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Herbal Remedies:

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Insect bites. Migraine headaches. FeverFew. Pharmacologic Properties. Sesquiterpene lactones ... Stick with the same product. Caution ! ! ! Do Not Use if: ... – PowerPoint PPT presentation

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Title: Herbal Remedies:


1
Herbal Remedies
  • Facts For Advanced Practice Nurses

2
Objectives
  • Explain the dramatic rise in the use of herbal
    products
  • Discuss the current laws dealing with herbal
    products
  • Discuss some of the most popular herbs used in
    the U.S.
  • Explain how an Advanced Practice Nurse should
    deal with patients considering the use of herbs

3
Reasons For Increased Use of Herbal Products
  • Disillusionment with modern medicine
  • Superior because theyre natural
  • Emphasis on disease prevention
  • Multimillion-dollar ad campaigns
  • Health conscious American public

4
The Dietary Supplement Health and Education Act
(DSHE)
  • Went into effect on October 25, 1994
  • Includes vitamins, minerals, amino acids and
    herbs
  • FDA does not regulate quality control
  • Category II or III OTC drugs
  • Must prove substantial and reasonable risk to
    ban the sale of a product

5
Advertisement of Herbal Products
  • Regulated by DSHE
  • Effect on physiological structure and function
  • Cant be labeled for treatment of a disease
  • Must include disclaimer
  • Names of products not regulated by FDA

6
Advanced Practice Nurses and Herbal Products
  • Economic opportunities
  • Lack of good scientific data
  • Little emphasis in colleges of pharmacy
  • Numerous CE courses available
  • Research manufacturers
  • Assume that patients may be taking herbal products

7
Aloe Vera
  • Tropical
  • Light Green Leaves that contain gel

8
Aloe Vera
  • History
  • 1500 BC
  • Ramses the 2nd and Jesus Christ

9
Aloe Vera
  • Various uses
  • External use - Skin application
  • Internal use - Aloe vera drinks

10
Aloe Vera
  • 96 water
  • The remaining constituents - Known as aloin
    made up of complex carbs, enzymes, vitamins, and
    minerals.

11
Aloe Vera
  • Sold OTC
  • Is available in many different preparations.

12
Aloe Vera
  • Conflicting reports and data
  • External vs. Internal use
  • Advanced Practice Nurse involvement

13
Arnica
  • Latin name is Arnica Montana
  • AKA Leopards Bane
  • Used for pain and inflammation

14
Arnica
  • Sesquiterpene lactones
  • Used externally
  • Toxic internally
  • Sold in lotions and creams

15
Bilberry
  • Vaccinium myrtillus aka Huckleberry
  • Low growing shrub
  • Fruit and leaves used since 16th century

16
Bilberry
  • Uses
  • Vascular and blood disorders
  • Visual uses
  • Gastro-intestinal

17
Bilberry
  • Diabetes 7-methyl delphinidin or
    other active substance.

18
Bilberry
  • Many uses
  • Need more proof
  • Bilberry is available now in various products

19
Cats Claw (Uncaria tomentosa)
  • Many different species
  • Tropical vine

20
Cats Claw
  • History
  • South America
  • Ashanica Indians

21
Cats Claw
  • Immune system booster
  • Antihypertensive
  • Stroke and heart attack
  • Cholesterol
  • Crohns disease
  • Gastric ulcers
  • Diabetes
  • Contraceptive

22
Cats Claw
  • No supporting clinical studies
  • Diarrhea reported

23
Dong quai (Angelica sinensis)
  • Extract from Angelica sinensis
  • All-purpose womens tonic herb
  • No supporting clinical studies
  • Discourage use

24
Dong quai
  • Claims
  • Menstrual cramps
  • Menopausal symptoms
  • Strengthens heart, liver, spleen, kidneys

25
Echinacea (Echinacea purpurea)
  • Most studied and used
  • Parthenium integrifolium L.
  • Traditional medicine by Native Americans

26
Echinacea
  • Claims
  • Immunostimulant
  • Wound healing

27
Echinacea
  • Pharmacological effects
  • Phagocytosis stimulation
  • Increased cellular respiratory activity
  • Increased WBC motility

28
Echinacea
  • Contraindications
  • Autoimmune disorders
  • Immunosuppressive therapy

29
Echinacea
New evidence
30
Evening Primrose OilCommon uses
  • Atopic eczema
  • Mastalgia
  • Diabetic neuropathy
  • Rheumatiod arthritis
  • Menopausal flushing

31
Evening Primrose OilPharmacologic Properties
  • Linoleic acid
  • Gamma-linoleic acid
  • essential fatty acids
  • precursors to prostaglandin
  • heart protective effect

32
FeverFewCommon uses
  • Headache
  • Menstrual irregularities
  • Stomachache
  • Arthritis
  • Insect bites
  • Migraine headaches

