Herbal medications.ppt

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Herbal medications.ppt

  1. 1. What medicines came from these plants and fungi? <ul><li>Willow </li></ul><ul><li>Wintergreen berry </li></ul><ul><li>Rye mold </li></ul><ul><li>Bread mold </li></ul><ul><li>Madagascar periwinkle </li></ul><ul><li>Pacific yew </li></ul><ul><li>Belladonna </li></ul><ul><li>Foxglove </li></ul><ul><li>Wormwood spp. </li></ul><ul><li>Cassia spp. </li></ul><ul><li>Autumn crocus </li></ul><ul><li>Snakeroot (Rawulfia spp.) </li></ul>
  2. 2. Top-selling Herbs <ul><li>Garlic, ginko, ginseng, ginger, green tea extract </li></ul><ul><li>Echinacea </li></ul><ul><li>Saw palmetto </li></ul><ul><li>Cranberry, and other berry extracts like acai, bilberry, blueberry and blackberry </li></ul><ul><li>Soy isoflavones </li></ul><ul><li>Black cohosh </li></ul><ul><li>St. John’s wort </li></ul><ul><li>Mild thistle </li></ul><ul><li>Valerian </li></ul><ul><li>Red yeast rice </li></ul><ul><li>Guarana, mate </li></ul><ul><li>Castor oil </li></ul><ul><li>Senna </li></ul><ul><li>Hot pepper oil </li></ul><ul><li>Yohimbe, goat weed </li></ul><ul><li>Hawthorne </li></ul><ul><li>Ma huang (ephedra) </li></ul><ul><li>Kava-kava, betel, coca leaf, qat, marijuana </li></ul>
  3. 3. Top-selling Supplements <ul><li>Glucosamine/chondroitin </li></ul><ul><li>Calcium and vitamin D </li></ul><ul><li>B vitamins </li></ul><ul><li>Vitamin E </li></ul><ul><li>Iron sulfate </li></ul><ul><li>Fish oil (and flax oil) </li></ul><ul><li>Probiotics, particularly lactobacillus </li></ul><ul><li>Coenzyme Q </li></ul><ul><li>Creating </li></ul><ul><li>S-adenosyl methionine (SAMe) </li></ul><ul><li>Melatonin </li></ul><ul><li>Colloidal silver </li></ul><ul><li>Innumerable “male enhancers” and “anabolic boosters” </li></ul><ul><li>Innumerable “colon- or liver-cleansers/detoxifyers” </li></ul>
  4. 4. Reasons patients take herbs/supplements <ul><li>Natural = safe </li></ul><ul><li>Natural = God’s will (i.e., not a product of human hubris) </li></ul><ul><li>Supplements promise results that currently only illegal drugs can achieve </li></ul><ul><li>Different system of health beliefs, i.e., Ayurveda, homeopathy and the doctine of signatures, traditional Chinese, Vodun-related beliefs </li></ul><ul><li>Many pt’s mix and match beliefs and systems freely </li></ul>
  5. 5. Case <ul><li>57 year old man with PMH of hypertension, on 2 HTN meds at baseline, comes to the ED complaining of severe headache and nausea, diminished urination </li></ul><ul><li>Found to have bp of 235/140, ISTAT of 0.32, Cr 4.5 (baseline 1.1). Attempts to control bp with bolus IV labetalol and hydralazine not successful, finally simultaneous IV labetalol and NTG drips worked to get sbp down to 200’s, able to titrate off drips starting about 18h after admission, troponin declined, renal failure resolved by discharge. </li></ul>
  6. 6. General principles <ul><li>Herbs/supplements are poorly researched in general due primarily to funding issues </li></ul><ul><li>Many herbs and supplements have effects, therefore side-effects </li></ul><ul><li>Regulation is deliberately very light and poorly funded—and supplements are often deliberately spiked with illicit modern pharmaceuticals </li></ul><ul><li>Consider subscribing to FDA alerts, browsing websites, subscribing to PDA herb/supplement databases </li></ul><ul><li>Ask your pt’s what herbs/supplements they are taking!! </li></ul>
  7. 7. Useful websites <ul><li>www.nccam.nih,gov/health/herbsataglance.htm (short list of herbs, effects, side effects, uses) </li></ul><ul><li>www.naturaldatabase.com (definitive database, monographs on herbs/supplements written by ethnobotanists, botanists, pharmacologists and peer reviewed—database from which most reputable sites get their info, but by subscription only) </li></ul><ul><li>www.nlm.nih.gov/medlineplus/druginformation.html (information for patients in lay language) </li></ul><ul><li>www.ods.od.nih.gov (office of dietary supplements </li></ul><ul><li>www.cfsan.fda.gov/~dms/ds-faq.html (frequently-asked questions about herbs/supplements and fda regulations) </li></ul><ul><li>www.cfsan.fda.gov/~dms/ds-warn.html (recent fda warning about problems with specific brand supplements) </li></ul>

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