Chart For Final - Saunders Shizzle A&s

Section

Class

Drug

Drug Information

Drug Interactions

Camellia sinensis (green/ black tea) Salvia miltorrhiza (crysanthemum type) Harpagophytum procumbens

Interaction Mechanism Platelet activating factor-induced platelet aggregation was inhibited Speeds elimination of heparin Omega 6 - reduces heparin effect Omega 6 - reduces heparin effect Omega 6 - reduces heparin effect Salicylates - inhibit heparin Inhibits anticoagulation (uncooked ONLY). Broccoli, cabbage, cauliflower Dec anticoag Inc anticoag Purpura

Allium sativum

INR doubles, Inc fibrinolysis, dec platelet aggregation

Ginkgo bilboa CoQ10 + Ginkgo Carica papaya Betula pendula

intra-cerebral hemorrhage No sig effect on INR unripe fruit --> bleed more Inc INR, bruising No effect in human, dec platelet agg, inc fibrinolytic activity (rat), Inc PT (rabbit) Sppeds clearance, CYP450 1A1, 2A1, 2A2, 2B1, 2B2 Very mixed results Countains coumarins - need to be fermented for anticoag effect. Inc INR, PT Lowers effect of warfarin dec INR (soy).

Ginkgo bilboa Heparin

Reversibly binds antithrombin III, inactivates coagulation Nicotiana tabacum Ribes nigrum factors IX, XI, XII and plasmin. Administered IV (immediate). Borago officinalis Oenothera biennis oils Filapendula ulmaria flowers Inhibits synthesis of vit K dependent clotting factors: II, VII, IX, I and anticoagulant proteins C, S. Antidote with vit K!

Brassica spp

Ananas comosus Nicotiana tabacum Vaccinium macrocarpon Warfarin, Coumadin Anticoagulant therapy

Aspirin

Angelica sinensis Panax ginseng Glycine max DEC A, C, K, Mg oxide Vit K dec warfarin or stabilize INR Fish Oil SHADED=SPECULATION Medicago sativa Gossypium herbaceum Tanacetum (chrysanthemum) vulagre Zingiber officinale Filipendula ulmaria Tabebuia avellanedae Gaultheria procumbens Melilotus officinalis Mangifera indica Caffeine Ginkgo bilboa Glycyrrhiza glabra Capsicum grutescens Inhibits thromboxane A2 synthesis via cyclooxygenase-1 Dec Folic acid, vit C, K, KCl, ferrous sulfate (iron) acetylation (COX-1 inhibitor). >65 more susceptible to Aesculus hippocastanum Side effects (tinnitus, GI bleed, Dec T3, T4) Tanacetum (chrysanthemum) parthenium Zingiber officinale Melilotus officinalis Salix alba and nigra Gaultheria procumbens

Green leafy vegetables will actually stablize INR - eat them. Some studies show no effect For vitamin K component Studied as male contraceptive. Inc PT. NS, then one big dose dec platelet aggregation Warfarin effect Methylsalicylate fermented Mango fruit Inc absorption, bioavailability Dec GI ulcer with ASA Dec Gastric mucosal damage Esculetin - natural anti-inflamm Anti I

ASA plant sources ASA plant sources

Coffea arabica

Beta-adrenergic blocking agents (propranolol)

Cardiac therapy - Angina

Cola nitida, C. acuminata, Paullina cupano, Ilex paraguayensis, Camellia sinensis Nicotiana tabacum

Dec chronotropic, inotropic & vasodilatory response. Risk: CHF, bronchospasm, anorexia, cold ext, Raynaud's Piper nigrum phenomenon, fatigue, lethargy, bradycardia, dec libido. Humulus lupulus Valeriana officinalis Lactuca virosa Serenoa repens Pausinystalia yohimbe Hypericum perferatum Calcium carbonate antacid Vit C Ephedra sinica

Calcium Channel blockers verapamil

Coffea arabica - inc caffeine effect. Cola nitida, C. acuminata, Paullina cupano, Ilex paraguayensis, Camellia Ca antagonist, modulates Ca across arterial smooth sinensis, Theobroma cacao muscles, myocardial conducting and contractile cells vasodilation, dec PVR, dec AV node conduction, prolings Nicotiana tabacum local anesthetic Hypericum perferatum Calcium carbonate antacid

