Wonders Of Weeds

Front 1

Botanical name for Devil's Claw

Back 1

harpagophytum procumbens D.C.

Front 2

Parts of Devil's claw (harpagophytum procumbens)used

Back 2

roots/tubers

Front 3

Devils' Claw (harpagophytum procumbens) use

Back 3

treatment of rheumatic and arthritic conditions

low back pain

Front 4

Major active ingredient in Devil's Claw (harpagophytum procumbens)

Back 4

Iridoidglycosides (major)

Harpagoside (PhEur: 1.2%) and Harpagid
Other compounds: flavenoids, amino acids, carbohydrates

Front 5

MOA of Devil's Claw (harpagophytum procumbens)

Back 5

Seems to inhibit COX-2 (but not COX-1) and nitric oxide synthetase (inflammation modulator)

Front 6

Dosage of Devil's Claw (harpagophytum procumbens)

Back 6

Using extract: 1200 mg x 2--3 times daily

ESCOP: 1.2 % harpagoside

Front 7

Contraindications of Devil's Claw (harpagophytum procumbens)

Back 7

Gastric and duodenal ulcers, gallstones

Front 8

Safety concerns with Devil's Claw (harpagophytum procumbens)

Back 8

Well tolerated when used daily for up to 1 yera

Unsafe in pregnancy when used orally

Front 9

Adverse reactions of Devil's Claw (harpagophytum procumbens)

Back 9

Diarrhea (~ 8% of patients)

Allergic skin reactions (in some topical preparations)

Front 10

Interactions with Devil's Claw (harpagophytum procumbens)

Back 10

Theoretically (based on MOA): antacids, antidiabetics and H2-blockers

Practically, warfarin (increased bleeding)....or if narrow therapeutic window

Front 11

Botanical name for Willow Bark

Back 11

Salix species

Salix alba, Salix daphnoides, Salix fragilis, Salic pentandra, Salic purpurea, and other Salix species

Front 12

Key compounds in Willow Bark (Salix species)

Back 12

Salicin (4--8%)--MAJOR

Salicortin (up to 9%) found in extracts from bark

Front 13

What is Salicin

Back 13

Natural prodrug to salicylic acid

Front 14

Indications for Willow Bark (Salix species)

Back 14

Relief of low back pain

Symptomatic relief of mild osteoarthritic and rheumatic complaints

Front 15

Dosage for Willow Bark (Salix species)

Back 15

120--240 mg of an aqueous extract

Front 16

Adverse Effects of Willow Bark (Salix species)

Back 16

GI adverse effects

Can also cause itching, rash, as well as serious allergic reactions

Front 17

Safety concerns with Willow Bark (Salix species)

Back 17

Possibly safe when use orally and appropriately (so not for a longe time)

Insufficient information in pregancy, but would avoid use

Possibly unsafe in lactation when used orally

Front 18

Interactions with Willow Bark (Salix species)

Back 18

Due to similar MOA, avoid antiplt and anticoag drugs

Aspirin, clopidogrel, dalteparin, enoxaparin, heparin, ticlodipine, warfarin and others

Front 19

Botanical name for Boswellia

Back 19

Boswellia serrata

Common names frankincense, olibanum

Also used in fragrances

Front 20

Key compounds for Boswellia (Boswellia serrata)

Back 20

alpha-boswellic acid, beta-boswellic acid, and 11-Keto-beta Boswellic acid

Front 21

Dosage for Boswellia (Boswellia serrata)

Back 21

for osteoarthritis: 333 mg three times daily

for RA: 3600 mg daily (likelty still TID)

Front 22

Botanical name for Cat's Claw

Back 22

Uncaria tormentosa D.C.
Uncaria guianensis Gmel.

Front 23

Parts of plant used from Cat's Claw (Uncaria tormentosa D.C.; Uncaria guianensis Gmel)

Back 23

Roots, stem bark

Front 24

Key compounds in Cat's Claw (Uncaria tormentosa D.C.; Uncaria guianensis Gmel)

Back 24

Oxindole alkaloids

2 forms:
1. Tetracyclic (from guianensis): rhochnophylline

2. Pentacyclic (from tomentosa): pteropodine

Front 25

Dosage for Cat's Claw (Uncaria tormentosa D.C.; Uncaria guianensis Gmel)

Back 25

For OA of knee: 100 mg daily

For RA: 60 mg daily in three divided doses

Front 26

Adverse effects of Cat's Claw (Uncaria tormentosa D.C.;
Uncaria guianensis Gmel)

Back 26

headachem dizziness, and vomiting

Front 27

Interactions with Cat's Claw ( Uncaria tormentosa D.C.; Uncaria guianensis Gmel)

Back 27

Theoretically....
Antihypertensive drugs (lowers BP)

Immunosuppressants (tormentosa and stimulate immune system)

Front 28

Botanical name for Cayenne pepper (capsicum)

Back 28

Capsicum annuum L., Capsicum frutescens L.

Solanacaea

Front 29

Use of Cayenne pepper (Capsicum annuum L., Capsicum frutescens L.)

Back 29

EXTERNAL use for treatment of painful muscle spasms in shoulder, arm and spine; arthritis, rheumatism, lumbago and chilblains

Front 30

Key compounds in Cayenne pepper (Capsicum annuum L., Capsicum frutescens L.)

Back 30

Capsaicinoids

Capsaicin (48.6%)

Other capsaicinoids: Homocapsaicin (2%), nordihydrocapsaicin (7.4%) and 6,7-dihydrocapsiacin (36%)

Front 31

Dosage of Cayenne pepper (Capsicum annuum L., Capsicum frutescens L.)

Back 31

Topical: most creams contain 0.025%--0.075% capsaicin concentrations

For back pain: capsicum containing plasters providing 11 mg capsaicin/plaster or 22 mcg/cm2 of plaster applied have been used

Front 32

Safety with Cayenne pepper (Capsicum annuum L., Capsicum frutescens L.)

Back 32

Duration: no longer than 2 days (on patient's own)

Extended application to the same area may cause damage to sensitive nerves

Front 33

T/F Chondroitin sulfate is an herbal

Back 33

False....actually is a dietary supplement)

Front 34

Components of chondroitin sulfate

Back 34

polysaccharide chains

Also, N-acetylgalactosamine and glucuronate

Front 35

Indication for chondroitin sulfate

Back 35

Most often used to treat: temporomandibular joint disorder, osteoarthritis of the low back and finger/knee/hip/tibiofibular and femotibial joints

Front 36

Chondroitin stimulates...

Back 36

increases proteoglycans
increases HA

Front 37

Chondroitin inhibits...

Back 37

Decreases cartilage degradative enzymes (collagenase, elastase, proteoglycanase, fosfolipase A2, N-acetylglucosaminidase, etc.)
Decreases cartilage damaging substances (free radicals)
Decreases apoptosis
Decreases NO
Decreases NF-kB (early inflammatory marker)

Front 38

Effect of chondroitin

Back 38

anti-inflammatory activity
membrane stabilising action

In one clinical study, effect continued for 3 months after stopping, but need to take for at least ~2 months.

Front 39

Dosage for chondroitin

Back 39

For OA: typical dose of chondroitin sulfate is 200--400 mg x 2--3 times daily --OR-- 1000--1200 mg as a single daily dose

Front 40

Adverse effects of chondroitin

Back 40

Generally, well tolerated

May have N/V

Front 41

How safe is chondroitin

Back 41

In studies, use lasted from 2 months to 6 years.