33
FeverFewPharmacologic Properties
  • Sesquiterpene lactones
  • Inhibit prostaglandin synthesis
  • Decrease platelet aggregation
  • Inhibit histamine release
  • Seratonin antagonist
  • Parthenolide

34
GarlicCommon uses
  • Antibiotic
  • Antiviral
  • Atherosclerosis
  • Reducing Blood Pressure
  • Reducing Cholesterol
  • Regulating circulatory system

35
GarlicPharmacologic properties
  • Allicin
  • antibiotic
  • antiplatelet
  • antihyperlipidemic
  • Ajoenes
  • antithrombotic

36
Ginger rootCommon uses
  • Ease congestion
  • Promote perspiration
  • Stimulates the circulatory system
  • Blocks muscle intestinal spasms
  • Provides stress relief
  • Indigestion, upset stomach
  • Motion morning sickness

37
GingerPharmacologic properties
  • Ginerols
  • Shogoals
  • Inhibit enzymes that produce
  • Prostaglandins
  • Leukotrienes
  • Clinical trials
  • /-

38
Ginkgo biloba
39
Ginkgo biloba
  • Background
  • Ginkgo tree
  • 2 lobed fan-shaped leaves
  • Seeds originally used

40
Ginkgo biloba
  • Active Constituents
  • Ginkgolides A, B, C, J, and M
  • Inhibit platelet activating factor (PAF)
  • PAF causes
  • Platelet aggregation
  • Bronchoconstriction
  • Peripheral vasodilation
  • Release of inflammatory mediators

41
Ginkgo biloba
  • Proposed Uses
  • Alzheimers dementia
  • Peripheral vascular disease
  • improves perfusion
  • Vertigo
  • Tinnitus
  • Short-term memory enhancement

42
Ginkgo biloba
  • Side Effects
  • Rare
  • Headache
  • Dizziness
  • GI upset
  • Standardization
  • 24 flavonoids
  • 6 terpenoids

43
Ginseng
  • Korean ginseng
  • (Panax ginseng)

44
Ginseng
  • Background
  • Human-shaped root
  • Different types of ginseng
  • Korean ginseng
  • American ginseng
  • Siberian ginseng

45
Ginseng
  • Active Constituents
  • triterpene saponins
  • structure related to steroids
  • no steroid effect

46
Ginseng
  • Proposed Uses
  • Adaptogen
  • Aphrodisiac
  • Improve athletic performance

47
Ginseng
  • Side Effects
  • Nervousness and excitation
  • Decrease with continued use or decreased dose
  • Hypoglycemia
  • Inverse relationship between dietary intake and
    stomach cancer

48
Ginseng
  • Standardization
  • Wide range in quantity of ginseng between ginseng
    products

49
Hawthorne
  • Derived from bright red berries grown on small
    bush
  • Very common in European medicine
  • Three dozen preparations marketed in
  • Germany

50
HawthorneUses
  • Increases blood flow to heart tissue
  • relieves angina
  • prevents arrhythmias
  • improves heart tone
  • Peripheral vasodilator
  • lowers blood pressure

51
HawthorneLimitations
  • Side effects at high doses
  • sedation
  • hypotension
  • arrhythmias
  • Safety and efficacy yet to be evaluated

52
Hawthorne
  • Appropriate Use
  • in healthy patients seeking a lifestyle
    supplemented with herbal therapies
  • Inappropriate Use
  • in patients with severe cardiovascular disease

53
Horse Chestnut
  • Aesculus hippocastanum
  • Derived from the dried seed extract
  • Related to American horse-chestnut and Ohio
    buckeye

54
Horse ChestnutUses
  • Increases overall venous tone
  • in turn improves return blood flow to heart
  • reduces edema caused by venous insufficiency
  • studies compared to compression stockings
  • Anti-inflammatory properties
  • treat phlebitis, varicosity, and hemorrhoids

55
Horse ChestnutLimitations
  • Relatively safe in recommended doses
  • Isolated cases of renal and hepatotoxicity

56
Horse Chestnut
  • Appropriate Use
  • in healthy patients
  • mild edema
  • Inappropriate Use
  • in patients with severe edema

57
Kava-kava
  • Member of the pepper family
  • Grows as a bush in the South Pacific
  • Derived from the extracts of the rhizomes

58
Kava-kavaUses
  • Anxiolytic
  • clinical studies showed reduction from 25.3 to
    12.6 on the Hamilton Anxiety Scale
  • Anesthetic
  • Anti-inflammatory
  • Antispasmodic

59
Kava-kavaLimitations
  • Mildly narcotic
  • euphoric changes such as elevated mood
  • Side effects at high doses
  • muscle weakness, visual impairment, dizziness,
    dry skin
  • Long term use
  • hypertension, reduced protein levels, liver
    damage, blood cell abnormalities

60
Kava-kava
  • Appropriate Use
  • in healthy patients
  • mild anxiety
  • Inappropriate Use
  • contraindicated for endogenous depression
  • sever anxiety
  • alcohol consumption

