پاورپوینت کامل Herbal Psychopharmacology 125 اسلاید در PowerPoint

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پاورپوینت کامل Herbal Psychopharmacology 125 اسلاید در PowerPoint

اسلاید ۴: ۲.Which of the following has been most closely associated with hepatotoxicityA.GinkgoB.KavaC.Saw palmettoD.St. John’s wortE.Valerian

اسلاید ۵: ۳.Which of the following is the clinically most important effect of St. John’s wort on the cytochrome P450 (CYP) systemA.1A2 inhibitionB.2D6 inhibitionC.2C9 inductionD.2E1 inductionE.3A4 induction

اسلاید ۶: ۴.St. John’s wort has been most extensively studied for the treatment of which of the following disordersA.BipolarB.Posttraumatic stressC.PanicD.Major depressiveE.Social aپاورپوینت کامل Herbal Psychopharmacology 125 اسلاید در PowerPointiety

اسلاید ۷: ۵.A placebo-controlled, double-blind study found Ginkgo biloba to be ineffective for treating antidepressant-induced sexual dysfunction.A.TrueB.False

اسلاید ۸: ObjectivesUnderstand the ramifications of DSHEAAppreciate the current efficacy status of herbals for treating psychiatric disordersBe aware of the potential effects of herbals on drug metabolism

اسلاید ۹: OutlineHistorical Overview – DSHEA and its RamificationsValerianA.Clinical StudiesB.Drug InteractionsGinkgoA.Clinical StudiesB.Drug InteractionsC.Bleeding

اسلاید ۱۰: Outline (Cont’d.)KavaA.Clinical StudiesB.HepatotoxicityC.Drug InteractionsSt. John’s WortA.Clinical StudiesB.Mechanism of ActionC.Side EffectsD.Drug Interactions

اسلاید ۱۱: Outline (Cont’d.)VI.Other HerbalsA.UsesB.Drug InteractionsVII.JuicesA.GrapefruitB.OrangeC.PomegranateVIII.Resources

اسلاید ۱۲: Historical overviewDSHEA (1994)Clinical efficacyDrug interactionsWords of warning

اسلاید ۱۳: Herbs and plants are medical jewels gracing the woods, fields and lanes which few eyes see, and few minds understand. Through this want of observation and knowledge the world suffers immense lossLinnaeus 1707-1778

اسلاید ۱۴: Progress1938: Food, Drug and Cosmetic Act Proof of safety1962: Kefauver-Harris AmendmentProof of efficacyRequired reporting of adverse events1994: Dietary Supplement Health and Education Act (DSHEA)(sponsored by Senator Orrin Hatch, signed by President Clinton)

اسلاید ۱۵: Dietary Supplement Healthand Education Act (1994)Removed supplements from food additive regulationsBurden of proof on FDANo federal regs for purity, etc.No mandatory reporting of AEs

اسلاید ۱۶: Since then, these products have flooded the market, subject only to the scruples of their manufacturers.Angell and Kassirer, NEJM 9/17/98

اسلاید ۱۷: “In the United States, the public spends almost $4 billion yearly on supplements, with little or no data on what they can expect.”Lewis and Strom. Ann Int Med 136:617-618, 2002In 2003, Americans spent nineteen billion dollars on dietary supplementsSpecter M. The New Yorker, Feb 2, 2004, pp 64-75

اسلاید ۱۸: ۵۰ Ginseng PreparationsAnalyzed for ginsenosides Content varied from 1.9% to 9% (4.7 fold difference) 6 (12%) had noneCui et al: Lancet 7/9/94

اسلاید ۱۹: Asian Patent Medicines from California Herbal StoresUndeclared pharmaceuticals – ephedrine, chlorphenarimine, methyltestosterone, phenacetinHeavy metal contamination – lead, arsenic, mercury32% of 260 medicinesCalifornia Dept. of Health Services, NEJM 9/17/98

اسلاید ۲۰: Tongkat Ali Power Plus: A Natural Remedy to Improve Sexual Health and Libido“Our products are natural herbal powder made in a more convenient-to-use form capsules” Analysis of 15 capsules found sildenafil, 59 mg/capsule. 10 of the 15 also contained tadalafil, 1.4 mg/capsuleKenyon et al. J Clin Pharmacology 2006;46:1379-1381BUT

اسلاید ۲۱: FDA Issues Dietary Supplements Final RuleTo require good manufacturing practices (GMPs) for supplementsTo ensure quality production, no contaminants, accurate labelingEffective August 24, 2007, but with a long phase-inDoes not address efficacy and safety issueshttp://v

اسلاید ۲۲: Valerian(Valeriana officinalis)

اسلاید ۲۳: Valerian(Valeriana officinalis)Galen – the Phu plant (dried roots stink)U.S. Pharmacopoeia 1820-1942 (the 19th century Valium)WWII – for shell shockRat-catchers baitCats-ecstasy

اسلاید ۲۴: Valerian in PsychiatryInsomniaBetter than placebo in 6/7 double-blind studiesSlow onset (2-3 weeks)Aپاورپوینت کامل Herbal Psychopharmacology 125 اسلاید در PowerPointietyOnly open-label reportsWell tolerated (mild hangover)Does odor defeat the blindKrystal and Ressler. CNS Spectrums 10/01