Nitrates - Nitroglycerin

Smooth muscle relaxation: peripheral arteris, veins --> Dec L ventricular end diastolic pressure (preload), coronary artery dilation. SE: tolerance, vertigo, HA

Cardiac Medications Class I, Type 1A Antiarrhytmic: Quinidine

Dec atenolol Dec propranolol May antagoinze BBs

Dec metabolism, serum levels (less effect) CYP 3A4 Inc verapamil, dec diltiazem (another CCB)

Caffeine Pausinystalia yohimbe Rauwolfia spp. Veratrum spp Salicylates

Vasoconstrictive Vasoconstrictive Vasorelaxant Vasorelaxant Dec therapeutic effect

Cyamopsis tetragonolobus

Chinese herb. Dec urinary excretion. AUC unchanged.

Hypericum perferatum

Dec peak, dec absorption Enganged dig in conary insufficiency. Dec dig toxicity, +inotropic, coronary vasodilation. Put patients on this!! Dec dig toxicity: coronary vasodilation, antiarrhythmic effect. Aryvedic herb. Reduces absorption Leads to muscle weakness/fatigue. Dec ATP, inc BP. With dig has a positive effect on CHF (especially if viral/bacterial origin) Inc plasma dig due to quinine

Plantago psyllium Direct on myocardium. Indirect on ANS - SA, AV nodes, Lowers Mg oxide baroreceptor sensitization. +inotropic, -chronotropic, dec conduction velocity. Risk: K depletion. Hyper Ca --> dig Berberine toxicity, hypo Ca, no dig effect. Hypo-Mg --> dig toxicity. Cinchona spp Use: arrhythmia, CHF. Plant fibre: guar, wheat bran, oat bran, pectin Hypo-K: Pheum palmatum, aloe vera, cassia acutifolia, rhamnus frangula, r purshiana, glycyrrhiza glabra Other cardiac glycosides: Convallaria majalis, Helleborus niger, Strophanthus kombe, Asclepias tuberosa Berberine - berberis vulgaris, coptis chinensis, C. groenlandica, Hydrastis canadensis, Mahonia spp Gossypium herbaceum Equisetum arvanse/hyemale Actea (cimicifuga) racemosa, tanacetum (chrysanthemum) parthenium, valeriana officinalis Depresses rapid inward depolarizing Na currents (Purkinje fibres) Anticholinergic, peripheral alphaadrenergic antagonist (vasodilator)

Inc metabolism of caffeine, Dec BB via vasoconstriction Inc intestinal permeability, more completely absorbed over 7d --> more drug effect Inc effect additive additive - non opiod analgesic Dec rat uterine contractions in rats protect mice from herb toxicity

Vasoconstrictive

Ammi visnaga

Cardiac therapy Arrhythmia

All contain caffeine

Ephedra sinica

Crataegus spp

Cardiac Glycosides: Digoxin

INC BP due to INC NE (reduce effect of BB)

Do NOT mix 2 cardiac glycosides!!!

hypo K hypo K P-glycoprotein

Citrus paradisi

Juice increases bioavailability

Cytisus scoparius/Sarothamnus soparius Mg oxide

Inhibited sparteine Dec quinidine sulfate

Cardiac therapy Arrhythmia Cardiac Medications

Class I, Type 1B Antiarrhythmic: Mexiletine

Class III Antiarrhythmic: Amiodarone

Theobroma cacao Inc caffeine effect: CYP1A2? Dec caffeine clearance? Blocks fast Na channels, esp Purkinje fibres. For lifetreatening ventricular arrhythmia, sustained V-tach. Dec Coffea arabica, Cola nitida, C acuminata, Paullina cupana, sinus rate if sick sinus syndrome. Ilex paraguayensis, Camellia sinensis Nicotiana tabacum Alters mexiletine uptake Blocks Na channels at rapid pacing frequencies. AntiDigitalis purpurea, D. lanata sympathetic activity. Lengthen cardiac action potential. Blocks K channels - slows conduction, prolong refraction Cinchona spp AV node. Vasodilation. Pulmonary fibrosis, aggrevation of arrhythmia, cirrhotic hepatitis. Hypo/hyperB6 Inc neurotoxicity thyroidism. Corneal micro-deposits in all patients.

Endogenous nucleoside given IV. Slows AV node Other Antiarrhythmic: Adenosine conduction.

