Herbal & Complementary Therapies NCLEX is increasing the number of questions related to alternative and complementary therapies, since

more clients are using these products. Pay particular attention to drugs that interfere with anticoagulants and those drugs that have multiple uses (garlic, ginger, gingo, ginseng, St. Johns wort). Products that boost the immune system should not be given with glucocorticoids (given to suppress immune function); therapies that sedate should not be given with CNS depressants or opioids.

Common Name Echinacea Feverfew Garlic

Therapeutics Immune function Migraine headaches CAD, clotting disorders Immune function Insulin resistance Nausea GI upset Memory

Interactions Amiodarone, steroids, ketoconazole NSAIDS, ASA, heparin, warfarin NSAIDS, ASA, heparin, warfarin OHAs NSAIDS, ASA, heparin, warfarin AEDs TCAs NSAIDS, ASA, warfarin, heparin CNS depressants Digoxin Diuretics Insulin and OHAs Warfarin Diuretics CNS depressants and opioids Cyclosporine NNRTIs Protease inhibitors SSRIs, TCAs Warfarin Barbiturates, opiates, ETOH

Toxicities Hepatic Bleeding Bleeding Hypoglycemia Bleeding Decreased AED effect Decreased seizure threshold Bleeding Sedation Digoxin toxicity Diuresis hypoglycemia Decreased anticoagulation Decreased diuresis Increased sedation Decreased levels Decreased efficacy Decreased efficacy Serotonin syndrome Decreased anticoagulation Increased sedation

Ginger Gingko biloba Dementia Insulin resistance Ginseng

Energy, libido Immune function Cardiac ischemia Insulin resistance

Goldenseal St. Johns Wort

Antibacterial, antifungal Depression

Valerian

Insomnia

Kava Evening Primrose

Cloves Cayenne

Insomnia Pain, neuropathy, MS, RA Hyperlipidemia, blood clots Eczema, PMS Dental pain Muscle pain/tension

CNS depressants AEDs

Increased sedation Decreased seizure threshold

Anticoagulants

Bleeding GI upset Skin, mucous membranes

Coenzyme Q10

Grape seed extract Carnitine Horse chestnut Cranberry extract Fish oils Selenium Horehound

Acidophilus Black Cohash Soy Saw palemetto Glucosamine & Chondroitin Aloe vera

Heart disease, angina Muscle weakness/pain HTN, high cholesterol Wound healing High cholesterol, angina Venous insufficiency Joint inflammation Prevention of UTIs Inflammation High triglycerides Cancer Prevention Respiratory illness Expectorant GI upset Digestive health Menopausal symptoms Menopausal symptoms BPH Arthritis, joint health Wound healing Moisturizing Burns Eye health/vision Diabetic retinopathy Oral inflammation

Anticoagulants

Bleeding

Anticoagulants Hypoglycemics Anticoagulants

Death in high doses

Bleeding

Antihypertensives Anti-estrogen therapies

Hypotension Cancer risk Pancreatic, Liver

Bilberry