اسلاید ۲۵: Valerian for InsomniaInternet-based, 4-week, double-blind, placebo-controlled6.4 mg valerenic acids hs (odor masked)Valerian (n=135) = placebo (n=135)Jacobs et al., Medicine 2005;84:197-207

اسلاید ۲۶: Valerian for Insomnia: Systematic Review and Meta-Analysis16 randomized, placebo-controlled trials, N=1dologic problems in most, and preparations, doses, durations varied considerably“The available evidence suggests that valerian might improve sleep quality”Better studies are needed Bent et al. Am J Medicine 2006;119:1005-1012

اسلاید ۲۷: Valerian-Drug Interactions (14 days, healthy vol., n=12)No clinically significant effects on CYP2D6 (dextromethorphan) or 3A4 (alprazolam)Alprazolam Cmax 20% (AUC, T1/2 unchanged)Donovan et al. Drug Metab Dispos 2004;32:1333-1336

اسلاید ۲۸: Valerian and CYP450 Inhibition (28 days, healthy subjects, n=12)No significant effect CYP1A2, 2D6, 2E1, 3A4Gurley et al., Clin Pharmacol Ther 2005;77:415-426

اسلاید ۲۹: Valerian and CYP450 InhibitionSo far, so goodClinical studies-very limited data -only in 24 healthy volunteers

اسلاید ۳۰: Ginkgo (Ginkgo biloba)

اسلاید ۳۱: Ginkgo Biloba Tree(Maidenhair Tree)Oldest living tree species (200 million years)Lives up to 1000 yearsGrows up to 122 feetDurable -only tree to survive Hiroshima -popular in NYC

اسلاید ۳۲: Ginkgo Biloba ComponentsFlavonal glycosidesKaempferolQuerectinIsorhamnetinMyricetinTerpene lactonesGinkgolidesBilobalideEtc.

اسلاید ۳۳: Ginkgo Biloba for DementiaInconsistent dataFurther research neededCholinesterase inhibitors preferredKurz and Van Baelen, Dement Geriatr Cogn Disord 2004;18:217-226Diamond et al., Drugs Aging 2003;20:981-998

اسلاید ۳۴: Extract of Ginkgo Biloba in DementiaGERRIPlaceboEGb ImprovedLe Bars et al: JAMA 278:1327-1332, 1997

اسلاید ۳۵: Ginkgo Biloba vs. Placebo on Cognitive Performance in Multiple Sclerosis 12-week, double-blind, n=38Dose: 120 mg twice dailyResults: Overall, no statistically significant improvement in cognitive functionLovera et al. Multiple Sclerosis 2007;13:376-385

اسلاید ۳۶: Ginkgo/Ginseng Combination and Cognitive FunctionHealthy, middle aged volunteers (n=256)14 week, double-blind, placeboSignificant improvement on Index of Memory Quality (7.5%)Wesnes et al. NCDEU Poster 81, June 2000

اسلاید ۳۷: Ginkgo for Memory Enhancement (6 week, double-blind, n = 230)Volunteers, over 60 years old40 mg t.id. versus placeboNo benefit, but well toleratedSolomon et. al. JAMA 288:835-840, 2002

اسلاید ۳۸: Ginkgo Biloba: No Robust effect on Cognitive Abilities or Mood in Healthy Young or Older Adults12-week, double-blind, placebo-controlled, n=93 older, n=104 young adultsDose: 120 mg/dayBurns et al. Human Psychopharmacol Clin Exp 2006;21:27-37

اسلاید ۳۹: Ginkgo Biloba Extract EGb 761 for Generalized Aپاورپوینت کامل Herbal Psychopharmacology 125 اسلاید در PowerPointiety Disorder (n=82) and Adjustment Disorder with Aپاورپوینت کامل Herbal Psychopharmacology 125 اسلاید در PowerPointious Mood (n=25)4-week, double-blind, placebo-controlledDose: 240 mg or 480 mg/dayResults (HAM-A ): EGb 761 > placebo (both doses)Response: 480 mg 44%, 240 mg, 37%, placebo 22%Woelk et al. J Psychiatric Research 2007;41:472-480

اسلاید ۴۰: Ginkgo Biloba for Antidepressant–Induced Sexual Dysfunction (n=37)240 mg/day EGb761 vs. placebo8 week, double-blindIneffective!Kang et al. Human Psychopharmacol 2002;17:279-284

اسلاید ۴۱: Ginkgo Biloba-Drug InteractionsDonepezil (2D6, 3A4 substrate)*30-days, 90 mg/day, n=14no effectNifedipine (3A4 substrate)**simultaneous, single dose, n=12no effect overallblood levels doubled in 2Omeprazole (2C19, 3A4 substrate)***12-day, 280 mg/day, n=18CYP2C19 induction ~ 58% AUC *Yasui-Furukori et al., J Clin Pharmacol 2004;44:538-542 **Yoshioka et al.,