Herbs,Supplements , Spices and Other Product Interactions - PowerPoint Presentation

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Herbs,Supplements, Spices and Other Product Interactions

Presented by: Debbie Rosenberger BSN, RN- BC University of Mary Hardin-Baylor

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Conflicts of interestI have no potential conflict of interest in relation to this educational activity or presentation.

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Objectives

Discuss some current medication types and possible changes to how we ask questions.Describe a few of the more commonly used herbs/spices and their potential affect.List common complications for certain herbs/spices not commonly known.

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Case Study #121 year old nursing student arrives for a TB skin test which was applied. Afterwards she keeps oozing from the site to fill a 2x2.

Did you use the wrong gauge needle? Nope, 27 gaugeDid you not get a wheel – induration? Nice induration noted

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Questions explored:

Are you taking blood thinners? Answer: NoHave you taken NSAIDS? Answer: Yes, 2 Advil yesterday

Are you taking anything else? Yes, turmeric for arthritis and I’m having oral surgery in 2 days

You would tell her to check with her local pharmacist for ½ life of turmeric and

Student to call her surgeon’s office to advise about use of turmeric

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Case Study #265 year old man arrives comatose to the ER.

All lab work, testing and scans are normal.Patient wakes up in ICU after two days and is alert and oriented.Later that day he asks that his wife be called to bring his WD40? When questioned as to request he reports he puts the WD40 on his knees and elsewhere – it helps his pain.

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Patient intake ?’s

How do we phrase our questions to get the complete picture?

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Herb and dietary Supplement Efficacy, Safety and government regulations Food and Chemical Toxicology Volume 107, Part A, September 2017, Pages 449-47l.

Department of Complementary and Alternative Medicine, John A. Burns School of Medicine, 651 Ilalo Street, MEB 223, University of Hawaii at Manoa, Honolulu, HI, 96813, United States

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Define/identify certain products

PrescribedOTCSupplementsVitaminsHerbs/spicesInhalants

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Definition of dietary supplement (DS)

DS are officially defined as food by the Dietary Supplement Health and Education Act (DSHEA) of 1994 (public Law 103-417), which amended the 1958 Food Additive Amendments to the 1938 Federal Food Drug and Cosmetic Act (FD&C) (Camire and Kantor, 1999). DSHEA provides the regulatory framework for DS and starts by defining DS as:“A product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients:” vitamin, mineral, herb [must list the part of the plant from which they originated (leaf, flower, root, etc.) or other botanical, or drug.

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United States pharmacopeia convention (USP) publicationsThe 200 + year old, non-profit USP is not a government regulatory agency, but a public health mission-driven private entity. It plays a major role in promoting the safety of drugs, foods, and DS by publishing standards for quality, purity, and strength n the USP and NF, which is enforceable by the FDA (Schiff et al., 2006).

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Most significant safety concern:The biggest threat posed by DS is the sale of adulterated products. The number one adulterant in DS is drugs, followed by an unquantified numbers of New Dietary Ingredients (NDIs) (Johnson, 2015).

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FDA regulationDS are under the “umbrella” of foods, the FDA’s Food Safety and Applied Nutrition (CFSAN) is responsible for the agency’s oversight of these products (FDA-3).

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FDA Warns Against Unregulated ProductsSome drugs are not approved by FDA but can still be legally sold in the US.

The FDA reports on adverse events from two unregulated products.The agency’s BeSafeRX web page contains resources to help patients to determine if an online pharmacy is reputable.

Source: AJN March 2018, Vol. 118, No. 3 page 22-23.

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Client instructionsCheck with pharmacist &/or tell provider

ALL substances ingested, applied or inhaled. Tell the amount you take and how often, along with other meds.

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Used for stomach spasms, loss of appetite, intestinal gas, kidney conditions, fluid retention, head colds, warts, and worm infections. Also used to treat snake and insect bites.

Side Effects & Safety: Might slow blood clothing and increase bleeding. Might lower blood pressure.Interactions: No information available

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CinnamonUses: lower blood sugar for diabetics, lower cholesterol and treating yeast infections.

Side effects: heavy use may irritate the mouth and lips, causing sores. Allergic reaction. Applied to skin, it might cause redness and irritation.Interactions: antibiotics, diabetes drugs, blood thinners, heart medicines and others.

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Apple Cider VinegarUse: Might help lower blood sugar levels; might prevent breakdown of some foods

Side effects: Consuming 8 oz./day long-term might lead to low potassium; might lower blood sugar levelsInteractions: Digoxin (Lanoxin) interacts with Apple Cider vinegar. Insulin interacts; diuretics interact

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Use: stomach problems, IBS, rheumatoid arthritis, osteoarthritis, menstrual pain, migraine, to treat burns, diabetes, to stimulate breast milkSide effects: Might increase your risk of bleeding. Increase your insulin levels and/or lower your blood sugar. High doses of ginger might worsen some heart conditions.

Interactions: Antiplatelet drugs –slows clotting. Medications for diabetes (antidiabetics drugs) interact with ginger. Meds for high blood pressure (calcium channel blockers) may interact.

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Use: High cholesterol, osteoarthritis, itching.Side Effects: Might promote a menstrual period or stimulate the uterus, putting the pregnancy at risk. Can make gallbladder problems worse. Might decrease blood sugar in diabetics. GERD – worsens. Could lower testosterone levels and decrease sperm movement. May prevent the absorption of iron. Might slow blood clotting.

Interactions: Anticoagulant/antiplatelet drugs. Slows clotting time.

