SEs (3)?

Back 99

hyperthermia (looks like MH) ,

muscle rigidity, autonomic hyperactivity and death

Front 100

How can ecstacy cause seizures (2 ways)?

Back 100

Drinking all night can lead to dehydration and hypernatremia leading to seizures

or

drinking excessive free water can lead to hyponatremia, seizures, coma, death

Front 101

LSD, Mescaline are hallucinogens that produce....

Back 101

visual distortion, depersonalization, distorted time perception,dizziness, nausea, parasthesias, and can precipitate intense flashbacks forseveral years after last drug exposure

Front 102

LSD, Mescaline MOA

Back 102

thought to increase release of glutamate in cortex (#1 excitatory neurotransmitter in the brain)