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Nutrition Lecture 6
binging on ensure day
74
Health Care
Professional
08/15/2012

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Term
When referring to the economics of herbals, what does CAM stand for?
Definition
Complementary and Alternative Medicine
Term
In 2005, how much money was spent on herbals in the US?
Definition
$250 million
-this continued to grow after 2007, when $33.9 billion was spent on out of pocket visits to CAM practitioners and CAM products
Term
List the medications derived from plants.
Definition
atropine
digoxin
colchicine
quinine
codeine
vincristine
ipecac
taxol
physostigmine
senna
ephedrine
cocaine
salicylin
capsaicin
scopolamine
respirine
Term
What does the 1994 Dietary Supplement and Health Education Act say?
Definition
-the dietary supplement/ ingredient manufacturer is responsible for ensuring the supplement or ingredient is safe before it is marketed
Term
Are dietary supplement/ ingredient menufacturers regulated by the FDA?
Definition
no
-no safety or efficacy data is needed
-no claims for diagnosis, tx, cure or prevention of dz may be made
Term
Who is responsible for taking action against any unsafe supplement product AFTER it reaches the market?
Definition
FDA
Term
What are 4 herbal safety issues?
Definition
lack of standardization
questionable good manufacturing practices
adulterated/ mislabeled products
adverse reaction reports (high, 184 deaths from 1993-1998)
Term
In 2007, what did the FDA publish?
Definition
comprehensive regulations for Current Good Manufacturing Practices
-for those who manufacture, package or hold dietary supplement products

*meaning, products must be properly labeled
*must be free of adulterants
*must be manufactured according to specific standards
Term
Is there a maximum set for heavy metals with dietary supplements?
Definition
NO
Term
What are the top selling herbs?
Definition
Garlic
Echinacea
Saw palmetto
Ginkgo biloba
Cranberry
Soy
Ginseng
Black cohosh
St. John’s Wort
Milk thistle
Green tea
Evening primrose
Valerian
Grape seed extract
Horny Goat Weed
Kava
Bilberry
Red clover
Bilberry
Ginger
Horse chestnut seed
Grape seed extract

Valerian
Grape seed extract
Horny Goat Weed
Kava
Bilberry
Red clover
Bilberry
Ginger
Horse chestnut seed
Grape seed extract
Term
Of the top selling herbs, which ones have reactions to them?
Definition
echinacea
saw palmetto
ginkgo bilboa
ginseng
St. John's Wort
Horny Goat Weed
Kava
Term
What are the uses of glucosamine and chondroitin?
Definition
tx for osteoarthritis and other joint disorder
-used as primary tx in Portugal, Spain and Italy

