Scnm Q6 Botm 743 Final

Front 1

Definition of cardiotonic and the two main types.

Back 1

Cardio-tonic -herbs that stimulate circulation and action of the heart, generally used for improving vessel function and heart muscle contractility
1) Carminatives (Capsicum, Zingiber, Allium sativa)
Herbs that stimulate circulation through a warming action on the tissues. Many are also anti-thrombolytic, inhibit platelet aggregation and reduce lipid levels.
2) Flavonoids (Crataegus, Asculus)
Common nutritional constituents with high amounts found in berries and fruits. Support vasculature and reduces circulatory damage through anti-oxidant/anti-inflammatory activity

Front 2

Definition of Cardiac Glycoside and the 3 types of actions.

Back 2

Cardiac glycosides (Digitalis, Convallaria) Constituents that directly affect the Na/K pump by reducing Na+ levels. This leads to increased Ca+ levels that increase heart contractility.
1) Positive Inotrope
increases force of contraction
2) Negative Chronotrope
reduces rate of contraction
3) Anti-arrhythmic
Decreases conduction velocity thru the AV junction

Front 3

The 3 types of anti-hypertensives.

Back 3

1) Anti-sympathomimetics (Rauvolfia, Veratrum)
Herbs that work to reduce blood pressure through anti-sympathetic action, usually blocking a variety of amines from stimulating this pathway. The actions are due to the alkaloids in these plants and can be toxic.

2) Cardiac nervines (Leonorus, Rosmarinus)
These herbs work to reduce blood pressure and prevent arrhythmias by relaxation of the nervous system. Usually gentle in action

3) Peripheral vasodilators (Tilia, Viscum)
Herbs that cause vasodilation in the circulatory system which then reduces blood pressure

Front 4

Name 2 herbs that are positive ionotropic, negative chronotropic and anti-arrhythmic

Back 4

Digitalis purpurea (Foxglove)
Convallaria majalis (Lily of the Valley)

Front 5

What parts of Convallaria majalis do we use?

Back 5

The whole plant: leaf, flower, rhizome

Front 6

What are the main differences between the actions of Digitalis pupurea and Convallaria majalis?

Back 6

Convallaria majalis is much more gentle and less toxic; the glycosides in Digitalis are the strongest known.

The cardiac glycosides in Convallaria are not cumulative, making it a safe alternative to Digitalis.

Although they both reduce edema, Convallaria does it through a diuretic effect, whereas Digitalis probably does it through increasing the blood supply to the kidneys.

Front 7

Patient presents with weak, rapid and irregular heart action, with a weak and flaccid pulse, dyspnea, cough, edema, ascites with a scanty supply of dark urine. What herb is indicated?

Back 7

Digitalis purpurea

Front 8

A person has been taking Digoxin and has a rapid ventricular action and rapid pulse. What stage is this?

Back 8

Third stage. The ability of the CNS to inhibit heart function is lost and arrhythmia, insufficient circulation, extreme dilation and complete loss of function occur (heart failure).

Front 9

What is the first sign of toxicity with Digitalis? What other symptoms may occur together or very shortly after?

Back 9

GI disturbance (N/V, abdominal pain).

Dramatically slowed pulse, headache, tremors, anxiety, salivation, miosis, giddiness, blurred vision (may see yellow halo around lights), mental disturbance, constriction of renal blood vessels, anuria, arrhythmia, convulsions and/or death.

Front 10

What is the antidote to digitalis poisoning?

Back 10

Aconite

Front 11

What symptom of toxicity is specific to Digitalis?

Back 11

Seeing yellow halo around lights

Front 12

What are the drug interactions for Digitalis purpurea and Convallaria majalis?

Back 12

Not to be used with medications or plants that deplete potassium, including: Anthraquinone glycoside containing plants, Quinidine, Glycyrrhiza, non-potassium sparing diuretics and corticosteroids. May have additive effects with other cardiac glycoside containing plants.

Front 13

Patient presents with an irregular pulse, dyspnea, oppression in the chest and a sensation of a band around the chest. What herb is indicated?

Back 13

Convallaria majalis (Lily of the Valley)

Front 14

Patient presents with angina-like pain, feels disconnected to others, has arrhythmia and feels like there is a strong band around the heart. What herb is indicated?

