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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 reserved. 2 * * 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 Copyright © 2016 by Elsevier, Inc. All rights reserved. 3 * 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 * Copyright © 2016 by Elsevier, Inc. All rights reserved. 4 *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 * Copyright © 2016 by Elsevier, Inc. All rights reserved. 5 * Chamomile * Usually taken in tea form * Primary uses: antiinflammatory and antispasmodic * Promote sleep * Reduce anxiety * Copyright © 2016 by Elsevier, Inc. All rights reserved. 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 * Copyright © 2016 by Elsevier, Inc. All rights reserved. 7 * 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 reserved. 8 * 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 * Copyright © 2016 by Elsevier, Inc. All rights reserved. 9 * 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 reserved. 10 The teas, herbs, and supplements listed on the following slides are not associated with bleeding. * Copyright © 2016 by Elsevier, Inc. All rights reserved. 11 *Ginseng *Capsules, extracts, tinctures *Improves well-being and helps with stress adaptation *Enhances immunity *Decreases cellular oxidation *Potential side effects (Box 10-1) * Copyright © 2016 by Elsevier, Inc. All rights reserved. 12 *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 Copyright © 2016 by Elsevier, Inc. All rights reserved. 13 *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 14 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 Copyright © 2016 by Elsevier, Inc. All rights reserved. 15 * 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 * Copyright © 2016 by Elsevier, Inc. All rights reserved. 16 * 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 Copyright © 2016 by Elsevier, Inc. All rights reserved. 17 * 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 * Copyright © 2016 by Elsevier, Inc. All rights reserved. 18 * 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 * Copyright © 2016 by Elsevier, Inc. All rights reserved. 19 * 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 * Copyright © 2016 by Elsevier, Inc. All rights 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 * Copyright © 2016 by Elsevier, Inc. All rights reserved. 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 * Copyright © 2016 by Elsevier, Inc. All rights reserved. 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 * Copyright © 2016 by Elsevier, Inc. All rights reserved. 23 * 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 * Copyright © 2016 by Elsevier, Inc. All rights reserved. 24 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) * Copyright © 2016 by Elsevier, Inc. All rights reserved. 25 * 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 reserved. 26 * Education * Help elders understand the importance of reporting herb and supplement use * Review aspects of product safety * Discontinue if side effects occur * Copyright © 2016 by Elsevier, Inc. All rights reserved. 27 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. * Copyright © 2016 by Elsevier, Inc. All rights reserved. 28 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. 29