Inc serum digoxin Inc serum quinidine

Coffea arabica

None for 12 hours pre tx

Cola nitida, C. acuminata, Paullina cupano, Ilex paraguayensis, Camellia sinensis Nicotiana tabacum Ganoderma lucidum

inc circulatory effects adenosine in water extracts

Hypericum perferatum

Phenylephrine/Vasopresor Cardiac Therapy Sympathomimetics

Vasoconstriction longer than epinephrine, ephedrine. Slows HT rate, increases stroke output, not disturb rhythm.

Pausinystalia yohimbe Larrea tridentate, L. divaricata Hydrastis canadensis Serenoa repens Berberis vulgaris, Mahonia spp.

Dopamine/Intropin

ACE Inhibitors - PRLIS

Crategus Panax quinquefolius Increased HT output. Inc systolic and pulse pressure, not diastolic and peripheral resistance. Use in shock: MI, Larrea tridentate, L. divaricata trauma, septicemia, open heart surgery, renal failure, CHF Stops angtiogensin II: most vasoactive product of renin- Capsicum frutescens antiogensin. Lower renin in African's, therefore less effective. Dec systemic arteriolar resistance, diastolic BP, systolic BP, HT rate; INC HT output, stroke volume, Ferrous sulfate stroke work. KCl (Pottasium) Ephedra sinica

Inc dopamine circulation, inhibition of catechol-O-methyl transferase, by NDGA (potent antioxidant)

Cough. Slowed progression of chronic renal faulure (captopril only) DEC by captopril Inc by captopril, trandolapril May antagonize ACE inhibitors

DEC Na, Cl, K, H

Cardiac Therapy Congestive Heart Failure

Diuretics: Loop. Furosimide/ Lasix.

Inhibit Na reabsorption in ascending loop of Henle, proximal and distal tubules.

Glycyrrhiza glabra Crateagus Inc Iodide (KI) Antacids dec by ethacrynic acid Dec B1 Dec Folic acid Nicotiana tabacum Serenoa repens

Bile acid sequestrants cholestyramine (Questran), colestipol

Exchanges Cl for bile acid --> insoluble complex, feces. Elevated cholesterol, LDL. No drugs 1 hr before, 4-6 hours post use (particularly fat soluble) Mechanism unknown- Dec LV extraction free fatty acids Fibrates - clofibrate, benzafibrate, --> dec TG. With statin: sever myostitis, acute renal fenofibrate, gemfibrozil failure, dec vitamin E Cardiac Therapy Dyslipidemias

epenephrine IV - INC toxicity of yohimbe Inc clearance of dopamine, Norepinephrine Potentiated isoproterenol, tracheal smooth muscles guinea pig alpha 1A antagonist Inhibit contractions by phenylphrine: Ca antagonist, alpha 1A antagonist Inhibited contractions phenylephrine Enhanced vasoconstriction

Gossypium herbaceum Dec Vit A, B3, B12, folic acid, D3, E, K, Ca carbonate, Fe sulfate Given with B3 --> INC colestipol efficiency

Leads to hypo-K, may antagonize amiloride Increased exercise tolerance, dec adverse effects amiloride, spironolactone

vasoconstrictive nicotine --> dec furosemide Effect on rat uterus antagonized by amiloride, interfere alpha 1A antagonist hypo K

Dec vit A, B12, E, Fe sulfate Dec CoQ10

HMG-CoA reductase inhibitors statins (atorvastatin/lipitor).

B3 inc statin toxicity or additive clinical effect Rate limiting step in cholesterol synthesis

Hypericum perferatum Citrus paradisi Ananas comosus

Gastrointestinal lipase inhibitors- GI lipase absorption inhibitor. Used in obesity, fatty liver, Plantago psyllium orlistat NIDDM. SE: Gi upset, diarrhea Dec Vit A, D, E, K, B12

Dec simvastatin (p=glycoprotein, CYP 3A4. Pravastatin has no pglycoprotein so unaffected. Inc bioavailability Inc cholesterol reduction Dec GI flatulence

Edema

Loop Diuretics - bumetanide, ethacrynate, enthancrynic acid, furosemide Osmotic Diuretic - mannitol Potassium Sparing Diuretids: amiloride, spironolactone, triamterene, hydrochlorothiazide Thiazides and Related agents Various Diuretics Antiadrenergic Agents - Alpha 1,2 Adrenergic Blocking agents. Prazosin/minipress Antiadrenergic Agents - Alpha 1,2 Adrenergic Blocking agents. Phentolamine mesylate/ rogitine Centrally Acting Antiadrenergic Agents - Clonidine/ catapres

Dec Total peripheral resistance. SE: orthostatic hypotension, tachycardia

Hypertension

Due to alpha 2A antagonisms from phenolamine

alpha adrenergic agnoist/antagonist. Dec peripheral resistance, diastolic & systolic BP, HT rate, postural reflexes intact. SE: dry mouth (inc dental caries)

Inc BP. Clonidine dec anxiety induced by yohimbe.

