Herbal Medicines Exam 1

  1. Name four herbs used for BPH
    • saw palmetto
    • pygeum
    • pumpkin
    • stinging nettle
  2. Serenoa repens
    saw palmetto
  3. saw palmetto MOA
    Inhibits 5-alpha reductase types 1 and 2
  4. saw palmetto dosage
    • 320 mg QD or 160 mg BID
    • takes 4-6 weeks to work
  5. saw palmetto safety/adverse effects
    case report of bleeding; avoid in pregnancy; GI
  6. saw palmetto drug interactions
    • androgenic drugs
    • anti-androgenic drugs
  7. saw palmetto active compound
  8. saw palmetto part of plant used
  9. Pygeum africana
  10. pygeum MOA
    might inhibit growth factors
  11. pygeum dosage
    • 75-200 mg/day; may be taken QD or BID
    • takes a few months to work
  12. pygeum safety/adverse effects
    • likely safe
    • GI events
  13. pygeum drug interactions
  14. pygeum active compound
    • 14% triterpenes
    • 0.5% docosanol
  15. pygeum part of plant used
  16. Cucurbita pepo
    Cucurbita moschata
  17. pumpkin dosage
    480 mg/day in 3 divided doses taken with saw palmetto
  18. pumpkin safety/adverse effects
    electrolyte imbalance
  19. pumpkin drug interactions
  20. pumpkin part of plant used
  21. Urtica dioica
    stinging nettle
  22. stinging nettle MOA
  23. stinging nettle dosage
    • 300 mg capsule BID for 6-9 weeks
    • 80mg extract/day with saw palmetto
  24. stinging nettle safety/adverse effects
    potential with diuretics and/or hypertensive agents
  25. stinging nettle active compounds
    "nothing really special" (chlorogenic acid and kaempferol, also found in apples)
  26. stinging nettle parts of plant used
    • roots --> used for BPH
    • leaves
  27. Name two herbs used for UTI
    • cranberry
    • bearberry
  28. Vaccinium marcrocarpon
  29. cranberry MOA
    • urine acidification
    • e.coli adhesion
  30. cranberry dosage
    • 8-16 oz of pure juice/day for prevention of UTI
    • not as good evidence for treatment
  31. cranberry safety/adverse effects
    good, but could be risky for those who form kidney stones easily
  32. cranberry drug interactions
    possibly warfarin
  33. cranberry active compound
    anthocyanins (antioxidant, anti-inflam.)
  34. cranberry part of plant used
  35. Arctostaphylos uva-ursi
  36. bearberry MOA
    antibacterial, urinary antiseptic for uncomplicated cystitis
  37. bearberry dosage
    3 g/day of dried leaf = 400-800mg arbutin/day until disappearance of symptoms (maximum of 12 weeks)
  38. bearberry safety/adverse effects
    Nausea/vomiting (due to high tannin content)
  39. bearberry drug interactions
    corticosteroids, diuretics, NSAIDs
  40. bearberry active compound
    arbutin - sugar breaks down in alkaline urine to hydroquinone (anti-microbial)
  41. bearberry part of plant used
  42. Name 6 herbs with gynecological indications
    • chasteberry
    • black cohosh
    • soy
    • red clover
    • dong quai
    • wild yam
  43. Vitex agnus castus
  44. chasteberry indications
    • menstrual irregularities
    • menopause/PMS symptoms
    • female infertility
  45. chasteberry MOA
    acts at dopamine receptors to prevent prolactin formation
  46. chasteberry dosage
    • 30-40 mg/d extract
    • 500mg TID powdered berries
    • single dose each morning before breakfast throughout the cycle
  47. chasteberry safety/adverse effects
    • well-tolerated
    • allergic reactions
    • headaches
    • increase in menstrual flow
  48. chasteberry drug interactions
    • AVOID with dopamine agonists/antagonists
    • AVOID during pregnancy and lactation
  49. chasteberry active compound
    agnuside - not active compound but marker compound (quality measure)
  50. chasteberry part of plant used
    dried, ripe berries
  51. Cimifuga racemosa
    black cohosh
  52. black cohosh indications
    symptoms of menopause (hot flashes, mood swings, fatigue)
  53. black cohosh MOA
    SERM effects (can be estrogenic or anti-estrogenic in tissues)
  54. black cohosh dosage
    • ethanol extract: 40 mg of dried rhozome/root/day
    • remifenin: standardized extract = each 20 mg tablet contains 1mg active compound = 40 mg/day
  55. black cohosh safety/adverse effects
    • no GRAS status (“undefined” safety)
