Ginger for __________
Prevention of Motion Sickness
Ginger: portion of plant used ___________
Origin of Ginger
Inhibits serotonin receptors (antiemetic effects) Decrease vasopressin release (reduce motion-related nausea)
Mixed evidence 1st study: no benefit of ginger power or root over scopolamine or placebo 2nd study: positive benefits with ginger pretreatment on prolonging time before nausea, shortening recovery time, and reducing basopressin levels
Ginger Dosage and Standardization
How long before a trip should you take ginger before a trip?
30 min-4 hrs before 1-2 days before if possible
Should you continue to take ginger throughout the trip?
What is the standardization of ginger?
5-20% gingerols and shogoals 4% volatile oils
Not common Heartburn, diarrhea, mouth irritation
Can ginger be used in pregnancy?
Commonly used but German Commission E recommends NO Do not use more than dietary intake
Fibrinolytic activity at high doses Arrhythmias in animals
Contraindications with Ginger
What is the mechanism of action of ginger?
a. inhibits GABA receptors
b. inhibits serotonin receptors
c. inhibits dopamine receptors
d. inhibits H2 receptors
inhibits serotonin receptors
Ginger has been shown to:
a. prolong the onset of motion-induced nausea
b. shorten the recovery time of motion sickness
c. be as effective as conventional treatments
d. all of the above
all of the above
Which of the following is not a side effect
d. mouth irritation
Which of the following is a contraindication
for the use of ginger?
a. gallbladder disease
b. renal insufficiency
c. hepatic insufficiency
d. pancreatic disease
2001: lifestyle modification with phytosterol in ATP III
Phytosterols: Naturally available in
oils and fats nuts and seeds cereals vegetables fruits
hydrolyzed by cholesterol reductase and replaces cholesterols in the micelles not esterifiled by acyl CoA accumulation of phytosterols in the enterocytes leads to upregulation of ABCA1 transporter and increased removal of phytosterols and cholesterol
Dose of 2 g day has been proven to lower LDL cholesterol concentration by 10-11%
Phytosterols: Dosaged and Standardization
> 1.5 g of plant sterols per day Standardized by sterol content Natural sesame seeds: 360 mg of phtosterols per 100g Promise Active Light Spread: 1 g per tbsp
Generally well tolerated Nausea Indigestion Gas Diarrhea Constipation ED Loss of libido
Phytosterol drug interactions
Ezetimibe: reduced absorption of phytosterol Pravastatin: reduced blood levels of phytosterol
Phytosterol food and supplement interactions
Carotene and Vitamin E both may reduce absorption and blood levels
Sitosterolemia and phytosterols
Lipid storage disease which causes increased absorption of cholesterol
Phytosterols and Beta Carotene
may reduce absorption of beta carotenes which can lead to increased risk of chronic disease such as cancer or heart disease counteract w/ diet rich in fruits and vegetables, MVI