Pausinystalia yohimbe Fe sulfate dec drug effect. KCl decreased by drug.

Epedra sinica Pausinystalia yohimbe Lithium carbonate Depletes brain NE, serotonin depletes NE at peripheral Hypericum perferatum sympathetic nerve terminal, peripheral vasodilation. Used in HT and anxiety, Raynaud's. SE: hypotension, GI Camellia sinensis (green/ black tea) Curcuma longa upset. Vaccinium myrtillius Withania somnifera

Arteriolar Smooth Muscle Agents - Ca Channel Blockers (Felodipine) Arteriolar Smooth Muscle Agents - Vasodilators. Sodium nitroprusside. Diuretics - Osmotic (mannitol) Diuretics - Thiazides and related agents

Phase 1 CYP450 Update

Phase II Update

CYP 450 1A2 CYP 450 2E1 CYP 450 3A4 Glutathione s-transferase UDP glucuronosyltransferases (UGT) NADPH - quinone reductase Epoxide hydrolase

Bipolar Disorder

Inhibit alpha 1A antagonist cloned human receptors

Short duration, positive inotropic, chronotropic. Vascular Pausinystalia yohimbe smooth muscle dilator. Prevent HT episodes.

Centrally Acting Antiadrenergic Agents - Methyldopa

Centrally Acting Antiadrenergic Agents - Reserpine

Serenoa repens

Citrus paradisi

Reserpine dec epedrine induced catecholamines Induced head twiches sig decreased antagonized reserpine effect Dec GI ulcer Dec GI ulcer Dec GI ulcer Dec orofacial dyskinesia, poor memory, brain lipid peroxidation. SE: memory problems. Withania helps with this. Inc bioavailability

Dec B12 Dec Mg oxide, KCl Induce Na, water excretion by inhibiting sodium, Cl cotransporter. SE: inc chol, TG, LDL

Dec KCl, Zn

Crataegus spp Renin-Angiotensin System Agents Metabolized by P450 3A4. SE: syncope, hypotension. Citrus paradisi, hypericum perforatum (losartan potassium) Caffeine, Ginkgo bilboa, Hypericum perforatum, quercetin Hypericum perforatum, Allium sativum Amiodarone, quinidine, verapamil, hypericum perforatum, Camellia sinensis, Allium sativum, Citrus paradisi, Hydrastisi canadensis Larrea tridentata, Gossypium herbaceum, G hirsutum, Cinchona spp, Nicotiana tabacum, Allium sativum, Coriandrum sativum, Zingiber officinale

Inc exercise tolerance, dec adverse effects May use p-glycoprotein, CYP 450

Larrea tridentate, Allium sativum, A cepa Vaccinium myrtillus, V. macrocarpus, Allium sativum, A. cepa, Zingiber officinale Allium sativum, A. cepa

Lithium Carbonate

LOOK AT SUMMARY SLIDES Caffeine Plantago Psyllium Cydonia vulgaris Astragalus gummifer, Ulmus fulva (slippery elm) Oenothera Biennis Na transport. Inc K, Na in urine. Dec catecholamine Fucus vesiculosus clearance. Inhibit intracellular c-AMP formation. Low NaCl diet inc LI reabsorption. Thyroid - block T3 Laminaria digitans release (hypoT) Asparagus officinalis Barosma betulina Camellia sinensis Coffea arabica Oenothera Biennis

4 cup/d dec LI, withdrawl --> tremors, inc LI levels. Dec 14% therefore > 1hr quince seed Dec tremor SE (2-3g/day) May be beneficial for thyroid

Diuresis latent temporal lobe epilepsy (seizures)

Schizophrenia

Phenothiazine / Fluphenazine / thiodazine

MAOI (Monoamine oxidase Phenelzine, moclobemide, nardil, inhibitors) manerix

Psychiatric Disorders

SSRI (Selective serotonin (5HT) reuptake inhibitors)