61
Milk Thistle (Silybum marianum)
  • Tonic for liver function
  • regenerates liver tissue
  • protects liver cells

62
Milk Thistle
  • Silybin
  • Hepatoprotectant
  • Classified as flavonolignans

63
Milk Thistle
  • Treatment of cirrhosis and hepatitis
  • Increased survival of cirrhosis
  • APAP and mushroom poisoning

64
Milk Thistle
  • Adverse reactions
  • Laxative effect

65
St. Johns Wort (Hypericum perforatum)
  • Versus SSRIs and placebo
  • Components
  • Hypericin-MAO inhibitor
  • Other components

66
St. Johns Wort
  • Uses
  • Depression
  • Anxiety
  • Inflammation
  • AIDS

67
St. Johns Wort
  • RPh shouldnt recommend dietary supplements for
    treatment of depression or AIDS

68
St. Johns Wort
  • Drug Interactions
  • Potentiate MAO inhibitors
  • MAO inhibitor-like reactions
  • tyramine-containing foods
  • dextromethorphan
  • SSRIs
  • sympathomimetics
  • TCAs

69
St. Johns Wort
  • Adverse Reactions
  • Phototoxicity

70
Saw palmetto (Serenoa repens, Serenoa serrulata)
  • American dwarf palm
  • Native to southern U.S. Atlantic coast
  • Officially used for many ailments before WWII
  • French extract Permixon used

71
Saw palmettoUses
  • Anti-androgenic, anti-inflammatory, and
    anti-estrogenic activity
  • Benefits shown in the treatment of BPH
  • Has yet to undergo FDA safety and efficacy testing

72
Saw palmettoStudies
  • Proposed mechanisms of action
  • inhibition of 5-alpha-reductase
  • inhibition of androgen-receptor binding
  • Results of study versus finasteride
  • greater reduction in IPS score
  • greater increase in urinary peak flow

73
Saw palmettoLimitations
  • Studies criticized for lack of placebo
  • Little or no bioequivalence data among products
    available
  • Limited toxicity data
  • SEs headache, nausea, and abdominal pain

74
Saw palmettoOverview
  • Inexpensive
  • Decreased side effects compared to other drugs
  • No effect on PSA level
  • Look for fatty acid or lipophilic extract
  • Maintain regular physician visits

75
Valerian (Valeriana officinalis)
  • Commonly used sedative in Europe
  • Alternative to anxiolytic medications
  • Previously used to relieve menstrual and stomach
    cramps

76
Valerian
  • Popular herb all over the world
  • Major ingredient valerian acid
  • Available as tea, tincture, or capsule
  • Effects seen within one hour of administration
  • Hangover not associated with use

77
ValerianStudies
  • Used in patients suffering from sleep dysfunction
  • Results of study using extract
  • improved sleep quality
  • decreased sleep latency
  • Most benefit seen in smokers and poor sleepers

78
ValerianLimitations
  • Evidence subjective
  • SEs headache, excitability, and insomnia
  • Tea and tincture have foul odor
  • Depression possible after prolonged use

79
ValerianOverview
  • FDA generally regards as safe
  • Kava-kava and St. Johns Wort effective
    alternatives without the odor
  • May be most beneficial in smokers and poor
    sleepers

80
Requirements for Dietary Supplement Labels
  • Statement of identity (ex. Ginko biloba)
  • Net quantity of contents (ex. 50 capsules)
  • Directions for use (ex. 1 cap tid)
  • Constituent panel (ex. serving size, amt.,
    active ingredient)
  • Other ingredients (in descending order)
  • Name, place, address of manufacturer
  • Structure-function claim and statement

81
Advice for the Patients on the Use of Herbal
Products
  • Fraudulent Products/Claims
  • Quality Products
  • Caution With Use
  • RPhs Role in Patient Care

82
Fraudulent Products
  • Avoid break through, miracle cure, etc
  • Careful with detoxify, purify, energize
  • Claims for wide ranges of diseases
  • Backed by scientific studies
  • Benefits WITHOUT side effects
  • Notions about the medical community hiding
    information

83
Quality Products
  • Consider the manufacturer
  • Single agent products
  • Part of the plant used (ex. Saw Palmetto berries
    vs. the roots)
  • Stick with the same product

84
Caution ! ! !
  • Do Not Use if
  • Pregnant or Breast Feeding
  • Chronically Ill
  • Elderly
  • Under 18 y.o.
  • Taking Rx and OTC Medications
  • Discontinue STAT if Adverse Reaction!

85
Advanced Practice Nurses Role
  • Recognize a potential benefit
  • Do not criticize
  • Encourage to inform health care providers about
    product use
  • Inquire about successful outcomes
  • FDA Med-Watch Reporting

86
Conclusions
  • Herbals Drugs ????
  • Regulation and GMP
  • RPh Recommendations
  • Be There For The Patient
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