Chondroiting is derived from bovine cartilage...so need to watch for contramination with diseased animal parts (BSE)

Note: Glucosamine is from marine shells

Front 42

Interactions with Chondroitin

Back 42

Warfarin (increased bleeding)

Front 43

What are 3 major groups of herbals considered for GI issues?

Back 43

-Bitters
-Cholagogues
-Carminatives

Front 44

What is the bitter value?

Back 44

The inverse of dilution in which bitterness is still detectable
(Basically the lowest concentration where it still tastes bitter)

Front 45

What is the the reference compound for the bitter value and what is it's bitterness?

Back 45

Quinince HCL
~200,000

Front 46

What do bitters do?

Back 46

-Stimulate gastric and biliary secretions
-Increase the acidity of the gastric juice aiding digestion

Front 47

In what type of patients are bitters contraindicated?

Back 47

-Patients with gastric or duodenal ulcer
(because they can stimulate digestive secretions)

Front 48

What are some examples of bitters?

Back 48

-Wormwood
-Gentian

Front 49

What is the scientific name of Wormwood?

Back 49

Artemisia absinthium

Front 50

What parts of the wormwood plant are used?

Back 50

-Leaves
-Flowering tops

Front 51

What are the uses of wormwood?

Back 51

-Loss of appetite, digestive complaints, bloating, flatulence
-Used in food as a flavoring agent for alcoholic bitters and vermouth

Front 52

What are the bitter principles in wormwood?

Back 52

-Sesquiterpene lactones
-Absinthin

Front 53

Botanical name for Bitter melon

Back 53

momordica charantia

Front 54

Parts of the plant used from Bitter Melon (momordica charantia)

Back 54

Fruit and seeds

Front 55

Key components of Bitter Melon (momordica charantia)

Back 55

Polypeptide P (structurally similar to bovine insulin)

Front 56

MOA of Bitter Melon (momordica charantia)

Back 56

Polypeptide P:
Increases hepatic glycogen synthesis,
Increases peripheral glucose oxidation,
Increases pancreatic insulin secretion,
Insulin like secretion and increases glucose transport

Front 57

T/F The clinical studies regarding the use of Bitter Melon are preliminary.

Back 57

True
Of the studies conducted, none are comparable since used different preparations/parts. Also utilized small sample size, and poor study design (e.g. case study, open label, etc.)

Front 58

What is the essential oil in Wormwood?

Back 58

Thujone

Front 59

What are the key compounds in Wormwood?

Back 59

-Sesquiterpene lactones
-Absinthin
-Thujone

Front 60

What is responsible for Wormwood's CNS effects?

Back 60

Thujone (Toxic in high doses!)

Front 61

What is the dose of wormwood?

Back 61

-No typical dose is known
-Acts as an aromatic bitter in small doses (1.0 g in an infusion or tincture)
-Increased toxic effect at higher doses.

Front 62

What is the scientific name of Gentian?

Back 62

Gentiana lutea

Front 63

What part of the Gentian palnt is used?

Back 63

Roots

Front 64

What are the bitter principles of Gentian?

Back 64

-Gentiopicroside
-Amarogentin

Front 65

What is the most bitter compound known and what is its bitter value?

Back 65

Amarogentin
Bitter value: 58,000,000

Front 66

What are the indications for Gentian?

Back 66

-Digestive disorders such as loss of appetite
-Amarogentin stimulates taste receptors

Front 67

What is the dose of Gentian?

Back 67

Dose not well known
-2-4 grams crude drug in 150 mL H2O infusion, decoction, or maceration up to TID
-Tincture: 1 mL up to TID

Front 68

Adverse effects of Bitter Melon (momordica charantia)

Back 68

Well tolerated ata dose of 1 g TID

Sometimes: Diarrhea, GI upset, and epigastric pain

Front 69

Interactions with Bitter Melon (momordica charantia)

Back 69

Additive effects when used with antidiabetic drugs

Front 70

Dose for Bitter Melon (momordica charantia)

Back 70

No typical dose

Front 71

Botanical name for Cassia cinnamon

Back 71

Cinnamomum aromaticum

Lauraceae

Front 72

Difference between Cyeln cinnamon and Cassia cinnamon

Back 72

Ceylon: less dense, thinner bark and beige color

Cassia: stronger flavor, relatively hard/woody, and darker/redder color.

Cassia is what the US uses mostly

Front 73

Key compounds of Cassia cinnamon (Cinnamomum aromaticum)

Back 73

Cinnamic acid derviatives

Cinnamtannin B (tannins)
Cinnamaldehyde (gives smell)
Cinnamic acid

Front 74

Indications and MOA for use of Cassia cinnamon

Back 74

Polyphenolic polymers (e.g. hydroxychalcone found cassia) seem to potentiate insulin action

Greater insulin sensitivity and
Increased glucose uptake

Basically, increased phosphorylation of insulin receptor to increase insulin sensitivity

Front 75

Adverse effects of Cassia cinnamon (Cinnamomum aromaticum)

Back 75

Well tolerated

No significant side effects

Front 76

Safety with Cassia cinnamon (Cinnamomum aromaticum)

Back 76

Coumarin content

Coumarin can cause hepatotoxicity in animal models....BUT not in human models (different metabolism process)

Front 77

Interactions with Cassia cinnamon (Cinnamomum aromaticum)

Back 77

Additive effects in patients treated with antidiabetic agents


....although since contains coumarin, I would think anticoagulants may also be problematic

Front 78

When should Gentian be administered?

Back 78

-Anorexia: Single dose 30-60 minutes before a meal
-Dyspeptic complaints: Single dose after a meal

Front 79

What is the duration of Gentian administration?

Back 79

No restriction, but if symptoms persist, MD should be notified.

Front 80

When is Gentian contraindicated?

Back 80

-Gastric or duodenal ulcer
-Hyperacidity

Front 81

Dosage for Cassia cinnamon (Cinnamomum aromaticum)

Back 81

1--6 grams
(1 teaspoon = 4.75 grams)

Front 82

Botanical name for Prickly pear cactus

Back 82

Opuntia species

Cactaceae

Front 83

Parts used of Prickly pear cactus (Opuntia species)

Back 83

Mostly use fruits

Can use stems in high doses ...typically for diseases of urinary tract

Front 84

MOA for Prickly pear cactus (Opuntia species)

Back 84

High fibrous polysaccharide content

Slows carbohydrate absorption from the gut with a possible insulin-sensitizing effect

Front 85

Dosage of Prickly pear cactus (Opuntia species)

Back 85

Typical dose ranges from 100--500 g/day (divided into three times daily)

However, dose is not practical, but higher doses can lead to diarrhea

In Mexico: given prn (not practical!)

