Week 5 Workshop 11

Herbal medicine in Cardiovascular

disease
WORKSHOP PREPARATION
In advance of the workshop you will need to prepare answers to scenarios 1-7
below. Once you arrive at the workshop you will be divided into groups and
given 20-30 minutes to prepare a 5 minute presentation to the class on one of
the scenarios to be allocated once you arrive at the class. To do this refer to
references given below and year 2 herbal medicine work. Additionally, you will
be given a group question to answer/discuss to be distributed in the class.
Please bring a BNF (if you have one) and phone/tablets for accessing the
web as necessary.

QUESTIONS/TASKS/SCENARIOS:

1. Mr. Goodwin comes into your pharmacy and collects his prescription for
warfarin 5mg tablets [1 as directed]. He asks to buy some Potters Calcium and
Vitamin D with Glucosamine tablets as he is finding that his knees are getting
very stiff when going upstairs. Comment on this scenario. What advice would
you give your patient and what options do you have?
2. Angela Clarke hands in a prescription for simvastatin 40mg [1 nocte]. She asks
you whether she should continue to take her Echinacea tablets and comments
that she is committed to a strict exercise and diet regime. The diet includes
taking grapefruit juice every morning. Comment on the scenario. What options
do you have? What advice will you give your patient?
3. What medical problems may benefit from the use of herbal diuretics? What
medical problems would you be cautious about them using them on? Name 3-4
herbs that have reported diuretic properties. Give brief information on use,
side-effects, contraindications.
4. A patient wants advice on preventing high blood pressure as he has a family
history of hypertension. How would you deal with this situation? Give details of
any herbal options.
5. Mrs. Smith comes into your pharmacy saying they are nearly finished a herbal
remedy prescribed by their herbalist for palpitations and anxiety.. Before she
goes back to the herbalist for a refill she would like a consultation with the
pharmacist. Mrs Smith shows you the herbal bottle which is labelled with the
formula:
Ginkgo biloba
1:3 tincture
Crataegus monogyna
1:3 tincture
Valeriana officinalis
1:5 tincture
Total: 150mls
Dose: 7.5ml with water three times a day.

50ml
50ml
50ml

Mrs. Smith mentions she is going into hospital next week for a minor operation
on her hand.
She asks your opinion on the effectiveness of this mixture for her condition and
if there are any precautions she should take. How would you answer your
patient? What questions may you want to ask her?
6. A patient is picking up their prescription for Digoxin 125mcg [1 mane] plus
amlodipine 10 mg [1 daily]. They have a productive cough and would like to
buy Covonia herbal mucus cough syrup which they have used before. They
want to confirm that they can take the cough bottle with their prescription
medicines. What advice do you give? What options would you consider?
7. You receive a prescription from a patient for Warfarin 1mg [1 as directed],
which has just been started for a deep vein thrombosis (DVT). They mention
that they are getting on well with their St Johns Wort Max strength tablets
which they have been taking for 4 weeks now [425mg dried aerial extract] one
tablet daily. What advice would you give the patient regarding the
concomitant use of these products? What options do you have?
For each scenario you should look up information on the herbal, CAM and
conventional medicine that the patient is on: including: use, dose, side-effects,
interactions, contraindications/precautions to enable you to answer the specific
questions on each scenario.
Resources:
One of the complexities of use of herbal and CAM products is to find reliable
references so you will have to use several different resources to research the herbal
and CAM products. You should look at the following web links and references first:
Stockleys Herbal Medicines Interactions[ebook available in university library]
BNF Edition 70 Appendix 1.
http://naturaldatabase.therapeuticresearch.com/home.aspx?
cs=&s=ND&AspxAutoDetectCookieSupport=1
Bone K& Mills S Principles and Practice of Phytotherapy - Modern Herbal Medicine
(Second Edition); 2013. Electronic resource in university library.
http://www.nlm.nih.gov/medlineplus/herbalmedicine.html
http://www.boots.com/en/Covonia-Herbal-Mucus-Cough-Syrup-150ml_1236419/
https://www.medicines.org.uk/emc/medicine/25153 [details of Covonia cough syrup]