CM Final 2

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CM Final 2
2013-04-07 12:38:06
aa emory clinical methods

CM final - Herbal medicines and anesthsia
Show Answers:

  1. Define Dietary supplement:
    Not Drugs.  Manufacturer responsible for safety.  FDA takes action only if there is a problem. Cannot claim to "treat" on label.
  2. Dietary supplements include:
    • Nutrients: vitamins, min, amino acids
    • Botanicals: herbs, extracts
    • Glandular extracts: animal or synthetic
  3. What conventional drugs were originally form a plant source?
    • apsirin: willow bark
    • Digoxin: foxglove
    • Ephedrine: ma huang
    • Atropine: belladonna alkaloids
  4. Commonly missed on history and pre-op:
    nutraceuticals.  must ask the question
  5. Aloe uses and concerns:
    • Uses: digestin, cathartic (laxative), topically for burns, infections, wounds
    • concerns: HYPOKALEMIA (due to diarrhea)
  6. Echinacea uses and concerns:
    • Uses: Upper RI, flu
    • concerns:  Immunostimulant, inhibits CYP3A4 which can cause toxicity of certain drugs, hepatic inflammation
  7. Echinacea inhibits CYP3A4, which causes risk of toxicity with what drugs?
    Alpazolam, Ca2+ channel blockers, protease inhibitors
  8. Garlic uses and concerns:
    • Uses:  HTN, hyperlipidemia, infections, cancer prevention and tx, atherosclerosis
    • Concerns:  inhibit plt aggregation, induce CYP450, decrease effectiveness of cyclosporin and saquinavir
    • Toxicity:  GI and hemorrhage
    • Drug interaction:  INCREASE INR with warfarin
  9. Garlic will _____ INR when used with warfarin
  10. Ginseng uses and concerns:
    • Uses:  immunostim, improve stamina, DM, menopause
    • Potential concerns:  HTN, tachy, bledding, CNS stim, hypoglycemia. 
    • Toxicity causes HTN, tachycardia
    • Drug interactions:  decrease INR with warfarin, increase hypoglycemia fx with insulin and sulfonylureas, increase manic-like episodes with MAOIs
  11. When taking Ginseng and warfarin, INR will be ___________.
  12. SAW palmetto uses and concerns and drug interactions:
    • Uses: BPH, chronic pelvic pain, bladder disorders
    • concerns: intraop bledding, n/v diarrhea
    • Drug interactions: anticoags. increase bleeding
  13. St. John's Wort uses, concerns and drug interaction:
    • Uses: Depression, anxiety, sleep disorders, seasonal affective disorder, PMS
    • Concerns:  weak Maoi or SSRI (risk of seratonin syndrome)
    • Drug interactions:  Induction of CYP450, 3A4, Cyp2C9.  alters a lot of drugs.
  14. St johns wort interacts with
    • Ca2+ channel blockers, warfarin, digoxin, OCP.
    • OR drugs: opioids, symapthomimetics, benzo's.
    • *regional anesthesia preferred due to poptential cardiac colapse
  15. CoQ10 uses and interactions:
    • Uses: CHF, CAD, HTN, hyperlipidemia, DM, increase enery, antioxidant
    • Concerns:  Hypoglycemia, DECREASE effectiveness of Warfarin,  decrease in Statins in body
  16. Dong Quai uses and concerns:
    • Uses: Menopause, Gyn issues
    • Concerns: Plt aggregation inhibition
    • Interactions: INCREASE INR with warfarin, hormone meds (b/c estrogen-like effects)
  17. Vitamin E uses and concerns:
    • Uses: Antioxidant, antiaging, heart health, cancer prophylaxis, fibrocystic breast syndrome
    • concerns: Bleeding with high dose ( 800mg )
    • *fat soluble vitamin from plants
  18. How soon should dietary supplements be stopped prior to surgery?
  19. Is dietary supplement a reason to postpone surgery?
    yes- possibly
  20. Which drugs increase INR with warfarin?
    • Dong Quai
    • Garlic
  21. Which drugs cause a DECREASE in INR with warfarin?
    • Ginseng
    • CoQ10
  22. Ginkgo biloba uses and concerns:
    • Uses:  Circ disorders, increased mental acuity, tinnitus, vertigo, respiratory dz, sexual dysfunction
    • Concerns: inhibit plt activating factor, neurotoxin in seed and leaf
    • Toxicity:  GI discomfort, HA, dizziness, bleeding, seizures
    • Drug interactions: warfarin, MAOIs
  23. How long should the following drugs be stopped before surgery?
    St. Johns Wort
    • Garlic- 7 days
    • Ginkgo- 36 hours
    • Ginseng- 7 days
    • St. Johns Wort- 5 days