Front 86

Safety with Prickly pear cactus (Opuntia species)

Back 86

Well tolerated, some GI side effects

Diarrhea at high doses

Front 87

Interactions with Prickly pear cactus (Opuntia species)

Back 87

Careful when taking with other hypoglycemic drugs

Front 88

Botanical name of Gymnema

Back 88

Gymnema = sugar destroying

Gymnema sylvestre

Apocynaceae

Front 89

Parts of plant used of Gymnema

Back 89

Leaves

Front 90

Uses of Gymnema

Back 90

Diabetes, weight loss, laxative, diuretic, and snake bites

Front 91

Key compounds of Gymnema

Back 91

Gymnemic acid

Front 92

Botanical name of Psyllium

Back 92

Plantago ovata

Plantaginaceae

Front 93

Uses of Psyllium

Back 93

Diabetes

Traditionally used as stool softener, decrease lipids, weight loss and IBS

Front 94

MOA for Psyllium (Plantago ovata)

Back 94

Psyllium is a bulk-forming laxative and is high in fiber and mucilage (seeds containg 10--30% mucilage)

So...drink a lot of water with Psyllium to form a gel in gut that decreases postprandial glucose levels (by 14--20%)

Front 95

Dosage for Psyllium (Plantago ovata)

Back 95

15 g/day in divided doses

Stirred in large glass on wawter or juice and drunk immediately (no water/juice = SBO)

Front 96

Adverse effects of Psyllium (Plantago ovata)

Back 96

Usually well tolerated, sometimes allergies

Front 97

Interactions with Psyllium (Plantago ovata)

Back 97

may bind to oral medications

so take those medications separately

Front 98

Botanical name for Stevia

Back 98

Stevia rebaudiana

Asteraceae

known as "sweet leaf"

Front 99

Uses of Stevia

Back 99

Diabetes
Sweetner

Front 100

Parts of plant used of Stevia (Stevia rebaudiana)

Back 100

Leaves

Front 101

Key compounds of Stevia (Stevia rebaudiana)

Back 101

Stevioside

*Heat and acid stable
*Gives sweet taste as it has lots of sugars attached

Front 102

MOA of Stevia (Stevia rebaudiana)

Back 102

*Stimulates insulin secretion via a direct action on Beta cells
*Inhibits GI glucose absorption
*Increases insulin sensitivity and improves skeletal muscle glucose transport
*Increases hepatic glycogen synthesis in animal experiments

Front 103

T/F Evidence supporting the use of Stevia in DM consists of numerous studies with mixed results.

Back 103

False
Clinical evidence is scant for use of stevia in DM

Front 104

Dosage of Stevia (Stevia rebaudiana)

Back 104

1--1.5 grams/day

Front 105

Botanical name for American ginseng

Back 105

Panax quinquefolius

Ariliaceae

***Different from Asian ginseng

Front 106

Use of American ginseng

Back 106

DM

also used for immune system

Front 107

Key compounds in American ginseng (Panax quinquefolius)

Back 107

Ginsenosides, which differ based on the attached sugars

Glucose lowering effect may vary amonge preparations, variations in the concentration of ginsenosides (unsure which ginsenosides involved)

Front 108

MOA of American ginseng (Panax quinquefolius)

Back 108

Ginsenosides: reduce postprandial glucose levels

Insulin sensitization

Direct stimulation of insulin release

Front 109

Dose of American ginseng (Panax quinquefolius)

Back 109

3 grams, up to 2 hours before a meal

Front 110

Adverse effects of American ginseng (Panax quinquefolius)

Back 110

GI, insomnia, CV system adverse effects

Front 111

Interactions with American ginseng (Panax quinquefolius)

Back 111

Antidiabetic drugs, warfarin and caffeine

Front 112

T/F School buses have chromium on them

Back 112

True, as chromium is a yellow pigment

Front 113

Uses of chromium picolinate

Back 113

DM

Front 114

MOA of chromium

Back 114

*Decreases fasting blood glucose
*Decreases HbA1c
*Increases Indulin sensitivity in T2DM

All this occurs via glucose tolerance factor (GTF; a complex of different molucules that works with insulin to facilitate glucose uptake)

Front 115

Dosage of chromium

Back 115

200--1000 mcg daily in divided doses (limited evidence)

Front 116

Safety with chromium

Back 116

well tolerated

Chromium piccolate may cause headache, insomnia and mood changes

Front 117

Botanical name for Echinacea?

Back 117

Echinacea angustifolia, E. pallida, E. purpurea

Front 118

Part of plant Echinacea angustifolia, E. pallida

Back 118

Root

Front 119

Part of plant Echinacea purpurea

Back 119

Root and aerial parts

Front 120

Active ingredients echinacea

Back 120

Isobutylamides
Caffeic acid derivatives
-Echinacoside (not in E. purpurea)
-Cichoric acid (only E. purpurea)

Front 121

MOA echinacea

Back 121

Increase WBCs, immune modulating effects
In vitro experiments: increase TNF-alpha, IL1, 6, 10, increase macrophages and NK cells
Isobutylamides: phagocytosis, COX2 inhibition, immunostimulation

Front 122

Common uses Echinacea

Back 122

common cold

Front 123

Common dose Echinacea

Back 123

Optimal dose not clearly defined
Max 8 weeks, cycle on-off
Extract: 3 x 300 mg daily (best validated)

Front 124

DDI echinacea

Back 124

none reported...yet

Front 125

CIs and precautions echinacea

Back 125

Avoid in patients with leukemia or autoimmune disease
Likely safe for 8 weeks cyclic use

Front 126

Adverse effects echinacea

Back 126

Allergic reactions in those allergic to sunflower seeds

Front 127

How should you recommend using echinacea?

Back 127

for colds as soon as you notice signs and symptoms, for a maximum of 8 days for treatment

Front 128

Which preparation of echinacea is most researched?

Back 128

E. purpurea

Front 129

Goldenseal biological name

Back 129

Hydrastis canadensis

Front 130

Goldenseal (golden root) part of the plant

Back 130

dried root and rhizome

Front 131

Goldenseal (golden root) uses

Back 131

digestive, cholerectic, carminative, antibiotic, ***immune stimulant***, common cold, URTI, congestion, allergic rhinitis

Front 132

Active compound goldenseal (golden root)

Back 132

Isoquinoline alkaloids (poor oral absorption), hydrastine, berberine

Front 133

Goldenseal (golden root) MOA

Back 133

Might stimulate IgM production, berberine has macrophage activating activity

Front 134

Goldenseal (golden root) DDIs

Back 134

None known...yet

Front 135

Goldenseal (golden root) CIs or Precautions

Back 135

CI in high BP
Not recommended in pregnancy, lactation (berberine shown to cause uterine contractions)
Berberine well tolerated up to 500 mg

Front 136

Adverse effects goldenseal (golden root)

Back 136

>500 mg may cause eye irritation or nephritis or nose bleed

Front 137

What has goldenseal been used to cover up

Back 137

Mask horse doping (morphine in urine)

Front 138

Common dose goldenseal

Back 138

No typical dosage
Standard extract 5% hydrastine: 250-500mg BID

Front 139

What is an adaptogen?

Back 139

Increase resistance to stress or anxiety (psychological or psychosocial stress)

Front 140

What is an immunostimulant?

Back 140

A substance that increases the ability of the immune system to fight infection and disease

Front 141

What are the botanical names for ginseng

Back 141

Asian: Panax ginseng
North American: Panax quinquefolius (white ginseng)

Front 142

Parts of the plant for ginseng

Back 142

roots

Front 143

Uses of ginseng

Back 143

common cold, influenza

Front 144

Dose of ginseng

Back 144

200-600mg extract to >0.5% ginsenosides (Ro, Ra, Rb, etc)
0.5 to 2 g of dried root

Front 145

How does ginseng work with the immune system?