Antidepressants

CNS Depressants, Anesthetics

Areca catechu Silybum marianum Borago officinalis Dopamine-block receptor. Catecholamine - hepatotoxic. Linum usitatissimum Coffea arabica Camellia sinensis + high tannin: Geranium maculatum (Quercus spp.) Reserpine (Rauwolfia) L-tryptophan, L-Tyrosine, L-phenylalanine food (fermented), fava bean Kaolin MAO - brain, GI, LIV; Dec BP, inhibit breakdown catecholamines: seretonin, NE. MAO-A-5HT, MAO-B phenylethylamine. Inc. catecholamines => BP, tachycardia, occipital HA, intracranial bleed. 98% absorbed. 55% bioavail. 90% w/ repeat use.Slow metabolizers => 2% caucasians, 15% ASIANS. Washout 2 weeks post use.

effect norepinephrine, dopamine; nor adrenergic, histaminergic, muscarinergic, GABA, benzodiazepine receptor. Well absorbed, CYP450-1A2, 2C19, 2D6, 3A4; Citalopram, Fluoxetine, 98% metabolized. KI 64%, BM 36%; slower in elderly. Fluvoxamine maleate, paroxetine Enters breast milk. 2-5 wk washout MAOI => SSRI. W/ (paxil), Sertraline MAOI => Serotonin Syndrome: agitation, hyperreflexia, tremor, diarrhea, hyperthermia, seizure, DIC, vent. arrhythmia. SE = inc suicide < 18yo. dermatologic, hypoglycemia in diabetes, Tricyclic: Amitriptyline, Alter transport, storage, release catecholamine. Inhibit clomipramine, desipramine, doxepin, imipramine, nortripyline, histamine, 5HT, acetylcholine. CI: MAOI trimipramine Anticholinergic. CI: Seizure, seizure risk, children, postTetracyclic: Maptotiine acute MI, LV/KI damage, blood dyscrasias, tricyclic sensitivity. Mechanism unclear. 60-70% KI, 9-29% BM. SE: Other: Trazodone priapism, arrhythmia if HT Dz, latent seizures

Benzodiazepines: Alprazolam, bromazepam, chlordiazepoxide, clobazam, clonazepam, clorazepate, diazepam, flurazepam….PAM

GABA & Benzodiazepine receptors, chloride channels. Anxiolytic => anticonvulsant => Dec. muscle tonus => sedation => hypnosis=> death?. Well absorbed. Protein bound 80-99%. Concentrate in lipids: CNS, adipose tissue. Elimination KI, Highly addictive. CI: Myasthenia gravis, acute-angle closure glaucoma

Na bicarbonate (tums, IV) Coffea arabica, OTC amine, L, Dopa, Tricyclic antidepressants, Theobroma cacao (chocolate), Camellia sinensis, Ephedra sinensis, E. vulgaris, Panax Ginseng, Rauwolfia serpentina, potentiate hypoglycemics - B blocker, Hydrazine sulfare (anti-CA therapy) Passiflora incarnata Selenicereus grandiflorus Sarotharmnus scoparius Eleuthercoccus senticosus Hypericum perforatum NSAIDS, ASA (GI bleed), warfarin Gingko biloba Hypericum perforatum Hypericum perforatum Tanacetum (Chrysanthemum) pathenium Salix alba, S. nigra, Filipendula ulmaria, Gaultheria procumbens, Melilotus officinalis, Ephedra sinica Gingko biloba Nicotiana tabacum Pausinystalia yohimbe MAOI, digitalis, phenytoin, EtOH Hypericum perforatum Humulus lupulus Hypericum perforatum Tanacetum (Chrysanthemum) pathenium Valeriana officinalis Citrus paradisi Hypericum perforatum Piper methysticum EtoH Coffee arabica Valeriana officinalis Melatonin Cola nitida, C.acuminata, Puallina cupana, Ilex paraguayensis, Camellia sinensis, Theobroma cacao Eleuthercoccus senticosus Panax ginseng Passiflora incarnata Morphine Withania somnifera (mice)

Inc. SE. 400 mg bid DEC Liv toxicity.

tannin Dec GI

Inc. seretonin, NE URI (allergies/cold meds) Seretonin; Thyroid hormones Dec absorption retention ephedrine, pseudoephedrine => tremor, insomnia, tachycardia

alk act on MAO pathway. Potentiate hexobarbital alk, amines tyramine potentiate hexobarbital weak in-vitro MAOI effect dec sex dysfunction elderly, mild serotonin syn after 8 months SSRI => insomnia, groggy, incoherent, weak, lethargic Hyperforin Inhibits uptake serotonin, NE Inhibit serotonin release