    • GI upset due to high tannins
    • may cause liver disease
    • may cause hypotension
  56. black cohosh drug interactions
    • contraindicated in pregnancy
    • use for no more than 6 months due to lack of long-term data
    • use cautiously in breast cancer, uterine cancer
    • allergy to aspirin
    • contraindicated in patients with known estrogen sensitive condition
    • atorvastatin
  57. black cohosh active compound
  58. black cohosh part of plant used
  59. Name two phytoestrogens
    • soy
    • red clover
  60. Glycine max
  61. soy dosage
    • soy protein: 20-60 g
    • concentrated soy isoflavone extracts: providing 35-120mg isoflavones daily
  62. The beneficial components of soy
    fatty acids
  63. What should the ratio of omega-6 to omega-3 be?
  64. active compound of both soy and red clover
  65. Effects of phytoestrogens in human health
    • Cancer preventive
    • Post-menopausal supplement
    • Prevention of osteoporosis
    • Cardiovascular health
  66. Trifolium pratense
    red clover
  67. red clover part of plant used
    flowering tops
  68. red clover (isoflavones) dosage
    • hormone replacement: 40-80mg/day
    • hypercholesterolemia: 28.5mg, 57mg, 85.5mg/day
    • osteoporosis: 40mg/day
    • menopausal symptoms: 40mg, 80mg, or 160mg/day
  69. Two therapies for hot flashes that do not work very well, if at all
    • dong quai
    • yam cream
  70. Angelica sinensis
    dong quai
  71. What are some traditional uses of dong quai (but probably don't work well, if at all)?
    • dysmenorrhea
    • premenstrual syndrome (PMS)
    • menopausal symptoms
    • (doesn't work because dong quai doesn't contain any phytoestrogens)
  72. What does dong quai contain that increases bleeding risk?
    Coumarin derivatives
  73. dong quai dosage
    4.5g of powdered dong quai root
  74. dong quai safety/advers effects
    • well tolerated
    • risk of photodermatitis (psoralen derivatives)
  75. Disocorea species
    wild yam
  76. Uses for wild yam
    • menopausal complaints
    • osteoporosis
    • precursor for commercial chemical synthesis of human steroidal hormones
    • (however wild yam is not good for any of these because diosgenin does not convert into progesterone in the body)
  77. Wild yam applied topically is no better than placebo. True or false?
  78. Name 7 natural products with CV indications
    • garlic
    • red yeast rice
    • oat bran
    • artichoke
    • hawthorn
    • fish oil
    • horse chestnut
  79. Allium sativum
  80. garlic indication
  81. garlic MOA
    • regular garlic inhibits HMG-CoA (cholesterol lowering effect)
    • aged garlic scavenges reactive oxygen species (ROS)/free radicals (antioxidant effect)
    • aged garlic stimulates immune system
  82. garlic dosage
    • 600-900mg tabs or caps daily
    • odorless formulations other than EC tabs may be less effective
    • must be taken for 6 wk-2 mo for maximal effect
    • dried garlic leaves require enteric coating
  83. garlic safety/adverse effects
    • GRAS status
    • GI upset and odor
  84. garlic drug interactions
    • can enhance effects of warfarin
    • Norvir (GI toxicity)
    • Saquinavir (decreased effectiveness)
  85. garlic active compound
    allicin (gives garlic odor- odiferous)
  86. garlic part of plant used
  87. Monascus purpureus
    red yeast rice
  88. red yeast rice indication
    high cholesterol
  89. red yeast rice MOA
    HMG-CoA reductase inhibition
  90. red yeast rice dosage
    • Traditional dosage: 6-9g/day
    • Recommend dose (extract): 1.2g/day
    • Cholestin capsule contains 600 mg of red yeast rice (off the market)
    • (NOTE: Dr. Butterweck does not recommend red yeast rice. Suggest garlic or prescription statin instead.)
  91. red yeast rice safety/adverse effects
    mild: heartburn, flatulence, dizziness
  92. red yeast rice drug interactions
    • additive effect with statins and grapefruit juice
    • not recommended in pregnancy
  93. red yeast rice active ingredient
    Monacolin K or mevinolin
  94. Avena sativa
  95. oat part of plant used
    • oat brain (mostly)
    • seeds
    • straw
  96. oat indications (orally)
    • hypercholesterolemia
    • diabetes
    • lowering uric acid levels (may prevent gout)
  97. oat indications (topically)
    • seborrhea
    • dry and itchy skin
  98. oat active compound
    • beta-glucan (oat gum)
    • builds a 3-dimensional network that will form a gel
    • a water-soluble polysaccharide
  99. oat MOA (due to beta-glucan)
    • binds with bile acids
    • decreases cholesterol absorption
    • increases the viscosity of foods (delay absorption of food)