Back 145

Stimulates immune system
Improves resistance to infection
Increases natural killer cell activity
Increases resistance to stress and disease
(Both immunostimulant and adaptogen)

Front 146

What are the key compounds in ginseng

Back 146

25+ triterpenoid saponin glycosides, ginsenosides

Also 20(S)-protopanaxatriol and 20(S)-protopanaxodiol

Front 147

Adverse effects ginseng

Back 147

A STIMULANT
Hypertension, insomnia, euphoria, headaches, menstrual abnormalities, palpitations, tremors

Front 148

Who should not use ginseng?

Back 148

Those who have hypertension
Caution if: cardiac disorders, diabetes, steroid therapy, surgery

Front 149

How safe is ginseng?

Back 149

Likely safe when taken orally for up to 3 months or used cyclically (2 weeks on, 2 weeks off)

Front 150

Ginseng MOA

Back 150

Stimulates immune system, improves resistance to infection, increases natural killer cells and cytokines

Front 151

Ginseng DDI

Back 151

Nardil (phenelzine): mania
Coumadin: bleeding

Front 152

Ginseng abuse syndrome symtoms

Back 152

Ginseng overdose
Amounts ingested were excessive >15 g
Sleeplessness, anxiety, tight muscles, water retention, high blood pressure

Front 153

Botanical name Siberian Ginseng

Back 153

Eleutherococcus senticosus

Front 154

Siberian ginseng parts of the plant

Back 154

roots

Front 155

Dose siberian ginseng

Back 155

150-400 mg/day extract

Front 156

Active ingredients siberian ginseng

Back 156

Eleutherosides (lignin derivatives)
Saponins
NO ginsenosides

Front 157

Adverse effects siberian ginseng

Back 157

Drowsiness, anxiety, irritability, melancholy, uterine bleeding, HTN

Front 158

Uses of siberian ginseng

Back 158

May increase endurance, immunomodulation

Front 159

Natural ephedra botanical name

Back 159

Ephedra sinica

Front 160

Uses of natural ephedra

Back 160

Weight loss, body building, increase energy, mental concentration, sexual sensations

Front 161

Active compounds natural ephedra

Back 161

Stereoisomers:
1S,2R+Ephedrine (most common)
Also, 1R,2R-psuedoephedrine, 1R,2R-norpsuedoephedrine, 1S,2R+norephedrine, 1S,2R+n-methylephedrine, 1R2R-n-methylpseudoephedrine

Front 162

Natural ephedra MOA

Back 162

Indirectly increases NE release, activates brown adipose tissue, increase intracellular T3, thermogenesis

Front 163

Natural ephedra CI/Precautions

Back 163

Chronic use can lead to tolerance/dependence; increased risk of serious side effects
BANNED by FDA in 2004

Front 164

Adverse effects Natural ephedra

Back 164

Tingling, tremors, seizures, hyperactivity, nervousness, palpitations, hepatitis, depression, HA

Front 165

Bitter orange botanical name

Back 165

Citrus aurantium

Front 166

Parts of the plant used bitter orange

Back 166

rind of Seville oranges

Front 167

Dose of bitter orange

Back 167

Country mallow supplies ephedra compounds
Mormon tea, desert tea are actually types of ephedra

Front 168

Where do you find bitter orange

Back 168

In "legal ephedra" products

Front 169

MOA bitter orange

Back 169

thermogenesis, diuretic activities

Front 171

Fatal dose bitter orange

Back 171

10-14g (150-200 mg/kg)

Front 172

What is in bitter orange

Back 172

synephrine (similar to potent chemical in ephedra and acts like ephedra)

Front 173

Adverse effects bitter orange

Back 173

increase blood pressure and heart rate

Front 174

What are natural caffeine containing products?

Back 174

Green and black tea, cola nut (used in cola drinks), Guarana (substitute for cola drinks in Brazil), Yerba Mate

Front 175

How are natural caffeine containing products used?

Back 175

Stimulant, HA, relief, appetite, stimulating, exercise enhancing

Front 176

Caffeine containing products adverse effects at doses >200-300 mg/day

Back 176

May lead to increased blood pressure, heart rate, hyperglycemia, arrythmia

Front 177

Caffeine containing products MOA

Back 177

Thermogenesis, diuretic activity

Front 178

Fatal dose of caffeine

Back 178

10-14 g (150-200 mg/kg)

Front 179

Botanical name of green tea

Back 179

camellia sinsensis

Front 180

Part of the plant for green tea

Back 180

leaves

Front 181

Use of green tea

Back 181

Increase alertness, decrease cancer rates, lipids, BP, delay parkinson's disease, insufficient evidence in weight loss

Front 182

What do green tea products typically contain?

Back 182

7% caffeine
25% EGCG

Front 183

Active compound of green tea

Back 183

EGCG-destroyed during fermentation of black tea

Front 184

Green tea MOA

Back 184

powerful antioxidant, nothing to do with weight loss

Front 185

Green tea precautions

Back 185

May be unsafe in high doses

Front 186

Is green tea extract safe? How long can it be used?

Back 186

Oral extract is possibly safe and can be used for up to 6 months

Front 187

Does green tea help with weight loss?

Back 187

No studies for weight loss have been positive...

Front 188

What is DMAE

Back 188

dimethylaminoethanol

Front 189

How should DMAE be used in supplements?

Back 189

It is not a botanical, seen in weight loss products, 300-2000mg allowed in supplements

Front 190

What is DMAE?

Back 190

related to choline, but unlikely to be converted to choline b/c it requires methylation to charge the molecule

Front 191

Adverse effects DMAE

Back 191

raises blood pressure and causes insomnia

Front 192

Hoodia botanical name

Back 192

Hoodia gordonii

Front 193

Part of the hoodia used?

Back 193

cactus (very slow growing)

Front 194

Use of hoodia

Back 194

no evidence to support weight loss claims
Hoodia is endangered

Front 195

Hoodia active compound

Back 195

Steroidal cardiac glycoside

Front 196

MOA hoodia

Back 196

Anorectic mechanism, increase content of ATP by 50-150% in hypothalamic neurons which may signal energy sensing control of satiety

Front 197

Adverse effects of hoodia

Back 197

unknown

Front 198

Garcinia cambogia part of the plant used

Back 198

Fruit

Front 199

Garcinia cambogia active compound

Back 199

hydroxycitric acid (HCA)
found in hydroxycut

Front 200

Garcinia cambogia MOA

Back 200

interferes with enzyme necessary for fatty acid synthesis, just seen in test tube

Front 201

Adverse effects garcinia cambogia

Back 201

Severe acidosis

Front 202

What is Dexatrim?

Back 202

Not really ephedrine free
Green tea leaf extract, cola nut extract, guarana seed extract with added caffeine, bitter orange 120 mg
Chromium, siberian ginseng, fenugreek extract, ginger root, licorice

Front 203

What is in Xenadrine EFX

Back 203

Vitamin C, Vitamin B6, magnesium, cocoa extract, yerba mate, bitter orange, DMAE, grape seed extract

Front 204

What is Spurulina?

Back 204

Blue-green algae found in tropical or subtropical alkaline waters with a high salt content

Front 205

What is in spurulina?

Back 205

protein, B12 analogues, phenylalanine

Front 206

What is the MOA of spurulina?

Back 206

May incrase the release of cholesystokinine, proposed that phenylalanine may decrease appetite, 65% is protein, may increase satiety, vitamin B12 analogues are nutritionally insignificant

Front 207

What is the dose of spurulina?

Back 207

3-5 grams/day before meals

Front 208

What is in Carb Intercept? How does it work? What is an adverse effect?

