Page 936 - Cardiac Nursing

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912 PA R T V / Health Promotion and Disease Prevention
Several factors are important to keep in mind when considering
use of herbal remedies. Plant preparations do not have uniform ac-
tive ingredient composition; labeling can be confusing. The concen-
trations of active compounds in a plant vary according to climate,
soil conditions, and growing season. Plant components (e.g., flow-
ers, leaves, stems) vary in concentration and proportion of active
compounds. Extraction methods vary, producing highly variable
concentrations of active ingredients. For example, hawthorn prod-
ucts (see section titled “Hawthorn”) are usually described as con-
taining a certain amount (mg) of extract from the plant. The extract
can be from flowers or leaves or both. Extractions can be performed
using water, ethanol, or methanol; each of these methods results in
different quantities and ratios of active ingredients. When Vierling
et al. 29 tested the activity of the various hawthorn extractions on
contractility of a strip of aortic tissue, the pharmacologic effects were
remarkably diverse. Thus, it is difficult to standardize a dose of
hawthorn; the same is true with many other herbal products.
Often, herbal products contain multiple ingredients. For ex-
ample, the Natural Medicines Comprehensive Database lists more
■ Figure 41-4 Yoga posture. (From Lewis, S. M., Heitkemper, than 100 patented compounds containing hawthorn, each with
M. M., & Dirksen, S. R. [2004]. Medical surgical nursing: Assessment variable coingredients. In many cases, the specific active ingredi-
and management of clinical problems [6th ed.]. St. Louis: Mosby; used ent from a plant has not been identified, making it impossible to
with permission.)
achieve uniformity between products.
Another consideration involves contaminants. For example,
Yoga products sometimes contain heavy metals (e.g., lead, chromium)
or toxins or microbial elements (e.g., Fusarium, Aspergillus). Be-s s
The term yoga derives from a Sanskrit word meaning to join or cause testing, labeling, and manufacturing regulatory standards
unite. Yoga methods include physical and mental disciplines de- are significantly less rigorous with herbal than with pharmaceuti-
signed to produce unity (e.g., unity of the body with the mind, of cal products, the consumer is not well protected.
the mind with the soul, of the individual with a higher power). The 1994 Dietary Supplement and Health Act permits the sale
Unity is thought to result in a happy, balanced, useful life, and of herbal products that are not toxic as long as no claims are made
possibly improved health. Yoga methods include Asanas (yoga related to therapeutic efficacy. Regulations mandating quality
postures) (Fig. 41-4), Pranayamas (regulated breathing), Mudras control are lacking. In 2003, in an attempt to try to improve
(hand gestures), and Mantras (chanted words). Several small stud- product purity, potency, and consistency, the United States Food
ies suggest that yoga techniques can improve cardiac health. Vem- and Drug Administration proposed rules called good manufactur-
pati and Telles 25 studied healthy young adult males; yoga was as- ing practices to guide herbal product manufacturing practices.
sociated with acute reductions in heart rate and sympathetic tone These rules have not been mandated. However, some herbal prod-
(indicated by heart rate variability). Yoga lifestyle changes have uct manufacturers have adopted voluntary good manufacturing
been associated with improved cardiovascular risk factors such as practices. U.S. Pharmacopoeia is an independent group that
lower-body weight and improved lipid profile and blood pressure serves as the official standard-setting body for all U.S. medicines;
regulation. 26–28 Good experimental yoga studies are needed but some herbal manufacturers have sought U.S. Pharmacopoeia cer-
difficult to design. tification. Patients can be directed to seek products with the USP
logo indicating the product has passed stringent quality-control
standards (Fig. 41-5).
BIOLOGICALLY BASED
TREATMENTS
Herbal and dietary remedies are commonly used to treat cardiac
and vascular disease. Aromatherapy is also considered a biologi-
cally based therapy, although there is scant literature on the use of
aromatherapy for cardiac conditions.
Herbal Remedies
Herbal products are derived from plants. For thousands of years,
plant extracts have been to improve health. Some ancient herbs
(e.g., aspirin, reserpine, digitalis, caffeine) are now mainstays of ■ Figure 41-5 USP logo. This label on a dietary supplement indi-
conventional pharmacotherapy. Care providers can refer to the cates the product in the container has passed the stringent purity, po-
Natural Medicines Comprehensive Database Web site, http:// tency, and consistency standards set forth by U.S. Pharmacopeia.
www.naturaldatabase.com, for up-to-date information about (From the U.S. Pharmacopeia website. [http://www.usp-dsvp.org/,
herbal products used by their patients. retrieved November 12, 2003]; used with permission.)