1. Why are phytosterols not recommended first line for reduction in LDL?
a. They cause too many side effects
b. They are a potent CYP P450 inhibitor and therefore interact with many drugs
c. They do not demonstrate the same capacity to lower lipids as statins
d. They are not manufactured by a large drug
They do not demonstrate the same capacity to lower lipids as statins
1. Which of the following is false pertaining to phytosterols
A. They are added to many foods
B. They are effective in lowering cholesterol
C. They are not naturally found in many foods
D. They are recommended by ATP III
C. Theyare not naturally found in many foods
1. At a dose of _ g/day, phytosterols have been shown to lower LDL concentration by _ %.
a. 15 g/day; 10-11%
b. 1.5 g/day; 21-67%
c. 2g/day; 10-11%
d. 10-11 g/day; 2%
c. 2g/day; 10-11%
1. Although phytosterols are generally well tolerated, an adverse effect commonly noted in patients is
A. Transient loss of arm
B. Elevated LFTs
C. GI upset (nausea, dyspepsia, constipation, flatulence)
C. GIupset (nausea, dyspepsia, constipation, flatulence)
1. Phytosterols supplementation may reduce the absorption and transportation of which of the
c. Hydrocarbon carotenes
d. Both a and c
d. Both a and c
1. Phystosteral supplementation should be avoided in which disease states
a. Diabetes mellitus
b. Acid reflux
c. Morbid obesity
First use of curcumin
a) MOA: protects specific (MES23.5) dopaminergic cells from 6-hydroxydopamine (6-OHDA) induced neurotoxicity
i) Acts as a free radical scavenger/antioxidant ii) 6-ODHA causes neurotoxicity by 2 mechanisms: 1. Forms free radicals 2. Potential inhibitor of mitochondrial respiratory chain complexes I and IV
Scientists also hypothesize curcumin helps reduce glutathione-depleted oxidative dopaminergic neurons by increasing glutathione levels
Curcumin efficacy profile
No human clinical trials All hypothesized effects are result of speculation and animal tests
dermatitis bitter taste GI disturbances (with chronic use): dyspepsia, nausea, vomiting, dizziness, diarrhea
Hypersensitivity to tumeric/curcumin Bile duct obstruction/gallstones Gastric ulcer Surgery (risk of bleeding) Pregnancy/lactation (emmenagogue/uterine stimulant effects)
Curcumin Drug Interactions
Anticoagulation/antiplatelet: increased risk of bleeding, medium risk Diabetes medications: may increase risk of hypoglycemia H2RAs and PPIs: may block mechanism of action to result in increased acid secretion
Curcumin Food interactions
Cinnamon: Increased risk of bleeding Monitor: potential for interaction
Curcumin disease interactions
Bile duct obstruction/gallstones: may cause gallbladder contractions
Typically 1-3 500 mg capsules daily w or w/o food Dosage depends on taking curcumin
When should you D/C curcumin? (s/sx)
Breathing problems Tightness in throat/chest Chest pain Skin hives Itchy/swollen skin
1. What is the basic mechanism of action for how curcumin is suspected to reduce the progression of
A. Decreases oxidative stress to prevent degradation of
B. Increases oxidative stress to stimulate glutathione conjugates in the liver
C. Increases intracranial blood flow to increase oxygen supply to the brain
D. Stabilizes the myelin sheath around neurons to enhance signal transduction
A. Decreases oxidative stress to prevent degradation ofdopaminergic neurons
Which of the following is NOT a contraindication to curcumin?
D. Gastric Ulcers
Which of the following medications would result in a drug-interaction with curcumin?
Which of the following clinical trials support the use of curcumin in
A. CIPD (Curcumin in Parkinson’s Disease)
B. TTND (Turmeric Treatment in Neurodegenerative Disorders)
C. CMPHS (Curcumin: Managing Parkinson’s with Herbal Supplementation)
D. None of the above: there are NO clinical trials supporting the use of curcumin in Parkinson’s Disease
D. None of the above: there are NO clinical trials supporting theuse of curcumin in Parkinson’s Disease
Part of Maca used in medicine
Exact mechanism unknown-- does not affect concentration of hormones Marker compounds Macaene and macamide (polyunsaturated fatty acids)
Maca efficacy profile
Positive benefits over the placebo effect for menopause symptoms [not due to a change in estrogen or androgen content]
Maca compared to conventional medicine
Less efficacy but also fewer side effects
Maca dosage and standardization
> 0.6% glucosinolates, o.6% macamides and macaenes Dosage in clinical trials: 2 g/day
None verified Case reports: budd-chiari, attention disturbances, weight loss, agitation, abdominal pain, epistxis, gingival bleeding, HA, vomiting, and abdominal lifer function [none directly related to Maca]
Maca’s mechanism of action is which of the following:
b. stimulates GABA receptors in the brain
c. increases adrenal stimulation of alpha and beta receptors
d. Increases levels of nitrous oxide systemically
Maca’s commonly reported side effects are?
C. There are no commonly reported side effects
C. There are no commonly reported side effects
Where does Maca originate from?
b. United States
Maca is used to treat which of the following?
d. Muscle wasting
Saw Palmetto Indication
Saw Palmetto: Part of the plant used
whole berries or oily flesh of the berry
Saw Palmetto MOA
poorly understood antiandrogenic, antiproliferative, and anti-inflammatory properties inhibition of 5-alpha reductase --> decrease growth of prostate slow prostate cell proliferation: inhibition of fibroblast growth factor and epidermal growth factor, apoptosis Inhibition of alpha-adrenergic receptors Placebo effect
Saw Palmetto Efficacy Profile
showed no significant statistical improvement in symptoms or prostate size reduction in patients with BPH treated with Saw Palmetto
Saw Palmetto Dosage and Standardization
160 mg capsule BID (clinical trials) or 320 mg of a lipophilic extract containing 80-90% fatty acids
Saw Palmetto AE
Common: dizziness, nausea, HA, vomiting, constipation, diarrhea Less common: asthenia, loss of libido, ejaculation disorders, orthostatic hypotension
Saw Palmetto precautions
Antiplatelet and anti-estrogen effects Surgery: D/C 2 weeks prior to surgery
Saw Palmetto Drug Interactions
Anticoagulants: increase risk of bleeding Antiplatelets: increase risk of bleeding Oral Contraceptives: anti-estrogenic effects Estrogens: anti-estrogenic effects
Saw Palmetto Lab Test Interactions
Saw Palmetto Interactions with Other CAM
antiplatelet effects: angelica, clove, danshen, garlic, ginger, ginkgo, panax, ginseng