Back 208

A white kidney bean extract
"Starch blocker"
Works by inhibiting alpha amylase, delays absorption of starches
May cause diarrhea

Front 209

Botanical Name of St John's Wort?

Back 209

Hypericum perforatum L.

Front 210

Extracts of St John's Wort are made from what parts of the plant?

Back 210

Extracts made from upper third of the plant (steam, leaves, flowers)

Front 211

What is special about Hypericin?

Back 211

- Active Compound in St John's Wort
- When crushed causes a red color

Front 212

What is St John's wort used for?

Back 212

Major Use: Mild to moderate depression
Minor Uses: anxiety, ADD, OCD,

Front 213

T/F - Clinical Trials looking at St John's Wort in patients with severe depression showed positive results/outcomes?

Back 213

False - The trials looking at severe depression had negative outcomes.

St John's Wort is currently only recommended in Mild to moderate depression

Front 214

What are the active Principles (Standardization) in St john's Wort?

Back 214

Preparations are standardized to the amount of:
- Flavonoids (12%)
- Hypericin (0.3%)
- Hyperforin (3%)

Front 215

Which flavonoid is considered special to St john's Wort?

Back 215

Biflavonoids

Front 216

What is the mechanism behind St john's Wort having major drug interactions?

Back 216

SJW is an inducer
- Increases p-glycoprotein expression
-Increases CYP3A4 expression

Front 217

What are some medications that St john's Wort interacts with?

Back 217

-Digoxin
-Amitriptyline, Nortriptyline
-SSRI's
-Phenprocoumon
-Indinavir
-Cyclosporin
-Ethinylestradiol + desogestrel

Front 218

T/F In one study comparing St John's Wort to SSRI's, St John's Wort was seen to have less side effects.

Back 218

True

Front 219

T/F St John's Wort has the potential to cause unwanted pregnancies in women self-medicating with it as a OTC product?

Back 219

True - Pt case: Hypericum extract Helarium 425 (Bionorica) with daily doses up to 1700mg approximately 3 months prior to conception, and until conception no other meds taken except the hormonal contraceptive.

Could have occurred because SJW caused increase metabolism of the contraceptive.

Front 220

What ingredients was really found to be the cause of drug interactions in St John's Wort?

Back 220

Hyperforin

Front 221

What is the oil preparation of St John's wort used for?

Back 221

Wound healing properties: Increases epithelization

(ointments used for dermatitis)

Front 222

What side effects are seen with St John's Wort?

Back 222

- Usually well tolerated
- SE may include insomnia, vivid dreams, anxiety, agitation, GI upset, fatigue, and dry mouth
- Photosensitivity could occur in high doses (> 1800 mg). It is like a sunburn type of reaction.

Front 223

What is the recommended daily dose of St John's Wort?

Back 223

3 x 300mg = 900mg/day

Front 224

T/F St John's Wort should not be used with other anti-depressants?

Back 224

True - Should NOT be used with other antidepressants because they both work on similar neurotransmitters.

Front 225

Why do we limit Hyperforin to < 3% during standardization of St john's Wort?

Back 225

- Because hyperforin is thought to cause all the drug interactions.

- Conc of > 3% will likely cause even more drug interactions.

Front 226

What interactions have been reported with Gentian?

Back 226

None have been reported

Front 227

What adverse effects have been experienced with Gentian?

Back 227

Headache may occur

Front 228

What are choleretics?

Back 228

Agents that stimulate bile production in the liver

Front 229

What are cholekinetics?

Back 229

Agents that promote emptying of the gall bladder and extrahepatic bile ducts.

Front 230

What is the most frequent cause of biliary tract disease and discomfort?

Back 230

Gallstones

Front 231

What are examples of cholagogues?

Back 231

-Artichoke
-Turmeric

Front 232

What is artichoke used for?

Back 232

Reduces symptoms such as nausea, vomiting, flatulence, and abdominal pain in functional dyspepsia and dyspepsia associated with biliary disease

Front 233

How long does it take to see improvement when using artichoke?

Back 233

2-8 weeks

Front 234

What is the dose of artichoke?

Back 234

For dyspepsia: 320-640 mg artichoke leaf extract three times daily

Front 235

What is the scientific name of turmeric?

Back 235

Curcuma longa

Front 236

What part of the turmeric plant is used?

Back 236

Rhizome

Front 237

What is turmeric used for?

Back 237

-Symptomatic treatment of mild digestive disturbances and minor biliary dysfunction
-To enhance palatability and prevent oxidation/rancidity of fats and oils
-Food additive (main component of curry powder

Front 238

What are the key compounds in turmeric?

Back 238

3-5% curcuminoids
Curcumin

Front 239

What is the dose of turmeric?

Back 239

500mg 4x daily

Front 240

How long can turmeric be administered?

Back 240

No restriction, but should see MD if symptoms persist

Front 241

What are contraindications for turmeric use?

Back 241

Use with caution in patients with gallstones or gallbladder disease because turmeric can cause gallbladder contractions

Front 242

What adverse effects may occur with turmeric use?

Back 242

Generally well tolerated
Some GI adverse effects

Front 243

Drug interactions with turmeric?

Back 243

Antiplatelet drugs

Front 244

What are carminatives?

Back 244

-Herbal preparations that are useful to help relieve excessive amounts of intestinal gas
-Include products that are essential oils or plants extracts that have a high amount of essential oils

Front 245

What are examples of carminatives?

Back 245

-Fennel
-Caraway
-Anise

Front 246

What is the scientific name of fennel?

Back 246

Foeniculum vulgare

Front 247

What is the scientific name of anise?

Back 247

Pimpinella anisum

Front 248

What is the scientific name of caraway?

Back 248

Carum carvi

Front 249

How do carminatives work?

Back 249

Components of the essential oil cause stimulation of the gastric mucosa which leads to activation of the vagus nerve and an increase of stomach tonus
This results in eructation of air from the stomach and an increase in gastric secretion

Front 250

What are the key compounds of carminatives?

Back 250

Essential oils

Front 251

What is the dose of fennel?

Back 251

5-7 grams crushed fruit as an infusion

Front 252

What is the dose of anise?

Back 252

3 grams of crushed fruit as an infusion

Front 253

What is the dose of caraway?

Back 253

1-5 grams crushed fruit as an infusion

Front 254

What adverse reactions may be seen with carminatives?

Back 254

Allergic cross-sensitivity in people with allergies to carrot, celery, mugwort, or Apiaceae family plants

Front 255

What is the scientific name of chamomile?

Back 255

Matricaria recutica

Front 256

What should German chamomile (Matricaria recutica) not be confused with?

Back 256

Roman chamomile (Anthemis nobilis)

Front 257

What are the key compounds on chamomile?

Back 257

-Terpenoid volatile oils (Bisabolol, Chamazulene)- 15% in H2O extracts
-Flavonoids (Apigenin)
-Mucilages

Front 258

What is the benefit of each of the key compounds in chamomile?

Back 258

-Terpenoid volatile oils: anti-inflammatory
-Flavonoids: spasmolytic
-Mucilages: demulcent

Front 259

What are the therapeutic indications for chamomile?

Back 259

-Internal Use: GI spasm, inflammatory diseases of the GI tract, GI ulcers, anti-spasmodic for menstrual cramps
-Topical Use: Minor inflammation and irritation of the skin
-Inhalation: Inflammation of the respiratory tract

Front 260

What is the dose of chamomile?