Back 14

Selenicereus/Cactus/Cereus grandiflorus (Night-blooming Cactus)

Front 15

What herbs are anti-arrhythmic or indicated for palpitations? Which ones are indicated for abnormal rhythms due to anxiety and stress? Which one is indicated for arrhythmia/palpitations due to altered nervous stimulation?

Back 15

1) Digitalis purpurea (Foxglove)
2) Convallaria majalis (Lily of the Valley)
3) Cactus grandiflorus (Night-blooming Cereus) - this one is good for arrhythmia that is related to altered nervous stimulation
4) Leonurus cardiaca (Motherwort) - this one is good for abnormal rhythm due to anxiety and stress
5) Tilia cordata/platyphyllos/vulgaris (Linden Tree) - this one is good for decreasing nervous palpitations, anxiety or nervous tension

Front 16

Which herb normalizes the heart rhythm by modulating sympathetic output?

Back 16

Cactus grandiflorus

Front 17

Which of the cardiovascular herbs are safe in pregnancy?

Back 17

1) Cactus grandiflorus
2) Crataegus spp. (Hawthorne)
3) Tilia cordata/platyphyllos/vulgaris) (Linden Tree)
4) Capsicum spp. (Cayenne)
5) Centella asiatica (Gotu Kola)
6) Ginkgo biloba
7) Hamamelis virginiana (Witch Hazel)
8) Vaccinium myrtillus (Bilberry)

Front 18

You want to increase nutrition to the heart, augment contractile power and regulate irregular heart rhythm for a woman who is feeling mental depression. What should you use? Can she be pregnant or breast feeding?

Back 18

Selenicereus/Cactus grandiflorus (Night-blooming cereus)

Yes: Safe for use in pregnancy and lactation

Front 19

In very large doses, what are the possible side effects of Cactus grandiflorus?

Back 19

Tachycardia, arrhythmia, cardio-spasm, mental confusion, violent throbbing headaches, vertigo, nausea, delirium, hallucination, chest pain, visual dimming, noise sensitivity, sadness and paranoia, depression and pericarditis

Front 20

Which herbs can help with edema?

Back 20

1) Digitalis purpurea (Foxglove)
2) Convallaria majalis (Lily of the Valley)
3) Selenicereus/Cactus grandiflorus
4) Crataegus spp (Hawthorne)
5) Aesculus hippocastanum (Horse Chestnut)

Front 21

Which alkaloid in Selenicereus/Cactus grandiflorus has a digitalis-like activity on the heart but no glycosides, and increases renal secretion without weakening the nervous system?

Back 21

Cactine

Front 22

What herb is known as "food for the heart"

Back 22

Crataegus spp. (Hawthorne)

Front 23

How long does Crataegus need to be taken to see results?

Back 23

At least 3 months

Front 24

What herb is an overall good cardio-tonic that maintains healthy arteries, veins and heart by strengthening and protecting connective tissue and endothelial lining of the vessels?

Back 24

Crataegus spp (Hawthorne)

Front 25

Due to its protective effect against oxidative damage and its ability to increase the tensile binding strength of connective tissue and increase circulation, this herb is a good one to use in trauma, post-op, sprain/strain, RA or diabetes.

Back 25

Crataegus spp. (Hawthorne)

Front 26

This plant has a tannin (phlobaphene) that dilates the peripheral blood vessels and has a specific action on the coronary circulation.

Back 26

Crataegus spp (Hawthorne)

Front 27

This herb has a lot of paradoxes:
1) It is good for both closed hearts and hearts that are too readily opened.
2) It is good for both hypertension and hypotension.
3) The cyanogenic glycosides are sedative and increase the parasympathetic tone of the heart slowing it down, while the trimethylamine stimulates the pulse rate slightly.
4) It has a peripheral vasoconstrictor effect but it also increases circulation to to the extremities

Back 27

Crataegus spp (Hawthorne)

Front 28

Patient presents with rapid and feeble heart action, valvular insufficiency, and marked anemia. What herb would be best?

Back 28

Crataegus spp. (Hawthorne)

Front 29

This herb is good for cardiac disorders secondary to anxiety and is good during times of transition.

Back 29

Leonurus cardiaca (Motherwort)

Front 30

The name of this herb is derived from a Greek word meaning "lion's tail", describing the shaggy shape of the leaves.

Back 30

Leonurus cardiaca (Motherwort)

Front 31

What are the safety issues for Leonurus cardiaca?

Back 31

Contraindicated in pregnancy but can be used in labor to promote delivery.
Very safe for most patients, no known interactions with medications.