Amitriptyline blocked inc. BP offset sex dysfunction speeds tricylic elimination Dec orthostatic hypotension of climipramine, NE & BP of desipramine serotonin syndrome additive Hyperforin Inhibits uptake serotonin, NE Inhibit serotonin release Inc. Bioavailability, CYP-3A4 midazolam dec 60% after 12d tid vs levels pre-SJW, CYP-3A4 Enhanced sedation, GABA-A affinity, alprazolam counteracted diazepam 22%, clonazepam, antagonized triazolam Aids withdrawl Caffeine effect potentiate hexobarbital (diazepam) pentobarbital hexobarbital alkaloid of papaver somnifera tolerance to morphine analgesia inhibited & dependence blocked

Corticosteroids

Bethamethasone, cortisone, dexamethasone, fludrocortisone, Metab LV => urine, bile. CI: fungal infection, live viral hydrocortisone, vaccine. methylprednisolone, prednisolone, triamcinolone

Glucocorticoid - primary, inc. protein catabolism, glucaneogenesis; anti-inflammatory. Adipose redistribution => central from periphery. Ca2+ dec. GI absorption, inc. Antidiabetic (eg. Insulin), cyclosporine, digoxin, estrogen, isoniazid, urine excretion, inhibit macrophages, dec. immune oral anticoagulants, K losing diuretics, ASA, NSAIDS response, stimulate erythoid of bone marrow, inc survival rbc & platelets. mineralcorticoid - 2o, Na reabsorption, K, H excretion; salt retention. interfere with aldosterone, cortisol breakdown => inc half life; acid Glycyrrhiza glabra => potentiated topical hydrocortisone Riges nigrum oil RA - dec. joint tenderness # & score vs placebo Borago officinalis DBPC, cataract surgery, post-op => dec. lid edema, conjunctival Anamas comosus edema, mild hemorrhage Aloe spp., Rhamnus frangula, R.purshiana, Rheum Anthraquinones, potassium depletion => arrhythmia palmatum, R. officinale, Cassia acutifolia Astragalus membranaceus, Echinacea spp., Tabebuia Immune avellandae Estrogen, progesterone, pregnenolone, testosterone, DHEA

Antimetabolites

Methotrexate

Alkylating agents

Cyclophophamide (Nitrogen mustard analogs)

Cisplatin (Platinum compounds)

Folic acid analog. Competes w/, irreversibly binds dihydrofolate reductase; blocks active form: tetrahydrofolate; Inc. glycine, inc. homocysteine. 93% bioavailable IV, 36% oral. 80% urine excretion

ASA Folic acid Vit A, glutathione Vit E, Selenium Panax quinquefolium Cannibus sativa Matricaria recutita Betula lenta, actea racemosa, Filipendula ulmaria, Gaultheria procumbens, Populus balsamifera, P. tremuloides, salix alba, S. nigra Withania somnifera

May bind DNA => interstrand , intrastrand crosslinks => apoptosis. Post-IV - KI, LV, prostate; bladder, muscle, testicle, pancreas; later: bowel, adrenals, HT, Diuretics LU, brain. Platinum persists in tissues => 180 days. Excretion: 90% urine, 10% bile, 10-40% in urine @ 24h. SE: nephrotoxicity, ototoxicity. Vit A, E, glutathione, quercerin VIT C; B-Carotene+A+C+E; genistein, quercetin Cannibus sativa Panax ginseng Astragalus membranaceus

Dec. clearance => increase methotrexate toxicity Dec. therapeutic response Dec. toxicity Increased Tx effect Inc. Tx effect Est+ Breast CA Dec nausea in 78% (unresp. To antiemetics) resolved mucositis, oral ulcers

prevented myelosuppresion - rbc, wbc. Chemotherapeutic effect unknown. Delayed hypersensitivity rxn induced by cyclo suppressed at 1000 mg/kg.

