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*
The Use of Herbs and
Supplements
Copyright © 2016 by Elsevier, Inc. All rights
reserved.
* Older adults use a variety of complimentary and
alternative therapies, including herbs and
supplements
* In fact, 38% of American adults (mostly age 5059) spend 14.8 billion on these products
* Popular examples include fish oil/omega 3 fatty
acids, glucosamine, chondroitin, melatonin,
echinacea, flax seed, ginseng, ginkgo, and
garlic being the most commonly used
*
Copyright © 2016 by Elsevier, Inc. All rights
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*
* Standards in Manufacturing
* Regulated by Dietary Supplement Health and
Education Act
* Herbal manufacturers label herbs as foods
* NOT regulated by FDA like “medications”
* Good Manufacturing Practices required since
2007
* Preparation and storage, product
identification, purity, strength, composition
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* Different parts of herbs may have uses and
actions that are unrelated
* Manufactured in several forms
* Capsules, extracts, oils, tablets, salves, teas,
tinctures
* Efficacy varies depending on the form of the
parts used and how it is prepared
*
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*Teas
*Teas are both foods (regulated) and
herbs (not regulated)
*Research shows that green tea may
be beneficial for its antioxidant
properties
*Consumption of more than
recommended amounts of certain teas
may cause illness or death
*
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* Chamomile
* Usually taken in tea form
* Primary uses: antiinflammatory and
antispasmodic
* Promote sleep
* Reduce anxiety
*
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6
The teas, herbs, and supplements listed on the
following slides are considered to affect
coagulation and therefore pose a significant risk,
since they are commonly used by older adults
*
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* Echinacea
* Available commercially as capsules, tea, juice,
extract, and tincture
* Shown to be effective for the prevention of upper
respiratory infections or decreasing their duration by
1-2 days
* Adverse reactions include fever, sore throat,
diarrhea, nausea and vomiting, abdominal pain, and
dry eyes
* Persons with human immunodeficiency virus (HIV)
or autoimmune disease should use with caution
*
Copyright © 2016 by Elsevier, Inc. All rights
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* Garlic
* Composed of more than 200 chemicals
* Primary active ingredient is a sulfur called allicin
* Reported benefits include decreased blood clots and
reduced total serum cholesterol and low-density
lipoprotein
* Possible adverse reactions include severe allergic
reactions, increased flatulence, and upper
gastrointestinal (GI) irritation with nausea and
heartburn
*
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* Ginkgo biloba
* Prepared as capsules, extracts, and tablets
* May benefit cognitive function in dementia;
however, there is no scientific evidence that
ginkgo impacted cognitive impairment, memory,
attention, language, visual-spatial ability,
executive functions, or reduced prevalence of
dementia and Alzheimer’s disease
* Major serious side effect is bleeding
*
Copyright © 2016 by Elsevier, Inc. All rights
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The teas, herbs, and supplements listed on the
following slides are not associated with bleeding.
*
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*Ginseng
*Capsules, extracts, tinctures
*Improves well-being and helps with
stress adaptation
*Enhances immunity
*Decreases cellular oxidation
*Potential side effects (Box 10-1)
*
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*Glucosamine and Chondroitin
Sulfate
*Support cartilage and connective
tissue
*Typically used for osteoarthritis
*Mild antiinflammatory effects
*Use with caution in persons with
*
shellfish allergies, diabetes, and
asthma
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*Hawthorn
*Extracts, teas, capsules
*Used in the treatment of heart
disease, digestive, and kidney
problems
*Reported to increase cardiac
output
*
effects
*Antispasmodic and antianxiety
*Antiinflammatory, reduces lipids,
and has diuretic and
sedating
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effects
Copyright © 2016 by Elsevier, Inc. All rights
reserved.