Front 32

A new mother presents with hypertension, tachycardia and palpitations. Tests show she has mild hyperthyroidism. She seems anxious, restless and stressed. What herb is best indicated?

Back 32

Leonurus cardiaca (Motherwort)

Front 33

What alkaloid in Leonurus cardiaca acts as a uterine stimulant? What alkaloid acts as a CNS depressant and hypotensive in animal studies?

Back 33

Stachydrine - uterine stimulant
Leonurine - CNS depressant and hypotensive agent

Front 34

Which plant contains the alkaloid reserpine?

Back 34

Rauvolfia serpentina (Indian Snakeroot)

Front 35

This herb is a VERY effective hypotensive, has a very strong dose-dependent action, and is restricted.

Back 35

Rauvolfia serpentina (Indian Snakeroot)

Front 36

How long does it take to see a response in blood pressure when taking Rauvolfia serpentina?

Back 36

At least 2 weeks, though you could take reserpine with stronger, faster effects

Front 37

What are the safety issues for Rauvolfia serpentina?

Back 37

CI in pregnancy (maybe lactation), patients with depression, and patients with Parkinson's disease.
May lead to increased prolactin levels.
Caution in combination with other hypotensive medications. Digoxin or Quinidine may cause arrhythmia.
Do not combine with MAO inhibitors.

Front 38

What are some possible side effects with Rauvolfia serpentina?

Back 38

1) Nasal congestion
2) Loose stools or abdominal cramping
3) Rarely skin flushing, pupillary contraction, hypotension, bradycardia, vertigo, stupor, nightmares, tremors, depression and coma

Front 39

What type of dosing do you use with Rauvolfia serpentina? With reserpine?

Back 39

Begin gradually and wait 2 weeks to see if there is a change. Tincture 1:5 dose 1-10 gtts BID or < 1 ml/day

If dosing reserpine; starting dose is 0.1 mg BID for 2 weeks followed by 0.05 mg BID as maintenance

Front 40

55 year old man presents who has been taking medications for HTN for past 20 years. Doctors want to now add another one, since the old ones aren't controlling it anymore. What herb is indicated? What needs to be known about the patient before prescribing it?

Back 40

Rauvolfia serpentina. He must not have depression or Parkinson's disease.

Front 41

This herb has been used to decrease psychotic excitement associated with the delusions and hallucinations of schizophrenia.

Back 41

Rauvolfia serpentina (Indian Snakeroot)

Front 42

What alkaloid in Rauvolfia serpentina blocks the Mg/ATP-dependent transport of biogenic amines norepi, dopamine and serotonin from the cytoplasm into the storage vesicles, thus decreasing sympathetic function.

Back 42

Reserpine

Front 43

What plant is anti-spasmodic, cooling diaphoretic, hypotensive, mild sedative and antiviral?

Back 43

Tilia cordata (Linden tree)

Think of an epileptic sitting under a tree and finding themselves sweating out the disease. After, they're calm and their anxious hypertension is gone.

Front 44

What part of Tilia cordata do we use? What are the main constituents?

Back 44

Flowers

Flavonoids (quercitin, hesperidin), mucilage

Front 45

Which herb was used to treat madness and drive the devils out of people afflicted with seizures and mania?

Back 45

Veratrum viride (False Hellebore)

Front 46

A debilitated patient presents with HTN and a full and bounding pulse. What herb should you use?

Back 46

Veratrum viride (False Hellebore)

Front 47

What are the safety concerns with Veratrum viride?

Back 47

Strong alkaloids. Contraindicated in pregnancy and lactation. Use with caution due to toxicity. Drug interactions can occur with antiarrhythmics, antihypertensive, beta blockers. Usually used homeopathically. If used directly, 1-5 gtts max TID

Front 48

What 2 components in Veratrum viride are responsible for the vasodepressor response?

Back 48

Veratridine and protoveratrine

Front 49

overpowering (непреодолимый; подавляющий)

Back 49

豪

Hint 49

tall crowned pig:
подавляющий всех своим авторитетом высоченный король-свиня

Front 50

Which herbs help by acting specifically on connective tissue?

Back 50

Crataegus spp (Increases the tensile binding strength of connective tissue)

Centella asiatica (Aids in strengthening connective and muscle tissues of all organs)

Vaccinium myrtillus (Berries strengthen collagen cross-linking)