1. What is the most common use of Saw Palmetto?
a. pruritus caused from an allergic reaction
b. memory loss
c.lower urinary tract symptoms associated with benign
d. wart caused by tinea pedis
e. appetite suppressant
lower urinary tract symptoms associated with benignprostatic hyperplasia
1. Which of the following medications is most
likely to interact with Saw Palmetto?
a. metoprolol tartrate
e.none of the above
What is the most commonly proposed mechanism
of Saw Palmetto?
a. inhibitor of HMG-CoA reductase
b. inhibitor of 5-alpha reductase
c. alpha-2 agonist
d. inhibition of prostaglandin synthesis
e. both a & b
inhibitor of 5-alpha reductase
Did the systematic review favor Saw Palmetto
for the treatment of BPH?
a. Yes, because Saw Palmetto proved to be
effective in the treatment of BPH
b. No, because there are too many risks involved
in using Saw Palmetto
c. No, the studies in the systematic review did not
favor Saw Palmetto
d. Yes, but only favored one dosage form of Saw
Palmetto over another
No, the studies in the systematic review did notfavor Saw Palmetto
Cranberry Portion Used
Interferes with bacterial adherence to urinary tract epithelial cells Proanthocyanidins wrap around pathogens
Cranberry Juice Efficacy Profile
NMCD "possibly effective" May reduce risk of recurrent UTI but should not be used to treat active UTI Not sure if juice or percentage is effective
Dosage and Standardization
Cranberry juice 300-480 mL Cranberry capsule 400-800 mg BID
Drinking 1 L/day for extended period can increase urice acid kidney stone formations
ASA allergy Atrophic gastritis Diabetes Hyochlorydria (decrease in B12 absorption) Hx of kidney stones
Cranberry Drug Interactions
Warfarin: Increase INR
Cranberry Lab Interactions
Increases serum and urine salicylate levels
Cranberry Disease Interactions
ASA allergy Atrophic Gastritis Diabetes Hypochlorhydria Kidney Stones
What are possible adverse effects of using cranberry?
D) GI side effects
D) GI side effects
Cranberry is contraindicated in all of the following EXCEPT
b) Aspirin allergy
c) History of kidney stones
d) Penicillin allergy
Which of the following about the effectiveness of cranberry is FALSE?
a) It is unclear whether cranberry juice and capsule form are equal in effectiveness.
b) To prevent UTIs an exact dose of cranberry has been recommended.
c) Some studies have shown a decrease in recurrent UTIs as a result of taking cranberry.
d) The Natural Medicines Comprehensive Database has listed Cranberry as “possibly effective” for UTIs.
To prevent UTIs anexact dose of cranberry has been recommended.
What is the active ingredient responsible for the MOA of Cranberry against bacterial pathogens?
Type 2 Diabetes
Three proposed mechanisms: slows the absorption of food from the GI tract, direct pancreatic beta-cell stimulation, promotes insulin sensitivity
Fenugreek in combo with sulfonylurea vs. sulfonylurea 0.35 g fenugreek TID after meals Significant reductions in FBG, 2h PBG, and HbA1c compared to placebo group
Fenugreek Dosage and Standardization
No standardized dosage among products 4 g of Fenugreek seed recommended
flatulence bloating diarrhea mild abdominal distention hypoglycemia
Should Fenugreek be used in pregnant women? nursing women? children?