Back 260

-Tea infusion: 3 g drug to 150mL hot water 3-4x/day
-Tincture: 3-6 mL daily (Careful because 50% ethanol)

Front 261

What are contraindications to chamomile use?

Back 261

Sensitivity to Matricaria or other members of the daisy family

Front 262

What are interactions with chamomile?

Back 262

Not known

Front 263

What is the duration of treatment for chamomile?

Back 263

No restrictions

Front 264

What is the scientific name of licorice?

Back 264

Glycyrrhiza glabra

Front 265

What are the key compounds of licorice?

Back 265

-Tripterpene glycosides (2-15%)
-Glycyrrhizic acid (Glycyrrhizin)
-Glycyrrhetic acid
-Flavonoids (1-2%)
-Liquiritin
-Isoliquiritin

Front 266

What is the mecahnism of action for licorice?

Back 266

-Mineralcorticoid-like action
-Glycyrrhetic acid inhibits prostaglandin synthesis and lipoxygenase

Front 267

What is a caution with licorice use?

Back 267

Excessive ingestion may produce a syndrome of apparent mineralcorticoid excess

Front 268

What is the dose of licorice?

Back 268

5-15 g licorice root (200-600 mg glycyrrhizin)

Front 269

How long can licorice be used?

Back 269

Should not exceed 4-6 weeks

Front 270

What are contraindications for licorice?

Back 270

Cardiovascular disorders such as hypertension, renal disorders, hypokalemia

Front 271

What are drug interactions with licorice?

Back 271

Corticosteroids
Digoxin
Warfarin
Diuretic Drugs

Front 272

Peppermint is a cross between which types of mint?

Back 272

-watermint (Mentha aquatica)
-spearmint (Mentha spicata)
-Horse mint (Mentha longifolia)

Front 273

Which parts of peppermint are used?

Back 273

-Leaves
-Oil

Front 274

What is peppermint's MOA?

Back 274

-Antispasmodic effects
-Reduces slow wave frequency in the small intestine
-Direct relaxing effects on the GI tract smooth muscle
-Inhibits potassium depolarization-induced responses in the intestine
-Relieves esophageal spasms

Front 275

What is the dose of peppermint?

Back 275

-Oil: 0.2-0.4 mL TID in enteric coated capsules
-Leaves: 1.5-3 g dried leaves as an infusion (150 mL) TID

Front 276

What adverse events may be seen with peppermint?

Back 276

-Heartburn
-Nausea
-Vomiting
-Allergic reactions

Front 277

What is the scientific name of milk thistle?

Back 277

Silybum marianum

Front 278

What part of milk thistle is used?

Back 278

Ripe fruit

Front 279

What are the uses of milk thistle?

Back 279

-Antioxidant
-Liver health
-Protection against harmful chemicals, drugs, and pollution
-Digestive aid
-Acute and chronic hepatitis
-Alcoholic and other liver damage
-Gallbladder symptoms

Front 280

What are the key compounds of milk thistle?

Back 280

Silymarin- composed of the flavonoids silybin, isosilybin, dehydrosilybin, silydianin, silychristin
-Silybin- most active

Front 281

How does milk thistle work?

Back 281

-Silymarin increases the amount of glutathione in liver cells
-Silymarin stimulates protein synthesis
-Milk thistle interrupts enterohepatic recirculation of toxins

Front 282

What should milk thistle capsules and tinctures be standardized to?

Back 282

-70-80% silymarin

Front 283

Would milk thistle teas be expected to be beneficial?

Back 283

No, silymarin has poor water solubility

Front 284

What is the dose of milk thistle?

Back 284

200-400 mg silymarin daily

Front 285

What are possible side effects of milk thistle?

Back 285

-GI problems
-Headache
-Skin reactions
-Neuropsychological events
-Allergic reaction in patients sensitive to Asteraceae/Compositae family

Front 286

What is a cold?

Back 286

A benign catarrhal inflammation of the upper and middle respiratory tract caused by a viral infection

Front 287

What is the scientific name of eucalyptus?

Back 287

Eucalyptus globulus

Front 288

What part of eucalyptus is used?

Back 288

Leaves

Front 289

What is the key compound in eucalyptus?

Back 289

A volatile oil known as eucalyptol (1,8-cineol)

Front 290

To provide an effect, how much eucalyptol should the eucalyptus leaf oil contain?

Back 290

70-85%

Front 291

What are the indications for eucalyptus?

Back 291

-Adjuvant treatment of Chronic obstructive respiratory complaints including bronchitis and bronchial asthma
-Symptomatic relief of colds and catarrh of the upper respiratory tract

Front 292

What is eucalyptus' MOA?

Back 292

-Analgesic and anti-inflammatory effects
-Blocks the production of arachidonic acid metabolites that mediate pain
-Inhibits cyclooxygenase pathway

Front 293

What is the dose of cineol/eucalyptus oil?

Back 293

Internal Use:
-0.05-0.2 mL/dose (0.3-0.6 mL daily)
-Capsules: 100-200 mg 2-5x daily

External Use:
-Inhalation: 12 drops/150 mL boiling H2O
-Ointment: 1.3% V/m for patients > 12 y/o to be applied as a thick layer up to TID

Front 294

What are safety concerns with eucalyptus?

Back 294

-Should not be used internally in cases of inflammation of the GI tract or gallbladder
-Should not be applied to the face, especially the nose, of babies and very young children
-Neurotoxicity in high doses

Front 295

What is the scientific name for peppermint?

Back 295

Mentha x piperita

Front 296

What are the oral uses of peppermint?

Back 296

Common cold, cough, inflammation of the mouth and pharynx, liver and gallbladder complaints, IBS, cramps of the upper GI tract and bile ducts, dyspepsia, flatulence

Front 297

What are the topical uses of peppermint?

Back 297

Headache, myalgia, neuralgia, toothache, oral mucosa inflammation, rheumatic conditions, mosquito repellant

Front 298

What are the inhalational uses of peppermint?

Back 298

The oil is used as an aromatic for symptomatic treatment of cough and colds, and as an analgesic for pain

Front 299

What are the principle compounds of peppermint oil?

Back 299

-Menthol (30%)
-Menthone (20-30%)
-Menthly acetate (3-10%)

Front 300

What is the dose of peppermint oil?

Back 300

External use only
-Inhalation: 3-4 drops added to hot water
-Semisolid preparations:
age 4-10: 2-10%
age 10-16: 5-15%

Front 301

What adverse effects may occur with external use of peppermint oil?

Back 301

-Skin irritation
-Apnoea (when inhaled)
-Jaundice in newborns may be seen with menthol

Front 302

What is the scientific name of camphor?

Back 302

Cinnamomum camphora

Front 303

At what concentrations is camphor approved for use with cough? pain? pruritis?

Back 303

-Cough: Less than 11%
-Pain: 3-11%
-Pruritis: 3-11%

Front 304

What is the dose for camphor?

Back 304

-Topical: Apply a thick layer of 4.7-5.3% camphor to throat and chest
-Inhalation: One tablespoon of solution per quart of H2O is placed in vaporizer, bowl, or washbasin. May repeat up to TID.

Front 305

What adverse reactions may occur with camphor use?

Back 305

-Burning of mouth and throat
-Nausea and vomiting
-Visual symptoms
-Seizure
-Death

Front 306

What is an important counseling point in regards to camphor-containing products?