Increase ototoxicity

inc. tx effect Inc. cytotoxicity Dec nausea in 78% (unresp. To antiemetics) stage II ST CA - doubled survival time, improved CD3, CD4 while on 5FU+Cisplatin non-small cell LU CA - reduced death risk, inc proliferation SP cells, B cell IgG, cytotoxic T cells, macrophage IL-6 & TNF

Pyrimidine analogs Antimetabolites

Fluorouracil Capecitabine

Chemotherapeutic Agents Cytotoxic Antibiotics

(Antracyclines) Doxorubicin, Daunorubicin, epirubicin, idarubicin, valrubicin

B-carotene, melatonin Vit C, glutathione Vit A, CoQ10, gluthathione Metabolized to 5FU by thymidine phosphorylase in tumor Melilotus officinalis and normal cells => cell damage; colorectal => LV CA CYP450 2C9 CoQ 10, Vit A, C, E, Selenium, Melatonin Vit A, C, E, Selenium, B-Carotene, quercetin, green tea Panax quinquefolium Bind DNA, inhibit nucleic acid synthesis, 4-5% Cannibus sativa excreted in urine in 4-5d. 40-50% in bile/feces in 7d, slowed if impaired LV function. SE: progressive Rosmarinus officinalis methanol extract diverse cardiac toxicity (permanent). Disposal Camellia sinensis extract anything that contacts if must be labelled & treated as hazardous waste. Actea racemosa Blocks methylation of deoxyuridylic acid => thymidylic acid therefore interferes w/ DAN, RNA synthesis

Digitalis spp., Rauwolfia serpentina, Selenicereus grandiflorus…

Dec Tx effect Inc Tx effect Dec. toxicity coumarin anti-coagulants Dec Toxicity Inc Tx effect Inc Tx effect Est+ Breast CA Dec nausea in 78% (unresp. To antiemetics) Inc DOX in Breast CA cells via P-glycoprotein transport pump Inc DOX in ovarian sarcoma, Dec. DOX in normal tissue, Dec. tumor size (mice) Inc. cytotoxicity (mice) also MCF-7 Direct herbal regulation of cardiac function

Chemotherapeutic Agents

Anti-androgens - bicalutamide, sypoterone, flutamide, nilutamide Non-steroidal aromatase inhibitors - anastrozole, exemestane, letrozole Anti-estrogen - Tamoxifen

Competes w/ estrogen binding sites in breast, uterus. Displays estrogen-like effect on endometrium, bone, blood lipids

Hormone Antagonists

Protease Inhibitor - Velcade bortezmii PS-341

Oral Contraceptives

Estrogen & progesterone monophasic Estrogen & progesterone biphasic Estrogen & progesterone triphasic

marvelon, cyclen, ovral-21

Histamine H2 Receptor Antagonists Gastroesophageal Reflux Proton Pump Inhibitors

Inc. Tx effect Inc. Cytotoxicity

Induces apoptosis via inhibition NK kappaB, stabilization protoapoptotic proteins. Promotes chemo & radioVitamin C sensitization. Relapsed multiple myeloma B12, B2, B6, Vit C, Magnesium, ASA (Salix alba/nigra, Inhibit ovulation Filipendula ulmaria…)

Inc Tx effect Est+ Breast CA prevented KI damage HOT FLUSHES in post-meno breast CA survivors faster response to tamoxifen Human CA cells lines w/ anti-oxidants => not induce apoptosis. DO NOT GIVE VELCADE & VIT C TOGETHER => velcade does not generate intracellular reactive oxygen species. Dec Folic Acid

Suppress gonadotropins

Citrus paradisi, Vit C

may Inc. ethinyl estrogen

Alesse-21, Triphasil-21

Suppress gonadotropins => Dec ovarian androgens => Dec testosterone

Hypericum perforatum

Dec. contraceptive activity

Block androgen receptors

gaviscon, Aluminum-magnesium preparations - mylanta diovol, Antacid foam, coating agent. Acid absorption. Calcium preparations - tums, Magnesium preparations - phillips Cimitidene, famotidine, nizatidine, Onset 15-60 min, duration 4-8h, clearance 30-48h. ranitidine Inhibits CYP450-1A2, 2C9, 2D6, 3A4. Bind H2 receptors Iansoprazole, Omeprazole, Pantoprazole, Rabeprazole

Cyclosporin + azathioprine Immunosuppressants Medicago sativa + Actea racemosa Vaccines

Dec Tx effect

Vit A, melatonin Vit. C, tocotrienols (?) DEC Magnesium Increase Zinc Panax quinquefolium Oenothera Biennis Silybum marianum Actea - 58% EtOH extract Ribes nigrum