  100. oat dosage
    hypercholesterinaemia: 56-150g of whole oat products
  101. Under what conditions can the health claim for an oat products to claim it reduces the risk of heart disease?
    • if they contain at least 750mg of soluble fiber per serving
    • approximately 3g of soluble fiber taken daily
  102. Cynara scolymus
  103. artichoke part of plant used
    leaves from the stems
  104. artichoke indications
    mild to moderate hyperlipidemia (lipid lowering effects)
  105. artichoke MOA
    HMG-CoA reductase inhibition
  106. artichoke dosage
    artichoke leaf extract: 320-640mg PO TID
  107. artichoke safety/adverse effects
    • mild GI disturbances
    • allergic reactions
    • allergic contact dermatitis
  108. artichoke drug interactions
    • no interactions with other medications reported
    • no toxic effects reported due to overdose
    • no restriction on duration of treatment
    • GRAS
  109. Crataegus species
  110. hawthorn part of the plant used
    leaves and flowers (high in flavonoids)
  111. Two species of hawthorn
    • Crataegus monogyna
    • Crataegus laevigata
  112. hawthorn standardization
    flavonoids: 0.6-1.5% (calculated as hyperoside)
  113. hawthorn active compound
    proanthocyanidins (OPCs)
  114. hawthorn indications
    • hydroalcoholic extracts: declining cardiac performance (NYHA Class II)
    • herbal teas: nervous heart complains, support of cardiac and circulatory function
  115. hawthorn safety/adverse effects
    • in general, very well tolerated
    • mild GI complaints (due to high tannin content)
    • mild vertigo
    • mild headache
    • mild sleeplessness
    • safe, when used short-term (e.g., 6 months)
    • avoid use during pregnancy and lactation
    • no toxic effects reported during overdose
  116. hawthorn drug interactions
    • conventional cardiovascular drug therapy
    • no reported
  117. Hawthorn can be safely used with diuretics and laxatives. True or false?
  118. hawthorn MOA
    • increases force of contraction and lengthens refractory period
    • increases coronary blood flow and cardiac output and reduces oxygen consumption
    • increases membrane permeability for calcium and phosphodiesterase inhibition
    • increases cAMP (vasodilation and positive isotropic effects)
  119. hawthorn dosage
    • 160-900 hawthorn extract per day in 2-3 divided doses
    • use 4 to 8 weeks to determine benefit
    • Note: Dr. Butterweck recommends 900mg/day
  120. benefits of omega-3 EPA/DHA in fish oil
    • heart health
    • brain development
    • brain function
    • asthma
    • visual acuity
    • immune function
    • arthritis
    • skin & hair health
  121. fish oil dosage
    • two 4 oz. serving of fatty fish per week
    • 496mg of EPA+DHA [er dau
    • total EPA+DHA consumption of 56-100mg/day
  122. horse chestnut active compound
    • terpenoid compounds (escin, aka aescin)
    • coumarin derivative (e.g., aesculin from the bark, leaves twigs)
  123. horse chest nut standardization
    16-20% triterpene glyycosides calculated as escin (aescin)
  124. horse chestnut indication
    vericose veins (chronic venous insufficiency)
  125. horse chestnut dosage
    300 to 900mg of a 16% extract
  126. horse chestnut safety/adverse effects
    • FDA status: unsafe herb
    • Toxicity: attributed to the glycoside Aesculin, a warfarin-like structure (dilation of pupils, diarrhea, vomiting, paralysis)
  127. horse chestnut drug interactions
    • anticoagulants (theoretically)
    • no interaction reported
    • not to be used in pregnancy and lactation (applies to most every plant)
  128. Aesculus hippocastanum
    horse chestnut
  129. Latin name and English name: Cort.
    • cortex
    • bark
  130. Latin name and English name: Fol.
    • folium, folia
    • leave, leaves
  131. Latin name and English name: Frct.
    • fructus
    • fruits
  132. Latin name and English name: Pericarp.
    • pericarpium
    • peel
  133. Latin name and English name: Rad.
    • radix
    • root
  134. Latin name and English name: Rhiz.
    • rhizome
    • rhizome
  135. Latin name and English name: Sem.
    • semen
    • seed
  136. Latin name and English name: Flor.
    • flores
    • flowers
  137. Chemically defined constitutuents of herbal drugs of interest for control purpoces only.
    • marker substances
    • (may be independent of whether they have any therapeutic activity or not)
  138. Defined as all measures during manufacturing process and quality control to yield reproducibility.
  139. Parameters influencing extract composition (i.e., extract quality) related to HERB MATERIAL
    • extractive concentration
    • water content
    • drug particle size
    • powder fraction
  140. Parameters influencing extract composition (i.e., extract quality) related to SOLVENT EFFECTS
    • solvent type(s)
    • modifier concentration
    • solvent amount
    • flow-through rate
  141. Parameters influencing extract composition (i.e., extract quality) related to MANUFACTURING PLANT
    • filling amount
    • filling height (density)
    • static pressure
  142. Parameters influencing extract composition (i.e., extract quality) related to MANUFACTURING PROCEDURE
    • extraction mode
    • extraction time
    • extraction pressure
    • batch size
  143. Extracts prepared from the same (plant) material are similiar. True or false?
    False. Not necessarily.
  144. Describe 5 ramifications of the Dietary Substance Health Education Act
    • Food Safety Division of the FDA regulates herb products, not the Drug Division
    • No safety or efficacy tests required, but manufacturer is responsible for safety
    • No adverse event report to FDA necessary
    • No TREATMENT claim, but "structure-function" claims are acceptable
    • To halt sale or distribution, the FDA must prove that the product is "unsafe" (i.e., the manufacturer does not)
  145. Herbal medications may be produced ___________ the assurance of compliance standards for Good Manufacturing Practice.
  146. Herbal medications may be marketed ____________ prior approval of EFFICACY and SAFETY from the Food and Drug Administration (FDA).
  147. Name two reputable resources regarding herbal medicines.
    • Germany's Commission E
    • ESCOP Monographs
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Herbal Medicines Exam 1
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