Chapter 6 Herbal Therapies Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Herbs  Herbs  Plant or plant part used for its scent, flavor, or therapeutic properties  National Center for Complementary and Alternative Medicine (NCCAM) 2 Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Herbal Monographs  Therapeutic monographs contain information on use, dosage, side effects, and contraindications.  Qualitative monographs have information on areas such as compliance with compounding guidelines and standards of purity. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3

Dietary Supplement Health and Education Act of 1994 (DSHEA)  Clarified marketing regulations for herbal remedies  Premarket testing for safety and efficacy is not required, and manufacturing is not standardized.  Physiologic effects of the product can be noted, but no claims can be made about preventing or curing specific conditions. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4

Current Good Manufacturing Practices (CGMPs)  Standards are multifaceted and require that package labels give quality and strength of all contents and products be free of contaminants and impurities.  “Seal of approval” is awarded to products meeting criteria similar to the CGMPs by four organizations (the USP, ConsumerLab, National Products Association, and NSF International). Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5

Herbal Preparations  Dried herbs  Extracts  Fresh herbs  Oils  Salves  Teas  Tinctures  Syrups Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6

Selected Herbs  Aloe vera  External: relief of pain; promotes burn healing  Internal: constipation; may cause arrhythmias, neuropathies, edema  Black cohosh  Treats hot flashes, palpitations, irritability  Potentiates effects of insulin and oral hypoglycemics Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7

Selected Herbs (Cont.)  Chamomile  Relief of digestive complaints  May have sedative effects  Rare allergic reactions of urticaria and bronchoconstriction if allergic to daisy or ragweed  Dong quai  All-purpose woman’s tonic  Frequently mixed with fillers  Contains vitamin B 12 Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8

Selected Herbs (Cont.)  Echinacea  Stimulates immune system  For colds, flu, recurrent respiratory and urinary tract infections; limit use to 2 weeks  Evening primrose  Helps prevent cirrhosis, eczema, PMS, hypertension, heart disease  Lowers cholesterol  Relieves pain and inflammation  Feverfew  Interferes with platelet aggregation; for migraine headaches, RA, PMS Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9

 Garlic  Detoxifies and increases immune function  Decreases platelet aggregation  For hypercholesterolemia  For mild hypertension  Ginger  Stimulates digestion  Antispasmodic  Decreases platelet aggregation Selected Herbs (Cont.) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10

 Ginkgo biloba  Antioxidant  Peripheral vasodilator and increased blood flow to CNS  Decreased platelet aggregation  Ginseng  Used for stress relief  Boosts energy; helps digestion  Supports immune system, preventing infections  Goldenseal  Stimulates immune system and bile secretion Selected Herbs (Cont.) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11

Selected Herbs (Cont.)  Kava  CNS sedation without loss of mental acuity or memory; may be hepatotoxic  Licorice  Anti-inflammatory; antibacterial; antiviral; topical: psoriasis and eczema  Milk thistle  Increases liver cell regeneration; slows cirrhotic disease, increasing quality of life Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12

 Peppermint  Internal: stimulates appetite and aids in digestion  External: relief of tension headaches when rubbed on forehead (according to research in Germany, comparable to acetaminophen)  Sage  Used for sore throat and cough  Limit use to 2 weeks Selected Herbs (Cont.) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13

Selected Herbs (Cont.)  St. John’s wort  Antidepressant and antiviral For depression, anxiety, sleep disorders; effects in 4 to 8 weeks  Drug interactions May cause serotonin syndrome when taken with other antidepressants  Saw palmetto  Decreases size of prostate; discontinue herb 1 to 2 weeks before PSA test  “Plant catheter” Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14

Selected Herbs (Cont.)  Valerian  Mild sedative Sleep-inducing agent “Herbal valium” “Dirty socks” odor Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15

Potential Hazards of Herbs  No preparations safe in all situations  Contamination  Interaction with prescription and OTC drugs Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16

Selected Herb-Drug Interactions  Anticoagulants  Antidiabetics  Antihypertensives  Digoxin  Corticosteroids Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17

Tips for Herb Use  Do not take if pregnant.  Do not take if nursing.  Do not give herbs to infants or young children.  Do not take a large quantity of any herbal preparation. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18

Tips for Herb Use (Cont.)  Do not delay in seeking care from health care provider (HCP) for persistent/severe symptoms.  Buy only products with contents and quantity listed on label.  Contact HCP before stopping a prescription medication.  Store product in a cool, dry place; dark glass containers are preferred. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19

 Use only current products.  Advise against belief in “miracle cures.”  Herbs are not placebos.  There is increased risk of reactions when prescription and OTC medications with similar actions are combined with herbs. Tips for Herb Use (Cont.) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20

Nursing Process  Assessment  Obtain baseline of patient’s use of unconventional therapeutic agents and practices.  Identify complete product information.  Identify all prescription and OTC drugs. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21

Nursing Process (Cont.)  Interventions  Monitor patient’s response to prescription, OTC, and herbal products.  Consult with dietitian and others as appropriate.  Continue with same brand; discuss with HCP before changing or starting product. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22

Nursing Process (Cont.)  Patient teaching  General  Diet  Side effects  Self-administration  Cultural considerations  Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23

Practice Question #1 The nurse teaches a patient that a “drug holiday” is recommended with which herbal preparation? A.St. John’s wort B.Echinacea C.Ginkgo biloba D.Valerian Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24

Practice Question #2 A patient uses herbal products. Identify at least four guidelines that the nurse should teach the patient for the responsible use of herbs. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25

Practice Question #3 Which statement about St. John’s wort is true? A.Current research suggests that it is not effective when used by individuals with moderate to severe depression. B.When taken concomitantly with a prescription antidepressant, an adverse effect of St. John’s wort may be suicidal ideations. C.St. John’s wort has been approved by the U.S. Food and Drug Administration to treat depression. D.Users of St. John’s wort should avoid tyramine-rich foods while taking the supplement. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26

Practice Question #4 Which herb is thought to decrease memory loss associated with aging? A.Ginger B.Valerian C.Ginkgo biloba D.Echinacea Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27

Practice Question #5 A patient receives an anticoagulant secondary to previous blood clots. The nurse should reinforce that the patient should not take A.garlic. B.echinacea. C.valerian. D.goldenseal. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28