Supplement&Herbs Flashcards by JHope .

What is feverfew used for?

migraine prophylaxis;-reduce migraine frequency
-less severe symptoms,
Grade A - possibly effective 3/5 trials found efficacy, but well designed trial found no difference than placebo

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MOA theories for feverfew

inhibits platelet aggregation,
serotonin release,
leukotrienes,
prostaglandin synthesis

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Cautions for feverfew

safe for up to 4 months (length of study)
does not work for acute attacks
taper dose to prevent withdrawal
do not use if allergic to ragweed or related plants
caution in pts taking warfarin
*do NOT use during pregnancy/lactations

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What is coenzyme Q10 used for?

migraine prophylaxis-reduces migraine attack frequency, headache-days, days w/ nausea! can also be used for Co-Q10 deficiency, CHF, angina.
Grade A - more effective than placebo

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MOA for coenzyme Q10 and migraine prophylaxis

-might improve mitochondrial oxidative phosphorylation

well tolerated!

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What is riboflavin (Vitamin B2) used for?

migraine prophylaxis:may affect mitochondrial dysfunction Grade A

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What are the claims for riboflavin in regards to migraine prophylaxis?

high dose may reduce the frequency of migraines
does not reduce severity or duration,
must be used 3 months to see improvement

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ADE for migraine prophylaxis w/ riboflavin?

-higher dose may cause diarrhea and polyuria -yellow-orange discoloration of urine

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What is the MOA of Mg for migraine prophylaxis?

low Mg levels may induce cerebral arterial vasoconstriction –> increase platelet aggregation –> promote serotonin release *more likely to benefit pts with low Mg levels
Grade A -

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ADE for magnesium?

diarrhea

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What is St. John’s Wort indicated for?

depression - mild-to-moderate

Grade A -

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What is the major active constituent of St. John’s Wort?

hyperforin

inhibits reuptake of serotonin, norepinephrine, dopamine

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ADE of St. John’s Wort

incidence similar to placebo and less than conventional antidepressants
sexual dysfunction less than SSRIs
serotonin syndrome
hypertensive crisis reported with tyramine-containing foods
can induce abortion –> do not use during pregnancy!!

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Drug interactions of St. John’s Wort*

Potent inducer of CYP450 3A4

Reduce levels of

Amitriptyline and nortriptyline
Midazolam and alprazolam
cyclosporine and tacrolimus
indinavir and nevirapine
imatinib and irinotecan
digoxin, fexofenadine, methadone, omeprazole, oral contraceptives, simvastatin, theophylline, verapamil, warfarin

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Very important drug interactions to remember with St. John’s Wort!

FDA -protease inhibitors and non-nucleoside reverse transcriptase inhibitors
additive effects with antidepressants
allow 14 day washout period after treatment with an MAOI before starting St. John’s Wort

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What is S-adenosylmethionine (SAMe) indicated for?

depression Grade C

- osteoarthritis-Grade B

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What is the MOA for SAMe for treatment of depression?

increase dopamine & norepinephrine levels

**may be effective as TCAs for depression

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ADE for SAMe

additive effect on drugs that increase serotonin levels –> * not to combine SAMe with other antidepressants

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What is glucosamine/chondroitin indicated for?

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osteoarthritis- alone alleviate symptoms and slow joint deterioration in osteoarthritis

G - chitin (building block of exoskeletons of crustaceans) and stimulates the manufacturing of substances essential for proper joint function and joint repair stimulation; analgesic effects
C - bovine or shark cartilage, and acts as chondroprotective

What are the grades of evidence for both glucosamine/chondroitin?

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G: Grade A - mild-moderate knee OA Grade B - general OA

C: Grade A - OA of knee and other joints Grade B - urinary incontinence/detrusor instability

ADE of glucosamine/chondroitin

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-GI (nausea, indigestion, vomiting)
-headache
asthma exacerbations with chondroitin
AVOID-allergy to shellfish

What is methylsulfonylmethane (MSM) indicated for?