Back 306

Do not heat in microwave because it may result in serious burns and eye injury.

Front 307

What is the scientific name of elderberry?

Back 307

Sambucus nigra

Front 308

What parts of the elderberry plant are used?

Back 308

Flowers and berries

Front 309

What has elderberry been used for?

Back 309

-Sinusitis
-Cold
-Influenza
-Bronchitis
-Diabetes

Front 310

Why would it be a problem to confuse the American elder with elderberry?

Back 310

Elder leaves and unripe berries contain cyanogenic glycosides which can result in cyanide poisoning if ingested.

Front 311

What are the key compounds of elderberry?

Back 311

-Flavonolglycosides
-Rutin
-Isoquercitrin
-Standardized to 0.8% flavonoids calculated as isoquercitrin

Front 312

What is elderberry's status in terms of safety?

Back 312

-Oral use considered safe if used in amounts commonly found in foods
-Elderflower has GRAS status
-Interactions/Side effects not known

Front 313

What is the dose of Elderberry?

Back 313

Oral: 15mL 4x/day of elderberry juice-containing syrup daily x 3-5 days has been used

Front 314

What is the scientific name of thyme?

Back 314

Thymus vulgaris
Thymus zygis

Front 315

What parts of thyme are used?

Back 315

Flowers and leaves

Front 316

What are the key compounds of thyme?

Back 316

-Essential oils: mostly thymol (30-70%) and carvacrol (3-15%)
-Flavonoids like apigenin and luteolin

Front 317

What are the therapeutic indications of thyme?

Back 317

-Bronchitis, pertussis, and sore throat
-Topically: laryngitis, tonsillitis
-Thyme oil: topically as an antiseptic in mouthwash and liniments
-Thymol: used with chlorhexidine as a dental varnish to prevent caries

Front 318

What are the pharmacodynamic properties of thyme?

Back 318

-Bronchospasmolytic effects (attributed to flavonoids and thymol)
-Antimicrobial effects (thymol, carvacol)
-Antiviral effects (thymol, carvacol)
-Anti-inflammatory activity?

Front 319

What is the dose of thyme?

Back 319

-Herb: If > 1yr, 1-2 g dried herb as infusion several times daily. If < 1 yr, use 0.5-1 g.
-Fluid extract: Calculate in accordance with dosage of herb
-Tincture: 70% ethanol. 40 drops up to TID
-External use: 5% infusion as a gargle or mouthwash

Front 320

What is the safety of thyme?

Back 320

-No interactions yet reported
-No data available on pregnancy and lactation
-Side effects: Rare hypersensitivity

Front 321

What is the scientific name of marshmallow root?

Back 321

Althaea officinalis

Front 322

What part of marshmallow root is used?

Back 322

Roots

Front 323

What are the key compounds of marshmallow root?

Back 323

-Mucilage polysaccharides (arabinans, glucans, etc.)
-These are heat and light sensitive

Front 324

What are the therapeutic indications for marshmallow root?

Back 324

-Dry cough
-Irritation of the oral, pharangeal, or gastric mucosa

Front 325

What is the mechanism of action of marshmallow root?

Back 325

-Mucilage polysaccharides form a protective layer
-Mucilage suppresses cough
-Mucilage has antimicrobial, spasmolytic, antisecretory, diuretic, and wound-healing effects

Front 326

How should marshmallow tea be prepared?

Back 326

By cold maceration

Front 327

What is maceration?

Back 327

Process in which the drug is permitted to soak in the menstruum until the cellular structure is softened.
-May have some hygenic problems

Front 328

What is the dose of marshmallow root?

Back 328

-5 grams of the dried root
-Syrup: 2-10 mL up to TID

Front 329

What is known about marshmallow root in terms of safety?

Back 329

-Has GRAS status
-Side effects not known
-May delay absorption of other drugs
-Marshmallow can lower blood sugar levels

Front 330

T/F. Patients taking St John's Wort should discontinue its use at least 72 hours before undergoing surgery.

Back 330

True

Front 331

Is SAMe a herbal or dietary supplement?

Back 331

A dietary supplement

Front 332

What does "SAMe" Stand for?

Back 332

S-adenosyl-L-methionine

Front 333

What is SAMe commonly used for?

Back 333

-Depression
-Arthritis and other joint conditions
-Fibromyalgia
-Liver disease
-Seizures
-Migraine

Front 334

A patient has started taking SAMe for depression... how long should it take for them to start seeing some benefit from it?

Back 334

two to four weeks of daily administration

Front 335

What is the dosage of SAMe when used for depression?

Back 335

400-1600mg per day in divided doses

Front 336

T/F. The (S,S) isomer of SAMe is the biologically active form.

Back 336

True. The (R,S) isomer is biologically inactive.

Front 337

What are some drug-drug interactions seen with SAMe?

Back 337

- Use with levodopa decreases effectivesness

-Use with any drugs with serotonergic activity increases risk of serotonin syndrome

Front 338

What adverse events are seen with SAMe?

Back 338

- Generally well tolerated
-SE more common with higher doses
-Hypomania is seen in patients with bipolar disorder
-Hyperhomocysteinemia

Front 339

In what patients should SAMe NEVER be used?

Back 339

- Pregnancy & lactation (duh!)
-Pts with bipolar disease
-Pts with elevated homocystine levels

Front 340

What part of the Ginko Biloba plant is used?

Back 340

The leaves which are a fan shape`

Front 341

T/F. Only the female Ginko Biloba plants produce fruit.

Back 341

True. There are male and female plants but only the female ones produce fruit.

Front 342

Why should Ginko Biloba extracts be made free of ginkgolic acids?

Back 342

- Ginkgolic acids are responsible for allergic reactions

-Extracts are considered free of ginkgolic acids when they are < 5 ppm

Front 343

What are key compounds in Ginko Biloba?

Back 343

- Terpene lactones (which are the glinkolides and Bilobolide)

-Flavonoids (quercetin glycosides, kaempferol glycosides, isohamnetin glycosides)

-Ginkgolic acids (regular fatty acids)

Front 344

What is Ginko Biloba used for?

Back 344

- Delay of age-related dementia (memory loss)

- Inhibit platelet activating factor (PAF)

Front 345

What is the chemical composition of EGb 761, which is what Ginko Biloba is standardized to?

(She Said To Know This!)

Back 345

- 24% Flavonoids

- 6% Terpenoides (ginkgolides, bilobalide)

- 5-10% Organic acids (e.g. acetic acid, shikimic acid, 4-hydroxybenzoic acid)

Front 346

What is a key advantage of Ginko Biloba over pharmacotherapy options in the treatment of dementia?

Back 346

There was a significantly lower incidence of side effects seen with Ginko Biloba compared to the Pharmacotherapy options

1.69% (ginko) vs 5.42% (drugs)

Front 347

What is the take home message from Ginko Biloba clinical trials from before 1991 to after 1991?

Back 347

- Before 1991: clinical trials showed some benefit in more severe cases of dementia

- After 1991: clinical trials were only allowed to be tested on patients with mild cognitive deficits

- Currently only approved for mild dementia but due to some benefit seen in earlier trials should not rule of its use in more severe cases.

Front 348

What is the physiologic mechanism of action of Ginko Biloba?

Back 348

- Acts by releasing vasodilators, specifically nitric oxide
- Decreases blood viscosity
-Increases microcirulation

**Overall, decreasing plaques in the brain

Front 349

What is Ginkgo Biloba's role with Platelet Activating Factor (PAF)?