Synphasic, ortho 7/7/7

Androgen dependent acne Diane-35

Antacids

Citrus sinensis peel

Theobroma cacao, coffee arabica, cola nitida, paullinia cupana (guarana), Ilex paraguayensis, Camellia sinensis Glycyrrhiza glabra Nicotiana tabacum Digitalis spp. Vit C

Peak plasma 2h, duration 24h. 95% plasma protein bound. Excretion: urine 80%, feces 20%. CYP450-2C19. 70% reduction in peak HCl after 5d @ 20mg/d. Antacids H2 Hypericum perforatum, citrus paradisi Proton pump Inhibits purine synthesis: esp leukocytes, lymphocytes. Used in KI transplant, RA. SE: susceptible fungal, viral Cordyceps sinesis infection, cunvulsion, GI ulcer Used 6 wek acute KI rejection after 16 y. Serum cyclosporine unaltered. T cell activation via Lcanacanine?

Inc sereum Vit A, Vit K, calcium, zinc, caffeine hypertension clots, strokes, MI Dec. phosphorus, iron, folic acid Inc. Al absoprtion

Dec B12, Ca, Mg, Fe

Dec acid dependent nutrients

Dec nephrotoxicity

Pneumococcal vaccine Uncaria tomentosa - H2O extract enhanced immune response by elevating w/o oxindole alk lymph:neutrophil ratio in blood & dec serotype decay Dec Fe absoption Increase thermogenesis Inc. BP reaction via Inc. Norepinephrine Inhibits adenosine Clozapine Supraventricular Tachycardia Pentobarbital, diazepam, triazolam, zopiclone, clonazepam Antagonizes Increases ASA absorption Dec. Lithium levels Fluvoxamine, oral contraceptive, cimetidine, verapramil, disulfiram, fluconazole, mexiletine, phenylpropanolamine, Inc. caffeine stimulation idrocilamine, methoxsalen, phenacetin, furafylline Quinolone antibiotics (enoxacin, pipemidic acid), Caffeine inhibited norfloxacin, ciprofloxacin Ephedrine MAOIs, propranolol, metropolol, pheylpropanolamin

Caffeine

Phenytoin

Increase caffeine metabolism & loss

H2 blockers, acetaminophen, B12 Benzodiazepines, heparin, pentazocine, TCAs, caffeine, amobarbital, Vit C

Dec blood levels Speeds elimination

Phenylbutazone, quinine, estradial, flecainide, haloperidol, Speeds metabolism ligncaoine, tacrine, thiothixene, zolpidem, phenothiazines Nicotiana tabacum

Citrus Paradisi

Hypericum Perforatum

Induce CYP450-3A4, P-glycoprotein

Furosemide, insulin, dextropropxyphene, B-Blocker Renders less effective Glutethimide Enhances drug effect Oral Contraceptives Inc. stroke risk in women > 30 Adenosine Inc. circulatory effect Theophylline (green tea) Inc. Metabolism Cimetidine, ranitidine (H2 antagonists) Dec. breakdown of nicotine Nifedipine Inc. BP effect Felodipine, amlodipine, verapamil, nitrendripine, nisoldipine, Inc. bioavailability 3X nimodipine (Inhibit CYP450-3A$ Terfenadine Increase bioavailability => fatal arrhythmia Coumarin, benzodiazepines, simvastatin, lovastatin, saquinavir, quinidine, estradiol, ethinylestradiol (inhibit Inc. bioavailability CYP450-3A4) Cyclosporin (P-Glycoprotein inhibition) Inc. Plasma concentration Caffeine metabolism inhibited: Inc. AUC + dec 1/2life + Dec. Naringin (inhibits CYP450-1A2) caffeine clearance Clarithromycin, 14-hydroclarithromycin Dec. absorption Fexofenadine Dec. bioavailability Paroxetine Inc. sedation w/ surgery Nefazodone, sertaline, trazodone Serotonin syndrom (in elderly pts) Cyclosporine, Indinavir, ethinyestradiol, desogestrel, warfarin, phenprocoumon, midazolam, statins (HMG-CoDec. Plasma reductase), digitozin, B-Blockers Dec. Resperine (mice) Inc. EtOH effect (mice) MAOIs enhanced Opiod anesthetics, tamoxifen, taxol, etopisine, reduced pseudoephedrine, naloxone, proxicam, tetracycline