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osteoarthritis-Grade C = conflicting data

What is black cohosh indicated for?

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menopausal symptoms-Grade C

may relieve hot flashes
NO affect estrogen receptors
NO affect endometrial or breast tissue

What groups should avoid black cohosh?

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women w/ hx or family h/o breast CA

What is soy used to treat?

menopausal symptoms *conflicting data on efficacy for hot flashes metabolite INC estrogen activity

What groups should avoid soy?

Pt estrogen receptor positive breast cancer

What is saw palmetto used to treat?

BPH Grade A! -antiandrogenic, antiproliferative, anti-inflammatory properties -significantly improves many BPH symptoms --> frequent urination, painful urination, hesitancy, urgency

Side effects of saw palmetto

- well tolerated w/ few side effects - dizziness and GI - less impotence than finasteride - does not decrease PSA levels - INR w/warfarin

What are the grades of evidence for garlic and what it's able to treat?

Grade A = hyperlipidemia, HTN Grade B = decrease CVD risks | antimicrobial, antiviral, immune-enhancing, antispasmodic, antihypertensive, cholesterol lowering

What are drug interactions of garlic?

- reduces saquinavir by ~50% - advise pts on protease inhibitors not to start or stop - INC bleeding time and INR w/warfarin

ADE of garlic

- may inhibit platelet aggregation | - postop bleeding and spinal epidural hematoma

What are the claims of ginkgo biloba?

memory enhancement, cognitive improvement, and antiplatelet activity. Grade A = claudication (PVD), dementia Grade B = cerebral insufficiency

Drug interactions of ginkgo

- potent inhibitors of platelet-activating factor - may also CYP450 enzymes - DI warfarin, aspirin, ibuprofen - serotonergic effects - don't take w/ MAOIs and SSRIs! * NOT recommended if using w/ antiplatelet agents

ADE of ginkgo

- intracerebral hemorrhage, spontaneous bleeding in the eye, postop bleeding - variable insulin levels DM caution

What are the claims of ginseng?

``` 'mental performance' and 'increase energy' - immune function, antioxidant activity, analgesic effects, improved *glucose homeostasis, reduces cancer risk ```

What is the grade of evidence for ginseng and what it's able to treat?

Grade B = CV conditions, hyperglycemia in healthy individuals, immune system enhancement, DM2

ADE of ginseng

insomenia, nervousness, HTN

What supplements should be avoided with warfarin?

3 G's! Gingko, garlic, ginseng*

What is echinacea indicated for?

'immune modulating' agent - increases production of interleukins and NK cell activity, demonstrated weak antibiotic/antiviral/antifungal effects Grade B for URTI prevention/treatment-marketed to reduce duration of cold if started within 24hrs

ADE for echinacea

flu-like symptoms, unpleasant taste, GI discomfort

What is melatonin?

a serotonin derivative produced by pineal gland helps regulate sleep/wake cycles - release coincides w/ darkness and is suppressed by daylight

What are the grades of evidence for melatonin and what it's able to treat?

Grade A - jet lag Grade B - delayed sleep phase syndrome, insomnia in elderly, sleep disorders, sleep enhancement in healthy people

How to give melatonin for insomnia and jet lag?

At sunset! insomnia - QD HS jet lag- first dose at departure, 1-3 nights after arrival

ADE of melatonin

Rare | next day drowsiness, vivid dreams, HA

Does vitamin B3/Niacin prevent cancer!?

nonmelanoma skin cancer- Niacinamide 500mg BID Continue topical sunscreen

What supplements should never ever use!?

Comfrey- inflammatory ADE- liver failure irreversible; deaths reported Kava-GAD; ADE-liver liver failure -death reported Yohimbe- impotence; ADE-*changes in BP, arrhythmias, respiratory depression, heart attack

Supplement&Herbs Flashcards

(46 cards)