Phototherapy pharmacy

1. Phytotherapy
Dr. Rehab Hussein
Associate Prof. of Pharmacognosy.

2. Cardiovascular system problems
1- Congestive heart failure (CHF) ‫القلب‬ ‫فشل‬
‫االحتقاني‬ .
2- Hypertension .
3- Arteriosclerosis ‫الشرايين‬ ‫تصلب‬and arterial occlusion.
4- Angina pectoris.‫الصدرية‬ ‫الذبحة‬
5- Cardiac arrhythmiasis‫القلب‬ ‫ضربات‬ ‫انتظام‬ ‫عدم‬ .
6- Chronic venous insufficiency ‫المزمن‬ ‫الوريدي‬ ُ‫ر‬‫القصو‬.

3. 1- Congestive heart failure (CHF)
This is one of the common causes of death particularly in old age.
Causes:
Coronary artery diseases (arteriosclerosis).
Hypertension.
Congestive heart failure occurs when the cardiac output is
inadequate to provide the oxygen needed by the body .
Symptoms:
shortness of breath.
tiredness.
retention of salt and water leading to ankle swelling due to reduced
blood flow in the kidney .

4. Drug therapy of CHF :
1- A cardio tonic substance which improve the
function of the heart but under strict supervision of a
specialist.
2- A mild diuretic .
3- Vasodilator may be used such as ACE inhibitor or
β- blocker .

5. Herbal treatment of CHF :
1- A cardiotonic glycoside containing herb :
Cardenolides and bufadienolides have a positive inotropic
effect on the heart but they are not suitable for self treatment
due to their high toxicity .
Examples of these herbs are :
Digitalis purpurea (foxglove) and D. lanata .
Strophanthus kombe and other S. species .
Urginea maritima or Squill .

6. Cardiac glycosides , Mechanism of action:
The active principles of all mentioned herbs are complex
steroidal substances known as cardiac glycosides .
The most important cardiac glycosides are digoxin, digitoxin
present in Digitalis purpurea and the more powerful lanatosides
present in D. lanata .
Action:
Cardiac glycosides bind to the heart muscle leading to increase the
force of contraction of the heart without increasing the oxygen
consumption, thus the heart pumps more efficiently (positive
inotropic action).

7. 2- Crataegus = Hawthorn
It contains procyanidins, flavonoids (hyperoside, rutin
and vitexin)and cardiotonic amines.
Biological actions :
Increases coronary and myocardial circulation.
Improves myocardial contractility(positive inotropic).
Anti-arrhythmic effect.
Coronary and peripheral vasodilator.
Hypotensive.

8. 2- Hypertension
Hypertension is the most common cardiovascular disease,
which is defined as blood pressure ≥140/90 mm Hg.
Sustained arterial hypertension damages blood vessels in
kidney, heart and brain leading to increased incidence of
renal failure, coronary diseases, cardiac failure and stroke.
The antihypertensive agents include diuretics , direct
vasodilators, calcium channel blockers, adrenergic and
ganglionic blocking agents.

9. Hypertension (cont.)
Types:
Essential hypertension:
In about 90% of cases with hypertension there is no
identifiable cause.
Secondary hypertension:
The main cause is kidney diseases, contraction of the aorta,
endocrine diseases and pregnancy.
Generally, treatment of both types is the same, but the
cause should also be treated if possible.

10. Diet and lifestyle for hypertension:
Aerobic exercise for 20-60 minutes /day.
Weight loss.
Diet rich in fruits and vegetables .
Low fat dairy products.
Restriction of sodium salt.
Reduction of caffeine intake.
Use of high potassium and high magnesium salts.
6 g / day of fish oil had a mild lowering effect.

11. Herbal treatment of hypertension:
1- Hawthorn = (Crataegus) :
This herb has atrophic effect on the heart muscle , as well as ,
reducing high blood pressure .
The leaves are apparently more potent than berries for
reducing high blood pressure.
2- Garlic (Allium sativum) :
Due to its content of allicin- releasing preparation, garlic play
an important role in blood pressure management.

12. Herbal treatment of hypertension(cont.)
3-Valerian ( Valeriana species) :
Due to its content of essential oil and epoxy irridoid compounds known as
valepotriates.
Action:
valerian has a general calming effect on the nervous system, usually prescribed to
stressed patients.
4- Olive leaves (Olea europaea)
Due to its content of seco-irridoid (oleouropein).
Action:
1- Angiotensin converting enzyme activity (ACE inhibitor).
2- Calcium channel blocker activity.
3- Anti-oxidant.

13. 3- Arteriosclerosis and arterial occlusion
Hyperlipidemia which is the cause of atherosclerosis and arterial
occlusion has been defined as plasma cholesterol and triglyceride (TG)
levels that exceed normal level.
Hypercholesterolemia may occur as a result of genetic disorder ,
diabetes mellitus , smoking and hypertension.
Arteriosclerosis is characterized by fatty deposits in the arteries
accompanied with fibrosis and calcification of the inner walls which
leads to myocardial infarction and stroke.

14. Dietary treatment (Diet therapy )of
Arteriosclerosis
Reduced saturated fat intake .
Soluble fibers from fruits, vegetables, legumes, oats and
rice should be increased.
Oily fish consumption should be increased .
Cholesterol intake should be decreased .
Avoid alcohol intake .

15. Phytotherapy of Arteriosclerosis
Several herbs are commonly used for decreasing blood cholesterol
level and low density lipoprotein (LDL) and hence they have great
significance in management hypercholesterolemia and related
disorders :
Artichoke , Garlic , Ginseng , Silybum & Hawthorn.
Herbs rich in mucilage as Psyllium .
Gums as Guar .
Fibers as Bran.