Melatonin
Used as an alternative or adjuvant to sleep
medications to promote sleep
Low levels during the day and high during the
night improve the quality of sleep and morning
wakefulness
May be helpful with jet lag
Available in immediate and extended-release
forms
*
Use with caution in persons taking other
medications that can cause drowsiness
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* Red Yeast Rice
* Chemically equivalent and as effective as statins
and may be a potential alternative for patients
who cannot tolerate statins
* Be aware of a contaminant called “citinin,” which
can cause kidney failure
*
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* St. John’s Wort
* Used to treat mild or moderate depression and
seasonal affective disorder, anxiety, pain
* Metabolized through the cytochrome P450 3A4
enzyme; use with caution if person is on drugs
metabolized using the same pathways
* Contraindicated with other antidepressant use,
especially selective serotonin reuptake inhibitors
(SSRIs)
* Wait 2 weeks after discontinuing St. John’s wort
*
before beginning an antidepressant
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* Saw Palmetto
* Offers mild to modest symptom improvement for
benign prostatic hyperplasia (BPH)
* Don’t use with other drugs being used to treat
BPH or prostate cancer
*
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* Hypertension
* Hawthorn used as treatment for hypertension
* Caution is urged when erectile dysfunction drugs
are used concomitantly with hawthorn because
hypotension may result
* Dietary calcium in enriched low-fat dairy products
taken three times daily may lower blood pressure
in moderate hypertension
*
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* HIV
* Persons with HIV-related symptoms are known to
use alternative therapies, including herbs, to
assist with symptoms
* Use herbals with caution; some products may
lower therapeutic drug levels or alter metabolism
of antiretrovirals
* For example, St. John’s wort may help with
depression but lowers blood level of antiretroviral
medication
*
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reserved.
20
* GI Disorders
* Chinese have used herbal therapies for
thousands of years to treat irritable bowel
syndrome
* Popular herbals for GI disorders include psyllium,
calcium, cranberry, and probiotics
* Chronic alcohol-induced and fulminate hepatitis
have both been positively affected by the use of
milk thistle
*
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21
* Alzheimer's Disease
* Ginkgo used by older persons with dementia
because it increases blood supply to brain
* Improves memory and attention
* According to the Alzheimer’s Association,
moderate physical activity, drinking tea one to four
times a day, and maintaining normal serum
vitamin D levels decrease the risk of cognitive
decline
*
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22
* Diabetes
* Herbal approaches to diabetes management in
place before discovery of insulin in 1921
* Approximately 400 different plants affect blood
glucose; many still in use
* Overall there is not enough evidence to support
the use of herbal supplements to treat diabetes
*
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* Many herb and supplement products interact
with prescription or over-the-counter
medications, foods, and/or other herbs and
supplements
* The more herbs and other drugs that the client
is taking, the more likely it is that an interaction
will occur
*
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
Perioperative Assessment
*
Hypertension, excessive and prolonged bleeding,
and increased chance for interactions between herb
and other drugs may occur
*
Herbs that affect bleeding and clotting time, such as
garlic, ginger, ginkgo, and ginseng, should be
especially noted and reported to surgical team
*
Select herbs and the perioperative patient (Table
10-1)
*
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reserved.
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* Interventions
* Education
* Check for side effects, adverse reactions, and
interactions among herbs, supplements,
medications, foods, and illness
* Urge discontinuance of possibly harmful products
* Provide relevant information and correct use of
product as indicated
* Refer to person’s usual health care provider
*
Copyright © 2016 by Elsevier, Inc. All rights
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* Education
* Help elders understand the importance of
reporting herb and supplement use
* Review aspects of product safety
* Discontinue if side effects occur
*
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The National Health and Nutrition Examination
Survey indicates that the highest use of herbals
and supplements were among:
a.
b.
c.
d.
African Americans.
Asians.
White Caucasian.
Hispanic.
*
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Which of the following is chemically equivalent to
the statins?
a.
b.
c.
d.
Saw palmetto
Hawthorn
Echinacea
Red yeast rice
*
Copyright © 2016 by Elsevier, Inc. All rights
reserved.
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