typically used in combination: most common forms are glucosamine sulfate and chondroitin sulfate
Term
Do physicians in the field actually recommend glucosamine/ chondroitin before going directly to surgery?
Definition
yes.
Term
What are some adverse effects of glucosamine/ chondroitin?
Definition
constipation, diarrhea, drowsiness, stomach upset, headache, nausea, rash
Term
What drug should you worry about interacting with glucosamine?
Definition
diuretics
Term
What drug should you worry about interacting with chondroitin?
Definition
warfarin
Term
Who should you be cautious with when recommending glucosamine/ chondroitin?
Definition
diabetics
Term
How did a study in Belgium show that glucosamine works?
Definition
showed no joint space loss and an improvement in symptoms compared to progressive joint space narrowing and worsening symptoms with placebo (Lancet 1/2001)
Term
What do older studies suggest about glucosamine/chondroitin?
Definition
support a reduction in joint pain and improved ROM
Term
What is saw palmetto typically used for?
Definition
BPH
Term
How long does saw palmetto maintain effectiveness with BPH? When are benefits usually seen?
Definition
at least 3 yrs
within 4-6 wks.
Term
Approximately what percentage of men with BPH report improvement saw palmetto?
Definition
2/3
Term
What is the dose of saw palmetto?
Definition
160 mg twice daily or 320 mg daily
Term
What are some side effects of saw palmetto?
Definition
abdominal pain
back pain
constipation
diarrhea
headache
increased blood pressure
nausea
Term
Are there any known drug interactions with saw palmetto?
Definition
no
Term
What is the therapeutic application of ginger?
Definition
nausea
motion sickness
hyperemesis graviarum
control arthritis symptoms
Term
What are the contraindications of ginger?
Definition
in pregnancy and in those with gallstones
if someone has always had GI issues
Term
Are there any known adverse reactions with ginger?
Definition
no
Term
What are the 3 available sources of ginseng?
Definition
Panax ginseng- korean or asian
Panax quinquefolius- American
Eleutherococcus senticosus- Siberian (not actually ginseng, but has similar properties)
Term
What are the uses of ginseng?
Definition
sedative
aphrodisiac
diuretic
antidepressant
stamina
concentration
stress
improved "well being"
Term
How should ginseng be dosed?
Definition
depending on version...
use for 2-3 weeks followed by a 1-2 week break
Term
What are the adverse affects of ginseng?
Definition
chest pain
diarrhea
headache
impotence
increased BP
nausea
vomiting
nervousness
Term
What are the precautions of ginseng? (2 types of pathologies)
Definition
diabetics
liver dz
Term
What are the drug interactions with ginseng?
Definition
phenelzine
digoxin
warfarin
stimulants (ginseng abuse syndrome)
Term
What are the uses of ginkgo?
Definition
dementia
age-related memory loss
peripheral vascular insufficiency
Term
What is the dose of ginkgo? How long does it take to see full affects?
Definition
120-240 mg/day, divided 3 x daily
6-12 wks to see full effects
Term
What are the adverse effects of ginkgo?
Definition
diarrhea
flatulence
headache
nausea
vomiting
bleeding
seizures
rash when come in contact with the fruit.
Term
What are the drug interactions with gingko?
Definition
warfarin
aspirin
phenytoin
Term
What are the uses of St. John's Wort? (Hypericum perforatum)
Definition
mild to moderate depression
dysthmia- chronic but mild depression
Term
What is the dose of St. John's Wort?
Definition
300 mg TID
-900 mg/day total
Term
How do you convert from prescription antidepressant to St. John's Wort???
Definition
no definitive answer, but could:
cut dose of original agent in half and add St. John's
-After 1-2 wks: d/c original medication
Term
What are the side effects of St. John's Wort?
Definition
rarely seen:
mild stomach upset, constipation, allergic rxns (rash), tiredness, dizziness, restless ness, headache, dry mouth

severe phototoxicity seen in animals--> increased risk of cataracts
Term
Why is St. John's Wort often found in combination with kava?
Definition
for anxiety
Term
Why is St. John's Wort often found in combination with kava and valerian?
Definition
insomnia
Term
What are some St. John's Wort drug interactions?
Definition
DIGOXIN, WARFARIN and OCPs
protease inhibitors
cyclosporine
theophylline
olanzapine
clozapine
etoposide
teniposide
mitoxantrone
doxorubicin
SSRIs
sumatriptan
tramadol
photosensitizing agents
Term
What has St. John's Wort been tested against by the NCCAM and NIH?
Definition
sertraline
-most of these studies contain the flaw that the doses of the prescription antidepressant is inadequate
Term
For what is echinacea used?
Definition
wound healing agent
nonspecific immunostimulant- prevention of infection
Term
What are the doses of echinacea?
Definition
varies:
caps: 900 mg to 1 g TID
Should not be used for > 8 wks.
Term
For what is kava used?
Definition
kava-kava social drinking
seizures, anxiety, depression, insomnia, pain, rheumatism, muscle spasms
Term
What are the adverse effects of kava?
Definition
visual disturbances (red eyes)
slow reflexes
decrease blood counts
dry skin
yellow skin discoloration
mild GI disturbances
SOB
dependence
Term
What are the drug interactions with kava?
Definition
alcohol: increases kava side effects