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Caraway Uses: Digestive problems, to start menstruation and relieve menstrual cramps.

Side Effects: Menstrual bleeding. Might lower blood sugar. Might increase the absorption of iron leading to hemochromatosis.Interactions: Diabetic meds – lowers blood sugar.

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Uses: digestion issues, increasing menstrual flow and causing abortions. Topically to prevent and treat baldness and circulation problemsSide effects: in large amounts can cause emesis, uterine bleeding (miscarriage), kidney irritation, increased sun sensitivity, skin redness and allergic reactions.

Interactions: Might increase the risk of bleeding and bruising in people with bleeding disorders. Might make seizure disorders worse.

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Cayenne Pepper Uses: digestion issues, toothache, treat pain from shingles, osteoarthritis and fibromyalgia, hay fever, migraine headache, cluster headache and sinus infections

Side effects: Skin problems. Might increase bleeding during and after surgery Interactions: Increases the effect of cocaine leading to heart attack and death, slows blood clotting, interacts with Theophylline and may interact with ACE inhibitors to increase the blood pressure

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Uses: digestive problems, painful menses, applied to skin for cold sores, gum disease and sore mouth, throat or tongue; and swollen, painful nasal passages. AsthmaSide Effects: If taken in large amounts can cause poisoning due to thujone. Can bring on menses and cause miscarriage. Might lower blood sugar levels in diabetics. May affect blood pressure either lower or raise, can trigger seizures

Interactions: Diabetes meds, anticonvulsants, CNS depressants, may cause sleepiness and drowsiness – sedative effect

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Clove Uses: stomach upset and as an expectorant, gum irritation

Side effects: premature ejaculation, may slow clotting timesInteractions: anticoagulant/antiplatelet drugs

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Herbal Supplement Validation

1. Ask your doctor or pharmacist.2. Look for scientific research findings – the National Center for Complementary and Alternative Medicine (NCCAM) and the Office of Dietary Supplements. Both have websites.Contact the manufacturer. What data substantiates their products’ claims.

Tell

all

providers what

you take

– dentist, eye care professional, Emergency Room or Urgent care &/or complementary health practitioner: chiropractor or naturopathic practitioner

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Tips on web searchesAsk yourself these questions:

Who runs the website?What is the website trying to do? Is it telling you about the product or just trying to sell it?Where does the website get its information? Are there studies that back it up?Is the information up to date? Check the date to see when it was posted or updated.

Source: FDA Office of Women’s Health Dietary Supplements last updated 5/4/ 2017

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Avoid Supplements if….

Taking OTCs – check with provider/pharmacistPregnant or breast-feedingGoing to have surgery – STOP all two weeks prior – follow providers/pharmacist instructionsYou are younger than 18 or older than 65

Be CAUTIOUS about supplements manufactured outside the US

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Online shoppingDon’t depend on information from the sellers

Use noncommercial sites: National Institutes of HealthFDAUnited States Department of Agriculture

Source: Food Facts FDA May 2017

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NIH – Test your KnowledgeTRUE or FALSE

Some supplements can decrease the effects of drugs?Some supplements can increase the effects – including unwanted side effects – of drugs.Some interactions between supplements and drugs are very dangerous?Scientists know a great deal about drug-supplement interactions?

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NIH – Test your KnowledgeAnswers

Some supplements can decrease the effects of drugs? TrueSome supplements can increase the effects – including unwanted side effects – of drugs. TrueSome interactions between supplements and drugs are very dangerous? True

Scientists know a great deal about drug-supplement interactions? False

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Report a problem or illnessConsults a Consumer Complaint Coordinator

http://www.fda.gov/Safety/ReportaProblem/ConsumerComplaintCoordinatorsOnline: http://www.safetyreporting.hhs.govSource: FDA Office of Women’s Health Food Facts, Dietary Supplements May 2017

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Comments/QuestionsWhat have you discovered in your practices?

Come to the mic and share with us all.

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References

Chaudhari, S. P., Tam, A. Y., Barr, J. A. (2015). Curcumin. Journal of Clinical & Aesthetic Dermatology.  8(11), 43-48. Retrieved from

http://jcadonline.com/

Brown, C. A. (2017). An overview of herb and dietary supplement efficacy, safety and

government regulations in the United States with suggested improvements.

Food and Chemical Toxicology, 107,

449-471.

https://doi.org/10.1016/j.fct.2016.11.001

Mayo Clinic. (2017). Herbal supplements and drug interactions. Retrieved from

http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/herbal-supplements/art-20046488?pg=2

Mayo Clinic. (2014). How do you know if herbal supplements' claims are true? Retrieved from

http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/herbal-supplements/art-20046714?pg=2

Mayo Clinic. (2016). Specific nutrients and botanicals. Retrieved from

http://www.mayoclinic.org/nutrition-and-pain/art-20208638?pg=2

National Center for Complementary and Integrative Health. (2016).

Herbs at a glance.

Retrieved

from

https://dewey.umhb.edu:3879/health/herbsataglance.htmhttp://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/herbal-supplements/art-20046488?pg=2

Pereira, K. (2016). Herbal supplements: Widely used, poorly understood.

Nursing

,

46

(2), 54–59. doi:10.1097/01.NURSE.0000476233.80384.53

Aschenbrenner

, D. (2018). Drug Watch. AJN, 118(3), 22-23.

Information from WebMD. Retrieved from URL.

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Thank you for your attention.Debbie Rosenberger BSN, RN-BC

University of Mary Hardin-BaylorCoordinator of Health Servicesdrosenberger@umhb.eduLet’s continue to learn together!