No Use caution in nursing women and children
Fenugreek Drug Interactions
Anticoagulants: enhances effects of anticoagulants Conventional antidiabetic meds: enhance glucose lowering properties
a. In which of these patients would you most likely recommend the use of fenugreek?
i. Diabetic patient
ii. Pregnant patient
iii. Nursing mother
iv. Pediatric patient
a. What part of the plant has therapeutic effects?
i. The leaf
ii. The root
iii. The stem
iv. The seed
Which of the following is a common adverse effect of fenugreek?
ii. Muscle cramps
iv. GI upset
In making an argument ‘For’ the use of fenugreek, which of the following is true?
i. Fenugreek should always be used in combination
with other diabetic agents.
ii. Fenugreek may be used as an oral supplement to lower blood glucose and HgbA1c and to increase insulin sensitivity.
iii. Fenugreek will have no effect on PPG if mixed
with food and consumed.
iv. Fenugreek may be used as an oral supplement to lower blood glucose and HgbA1c, but it will decrease insulin
Fenugreek may be used as an oral supplement to lower blood glucose and HgbA1c and to increase insulin sensitivity.
Cat's Claw for _________
Part of Cat's Claw used for medicinal purposes
Cat's Claw MOA
Inhibits production of prostaglandin E1 and TNF-alpha in vitro (anti-inflammatory)
Cat's Claw Efficacy
Effective in osteoarthritis of the knee vs. placebo Pain relief only with activity, not at rest
Cat's Claw Dosage and Standardization
None Both 100 mg daily and 60 mg daily were used in clinical trials
Cat's Claw in Pregnancy?
Avoid: used to prevent and abort pregnancy
Cat's Claw Contraindications
Renal dysfunction Pts. using immunosuppressants
Cat's Claw Precaution
Pts. with active bleeds Hx of bleeding Hemostatic disorders (D/C 14 days before surgery or dental procedures)
Cat's Claw Drug Interactions
Anticoagulants/antiplatelets: due to potential antiplatelet effects Antiarrhythmics: antiarrhythmics effects in vitro Antihypertensives Diuretics Immunosuppressants CYP 450 metabolized agents Herbs or supplements with hypotensive effects Chemotherapeutic agents
In what formulations is Cat’s Claw Prepared
i. Liquid extracts
iv. All of the above
All of the above
Cat’s claw should be discontinued _________ before medical or dental procedure.
i. 3 days
ii. 1 week
iii. 14 days
iv. 1 month
Which medications interact with Cat’s Claw?
iii. Oral contraceptive
Cat’s Claw was proposed for the use in what ailment?
Chasteberry for ___________
Treatment of Pre-menstrual Syndrome
Portion of chasteberry used
Indirectly affects hormones and neurotransmitters including dopamine, ACh, and opioid receptors Higher doses inhibit prolactin release as a result of pituitary dopamine agonism Linoleic acid component: selective for estrogen receptors
Chasteberry Active Ingredients
Essential oils Irioid glycosides (agnuside) Flavonoids Diterpenes
Chasteberry Efficacy Profile
One trial showed no difference between chasteberry and fluoxetine One trial showed efficacy vs placebo
20-40 mg daily
Chasteberry in pregnancy?
C.I. in pregnancy and lactation
GI upset (N/D) HA Itching Urticarial rash acne insomnia irregular menstrual bleeding weight gain
Chasteberry Drug Interactions
Birth control, estrogens Dopamine agonists: due to increased dopaminergic effects Dopamine antagonists: due to interference with dopamine antagonism Metoclopramide: due to interference with dopamine antagonism
Chasteberry Disease Interactions
Hormone sensitive cancers/conditions In-vitro fertilization: could terminate viable embryos
Vitex agnus-castus (chasteberry) affects all of the
following hormones and neurotransmitters except:
What is the most common indication for chasteberry?
1. Benign prostatic hyperplasia (BPH)
2. Insect repellant
4. Premenstrual syndrome (PMS)
Chasteberry should be avoided during in-vitro fertilization because:
1. Chasteberry causes the death of sperm cells
2. Chasteberry causes potential hyperstimulation syndrome that terminates viable embryos
3. Chasteberry has potential effects on estrogen levels
4. Chasteberry’s dopaminergic effects cause spontaneous abortion
Chasteberry causes potential hyperstimulation syndrome that terminates viable embryos
All of the following medications interact with chasteberry except:
3. Birth controls
Zinc for ________
Treatment of Acne
Prevents granulocytes from being attracted to the vicinity of invading pathogens, thuse preventing inflammation
Conflicting Data In combination w/ erythromycin was more effective than erythromycin alone Another trial showed the Zinc in combination with erythromycin was less effective than benzoyl peroxide + erythromycin