benxodiazepines (Valium): additive side effect
Xanax: coma

Levodopa: increased Parkinson's symptoms.
Term
What are the indications for the use of garlic?
Definition
treating hyperlipidemia and HTN

may be used in bacteria, fungal and viral infections
Term
What are the contraindications to using garlic?
Definition
should not be used by breast feeding mothers
flatulence, heartburn or dermatitis
Term
What are the adverse rxns of garlic?
Definition
reduces clotting time
increases blood levels of HIV meds
Term
For what is valerian used?
Definition
sedative for insomnia/restlessness
antispasmodic
Term
What are the adverse effects of Valerian?
Definition
blurred vision
headache
nausea
allergic rxns
liver toxicity*
Term
What are some drug interactions with Valerian?
Definition
alcohol, pain meds, Valium (causes increased sedation)
Term
What are some medications with high interaction potential with herbs?
Definition
Coumadin® (warfarin)
Dilantin® (phenytoin)
Lanoxin® (digoxin)
Neoral® (cyclosporine)
-Prevents organ rejection episodes with transplants
Tagamet® (cimetidine)
-For reflux
TheoDur® (theophylline)
Term
Which herbs have a rxn with wafarin?
Definition
Angelica root
Arnica flower
Anise
Asafoetida
Bogbean
Borage seed oil
Bromelain
Capsicum
Celery
Chamomile
Clove
CoEnzyme Q10**
Danshen
Devil’s claw
Don Quai**
Fenugreek
Feverfew
Garlic**
Ginger
Ginkgo**
Ginseng*
Green tea*
Horse chestnut
Licorice root
Lovage root
Meadowsweet
Onion
Parsley
Papain
Papaya extract
Passionflower Herb
Poplar
Quassia
Red clover
Rue
St. John’s Wort**
Sweet clover
Turmeric
Willow bark
Vitamin E**
Term
Herbs can potentially cause an increase in morbidity/ mortality in the perioperative period.
What 8 herbs have the greatest impact in pts undergoing surgery? (when interviewing someone about to have surgery, these should raise some red flags)
Definition
Echinacea
Ephedra
Garlic
Ginkgo
Ginseng
Kava
St. John's Wort
Valerian
Term
When monitoring a CBC for surgery, what should you remember if a pt is taking chondroitin?
Definition
it is a heparin like structure
Term
When monitoring a CBC for surgery, what should you remember if a pt is taking garlic?
Definition
it inhibits platelet aggregation
Term
When monitoring a CBC for surgery, what should you remember if a pt is taking kava?
Definition
decreased platelet and lymphocyte count
Term
When monitoring a CBC for surgery, what should you remember if a pt is taking mayapple?
Definition
causes leukopenia and thrombocytopenia
Term
You may need to look at the coag studies for a pt about to undergo surgery if they are on what herbs?
Definition
angelica (dong quai)
black haw
cat’s claw
fenugreek
feverfew
ginger
horse chestnut
kelp and kelpware
lungwort
pau d’arco
poplar
red clover
tonka bean
turmeric
willow
Term
When monitoring a CBC for surgery, what should you remember if a pt is taking licorice?
Definition
increases BP, liver and kidney toxicity
Term
When monitoring a CBC for surgery, what should you remember if a pt is taking Goldenseal?
Definition
worsens edema and increases BP
Term
What resources can be used to verify the quality of an herb?
Definition
consumerlab.com
national Natural Foods Association
Thorne Research
Quality statements from the manufacturer
Term
What might a quality statements from the manufacturer of an herbal supplement yield?
Definition
FDA approved or not
Follows code of federal regulations or not
inspection of incoming ingredients
Term
When should a pt reconsider and talk to their doctor regarding herbs? (5)
Definition
pregnant
child
plant/ pollen allergies
multiple medical problems
multiple medications
Term
Is it smart to select herbs with the manufacturer's name, address and contact number?
Definition
yes
Term
Should you avoid products without lot numbers or expiration dates?
Definition
yes
Term
Should you ever take more than the recommended amt of herbs?
Definition
no
Term
Does natural always mean safe?
Definition
no
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