16. Herbs of Arteriosclerosis(cont.)
1- Garlic (Allium sativum F. Liliaceae) :
It contains a large number of sulphur compounds , which are
responsible for the flavor and odor of garlic, as well as, the medicinal
effects .
The main constituent in the fresh plant is V.O. contain :
Alliin allicin (odorous and unstable yielding many S- compounds
(ajoenes) .
Action:
Treatment and prevention of hyperlipidemia , decrease LDL.
Anti-oxidation and anti-diabetic.
Adjunct in hypertension treatment.

17. Herbs of Arteriosclerosis(cont.)
2- Green tea (Camellia sinensis F.Theaceae)
Due to its content of catechin polyphenols.
Action:
1- Delay the reaction of gastric and pancreatic lipases in the body.These
enzymes responsible for converting calories in the body into fat. so stop fat
from being stored and prevent obesity.
2- Treatment of coronary artery disease.
3- Treatment of peripheral vascular disease. (PVS).
4- Anti-oxidant, hepatoprotective and immunostimulant.

18. 4- Angina pectoris
Ischemia of the heart muscle, due to mechanical obstruction (mainly arterial
narrowing of the blood supply). The main symptoms are chest pain.
Herbs used in treatment :
1- Khella (Ammi visnaga F. umbelliferae)
Constituents: visnadin.
Furano-chromone (khellin and visnagin)
Uses: Coronary vasodilator.
N.B. visnadin showed a higher vasodilator potency than khellin and visnagin.
Khellin and visnagin exhibit antispasmodic and smooth muscle relaxant effect in
case of renal calculi.

19. Herbal treatment for Angina
2- Inula racemosa
Constituents: Inulin and sesquiterpene lactone.
Action: Natural β- blocker.
3- Capsicum
Has a fibrinolytic activity and used to improve myocardial blood
supply.
4- Lime flower (Tilia species) andValeriana
They are used for treatment of angina associated with stress and
anxiety.

20. 5- Cardiac arrhythmiasis
Result from disturbance in impulse formation or impulse
conduction or both (abnormal pacemaker activity and abnormal
impulse propagation).
Herbs used in treatment:
1- Quinidine: the alkaloid from various Cinchona species bark,
has a prophylactic use in atrial fibrillation ‫األذينى‬ ‫الرجفان‬
.
2- Hawthorn (Crataegus):
Leaves and flower extracts showed significant reduction in the
duration of fibrillation and the occurrence of tachycardia.

21. Herbs for arrhythmiasis (cont.)
3- Rauwolfia (Rauwolfia serpentina f. Apocyanaceae)
Ajmaline derived from R. serpentina has been found to possess
potent anti-arrhythmic effect.
N.B. Reserpine alkaloid has anti-hypertensive effect.
4- Ginseng (Panax ginseng (F. Araliaceae)
Due to its content of ginsenoside (Triterpenoid saponins), used as
antioxidant, immunostimulant, ttt of anemia, stress and
arrythmiasis and protect from cancer.

22. N.B. Ginseng is adaptogen ; improve body overall ability to adapt
with negative effects of physical and environmental stress.
Improve mental performance.
Strengthen body functions and immune system.
Tonic which increase energy during physical activity.

23. 6- Chronic venous insufficiency
Diseases of the venous system include : varicose veins, varicose
eczema and varicose ulcer .
Cause:
Varicose veins largely occur as a result of destruction of the
network of ‘’ proteoglycan ‘’ in the elastic tissue of the vein wall
by lysosomal enzymes .
This situation causes an abnormal dilatation of the vein and a
passage of electrolytes , proteins and water through the venous
wall leading to edema formation .

24. Life style for varicose veins
1- Fruits and vegetables intake should be increased to maintain
optimum levels of flavonols and the supportive elements .
2- Regular walking .
3- Resting or sleeping with legs elevated .
4- Elastic stocking are useful , specially if applied in the morning .
5- Cold water should be applied to the legs from the knee to the
foot to stimulate circulation .

25. Phytotherapy of varicose veins
1- Horse chestnut seeds (Aesculus hippocastanum ) :
It contains a mixture of triterpenoid saponin glycosides which are
β– aescin and α- aescin , in addition to coumarins (e.g. aesculetin)
, flavonoids and tannins.
Several mechanisms explain “ aescin’’ effects :
a- The ability to inhibit lysosomal enzyme activity .
b- Reduce the number and diameter of the capillary pores and
thus, decreases water and proteins filtration.
c- Increases the tone of the veins.

26. Aescin for varicose veins
Aescin is less potent than Horse chestnut extract .
The combination of aescin with flavonoids “ present in the extract
“ is superior to aescin alone.
Aescin is a registered drug in Germany and is used in number of
preparations either topically or orally for the treatment of
peripheral vascular diseases.

27. Herbs for varicose vein (cont.)
2- Butcher ̕s broom root and rhizomes
The drug contains steroidal saponins mainly ruscogenin and
neoruscogenin. In addition to flavonoids.
Action:
1- constriction of venules without affecting arterioles.
2- stimulation of adrenergic receptors i.e. increase the venous tone.
3- supportive therapy for discomfort of chronic venous insufficiency,
such as pain and heaviness, cramps in the legs and swelling
4- therapy for hemorrhoids complaints such as itching and burning

28. 3- Grape seeds extract (Seeds of Vitis vinifera F. Vitaceae)
Constituents: polyphenols (procyanidins)
Action: strong antioxidant activity (free radicle scavenger and inhibit of lipid
peroxidation).
Stronger effect than vitamin C and E.
N.B. Diosmin, Hesperidin and Rutin flavonoids are used for treatment of venous
insufficiency and varicose vein.