Back 349

- Ginko balances the overproduction of PAF that comes from poor food selection, physical stress

- Excessive PAF can lead to cardiovascular disease or brain damage

Front 350

What are some positive effects of Ginkgo?

Back 350

- Increases the release of neurotransmitters

- Antioxidant activity

- Prevention of free radical damage

Front 351

What is the recommended dosage of Ginkgo?

Back 351

120-240 mg/ day total; divided into 2-3 doses

Front 352

What are some drugs that Ginkgo may potential interact with?

Back 352

- Acetylsalicylic Acid
- Coumadin
- Vioxx (refecoxib)
-Desyrl (trazodone)

Front 353

What are some side effects seen with Ginkgo?

Back 353

Overall relatively safe

-5 reported cases: hemorrhage, hematoma, and hyphema (bleeding in the eye)

Front 354

T/F. Patients taking Ginkgo should stop using it 72 hours before any surgeries.

Back 354

True. because it acts as a blood thinner

Front 355

What is Vinpocetine?

Back 355

A synthetic derivative of vincamine which is found in periwinkle, Vinca minor.

Front 356

Potential Drug Ineteractions with Vinpocetine?

Back 356

blood thinners such as warfarin, clopidogrel, etc.

Front 357

What is Huperzine A?

Back 357

A naturally occurring sesquiterpene alkaloid found in the extracts of the firmoss Huperzia serrata.

Front 358

Huperzine A is used for ?

Back 358

- Dementia (particularly Alzheimer's disease)

- Memory Improvement

Front 359

What is the MOA/pharmacology behind Huperzine A?

Back 359

- Inhibitor of the enzyme acetylcholinerase

- Rapid absorption, penetrates BBB, duration of action is 3h longer than prescription AchE-inhibitors

Front 360

Dosage of Huperzine A for Alzheimer's disease?

For Memory Improvement?

Back 360

- Alzheimer's: 50-200 mcg BID

- Memory: 100 mcg BID

Front 361

T/F. The Racemic form of Huperzine A is 3x less potent and unfortunately that is the product on shelves.

Back 361

True

Front 362

Drug Interactions seen with Huperzine A?

Back 362

- Interacts with MAOi --> hypertensive crisis

-Interacts with other AchE inhibitors (donepezil, tacrine)

Front 363

Adverse events seen with Huperzine A?

Back 363

- May cause seizures or heart rhythm changes

- Associated with Acetylcholine overdose symptoms (blurred vision, dizziness, nausea, and increased saliva/sweat).

Front 364

Contraindications seen with Huperzine A?

Back 364

- CI in patients with bradycardia, MI, Parkinson's disease, asthma.

- May worsen bladder conditions, BPH, bronchitis, emphysemia, or ulcers

- Pregnancy and lactation

Front 365

Botanical Name of Kava Kava?

Back 365

- Piper methysticum Forst.

Front 366

What part of the Kava Kava plant are used?

Back 366

- Roots

Front 367

What are the ingredients in Kava Kava?

Back 367

- kavalactones (kavain is most common)

Front 368

What are some precautions with Kava Kava?

Back 368

- additive effect with alcohol
- Don't take with other CNS depressants (documented problem when combined with alprazolam, Zoloft)
- Long use may result in rash and discolored skin or allergy
- not for use in pregnancy or depression

Front 369

T/F. Alpha pyrones in Kava Kava bind to the GABA receptors like benzodiazepines.

Back 369

True

Front 370

Safety concerns with kava kava?

Back 370

- FDA is advising about the potential risk of severe liver injury in pts taking relatively normal doses, short-term

- There have been 91 documented cases of liver toxicity following kava use but only 4 cases were really substantiated.
(After this kava was banned)

- her point was that Tylenol causes 70,000 reported cases of liver toxicity a yr... so kava is safer then tylenol and kava got pulled.

-

Front 371

Standardization for kava products

Back 371

most extracts are standardized to 70% kavalactones

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Dosage for Kava extracts

Back 372

300mg/d (3 x 100mg) for extracts

- AVOID over 300mg/d kvalactones

Front 373

Botanical name of Valerian?

Back 373

Valeriana officinalis L.

Front 374

T/F. Valerian usually comes in combination with other products like St John's Wort and Passion Flower rather than alone.

Back 374

True

Front 375

Indications for Valeran that is supported by clinical trials?

Back 375

- Insomnia
- Restlessness
- Nervous tension
- Depression? (when in combo with St John's Wort)
- Anxiety? (when in combo with Passion Flower)

Front 376

Key constituents of Valerian?

Back 376

- Valepotriates
- Essential Oil
- Valerenic acid

Front 377

T/F. Valerenic acid is unique to Valeriana officinails and is what discussed in teh monographs world wide

Back 377

True

Front 378

What is the MOA of Valerian?

Back 378

- Ligands from Valerian bind to the A1 (adenosine) receptor and activates it.


(Caffeine binds to that same receptor but it blocks it)

Front 379

Standardization of Valerian?

Back 379

0.8% of valerenic acid

Front 380

Dosage of Valerian?

Back 380

For Sleep: 400 - 600mg given 30-60 minutes before bedtime

Front 381

What was the outcome/results of the Valerian trial that compared 600mg/die valerian extract LI 156 (Sedonium) to 10 mg/die oxazepam taken for 6 weeks?

Back 381

- The valerian was at least as effectious as a treatment with oxazepam

- Most pts assessed their respective treatment as very good (82.8% valerian and 73.4% oxazepam)

Front 382

Safety of Valerian?

Back 382

- Can cause hangover effects if taken with alcohol

- Safety during pregnancy not determined

- Does have GRAS status though --> No adverse events seen yet

Front 383

Drug Interactions with Valerian?

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- Alcohol: additive effects
- Benzos: Theoretically can cause additive effects
- CNS depressants: Theoretically can cause additive effects
- CYP3A4 substrates: interaction has not yet been reported in humans

Front 384

What are the two US products available that contain Valerian?

Back 384

- Nature's Way Valerian
- Sedonium

Front 385

Botanical name of Hops?

Back 385

Humulus lupulus L.

Front 386

Which part of the Hops plant is used?

Back 386

Strobiles (the female part of the plant) that contain the bitter principles including humulone and lupulone

Front 387

What are the therapeutic uses of Hops?

Main uses?

Back 387

Therapeutic Uses:
- Sedative, Nervousness, Diarrhea, Insomnia, Restlessness, Stimulate appetite, relieve intestinal cramps

Main Uses:
- Brewing beer, Flavor, and aromas

Front 388

What are the key compounds in Hops?

Back 388

- Prenylated phloroglucinol derivatives called humulones and lupulones

- Essential Oils

- Flavonoids

- Prenylated flavonoids

Front 389

T/F. Hops can cause estrogenic effects.

Back 389

True. the estrogenic effetcs of hops is due to the 8-prenylnaringenin

Front 390

Botanical name of Passion Flower?

Back 390

Passiflora incarnata L.

Front 391

Therapeutic uses of passion Flower?

Back 391

Anxiety or Nervousness

Front 392

Key Compounds of Passion Flower?

Back 392

- Flavonoids

- Traces of carboline alkaloids

Front 393

Dosage/Standardization of Passion Flower?

Back 393

- Standardized products are not widely available

- Dosage: Nobody really knows.