RH Herb Safety & Contraindications 2 — Questions and Answers
Question 1: Which herb is most known for inducing CYP3A4 enzymes and reducing blood levels of many pharmaceutical drugs?
- Valerian root
- St. John's Wort (Correct answer)
- Echinacea
- Ashwagandha
Correct answer: St. John's Wort
St. John's Wort (Hypericum perforatum) is a potent inducer of CYP3A4 and P-glycoprotein, significantly reducing plasma levels of drugs like cyclosporine, antiretrovirals, and oral contraceptives.
Question 2: A patient taking warfarin asks about using Ginkgo biloba. The primary safety concern is:
- Hepatotoxicity risk
- Increased bleeding risk (Correct answer)
- Reduced drug absorption
- Hypertensive crisis
Correct answer: Increased bleeding risk
Ginkgo biloba has antiplatelet and mild anticoagulant properties that can potentiate warfarin, significantly increasing bleeding risk.
Question 3: Which herb is contraindicated in patients with autoimmune diseases such as lupus or multiple sclerosis?
- Chamomile
- Milk thistle
- Echinacea (Correct answer)
- Lavender
Correct answer: Echinacea
Echinacea stimulates immune function and is contraindicated in autoimmune conditions where immune upregulation could worsen symptoms.
Question 4: Licorice root (Glycyrrhiza glabra) is contraindicated in patients with which condition due to pseudohyperaldosteronism?
- Hypothyroidism
- Hypertension (Correct answer)
- Hypoglycemia
- Osteoporosis
Correct answer: Hypertension
Glycyrrhizin in licorice inhibits 11-beta-HSD, causing sodium retention and potassium loss, which raises blood pressure and is dangerous in hypertensive patients.
Question 5: Which herb's volatile oils can cause liver toxicity and are contraindicated in patients with hepatic disease?
- Peppermint oil (high dose) (Correct answer)
- Lavender essential oil
- German chamomile
- Rosehip
Correct answer: Peppermint oil (high dose)
High doses of peppermint oil can cause hepatotoxicity due to pulegone metabolites, and it is used with caution in patients with existing liver conditions.
Question 6: A client on SSRIs asks about combining them with 5-HTP supplements. The major risk is:
- Adrenal suppression
- Serotonin syndrome (Correct answer)
- Hypothyroidism
- Kidney failure
Correct answer: Serotonin syndrome
Combining 5-HTP with SSRIs can cause excessive serotonergic activity leading to serotonin syndrome, characterized by agitation, hyperthermia, and neuromuscular abnormalities.
Question 7: Which herb is known to inhibit platelet-activating factor and should be used cautiously before surgery?
- Slippery elm
- Feverfew (Correct answer)
- Astragalus
- Marshmallow root
Correct answer: Feverfew
Feverfew (Tanacetum parthenium) inhibits platelet aggregation and prostaglandin synthesis, increasing bleeding risk during surgical procedures.
RH Herb Safety & Contraindications 2
Which herb is most known for inducing CYP3A4 enzymes and reducing blood levels of many pharmaceutical drugs?