hawthorne

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hawthorne (Crataegus Species)

(haw-thorn) ,

aubepine

(trade name),

cum flore

(trade name),

hagedorn

(trade name),

maybush

(trade name),

whitehorn

(trade name)

Classification

Therapeutic: antihypertensives
HypertensionMild to moderate HFAnginaSpasmolyticSedative

Action

Active compounds in hawthorne include flavonoids and procyanidins.
Increase coronary blood flow.
Positive inotropic and chronotropic effects because of increased permeability to calcium and inhibition of phosphodiesterase.

Therapeutic effects

Increased cardiac output.
Decreased BP, myocardial workload, and oxygen consumption.

Pharmacokinetics

Absorption: Unknown.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: Unknown.

Time/action profile

ROUTEONSETPEAKDURATION
POunknown6-8 wkunknown

Contraindications/Precautions

Contraindicated in: Pregnancy (potential uterine activity); Lactation.
Use Cautiously in: Concurrent use with ACE inhibitors and digoxin; Do not discontinue use abruptly.

Adverse Reactions/Side Effects

Central nervous system

  • agitation
  • dizziness
  • fatigue
  • vertigo
  • headache
  • sedation (high dose)
  • sleeplessness
  • sweating

Cardiovascular

  • hypotension (high dose)
  • palpitations

Dermatologic

  • rash

Gastrointestinal

  • nausea

Interactions

May potentiate effects of digoxin, calcium channel blockers, and beta blockers.Concurrent use with phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil ) and nitrates may potentiate vasodilatory effects.May cause additive CNS depression when used with other CNS depressants.Additive effect with other cardiac glycoside–containing herbs (digitalis leaf, black hellebore, oleander leaf, and others).Additive hypotensive effects with herbs than lower BP such as ginger, panax ginseng, coenzyme Q-10and valerian.Additive effect with other cardioactive herbs (devil’s claw, fenugreek, and others).
Oral (Adults) Heart failure—160–1800 mg standardized hawthorne leaf with flower extract in 2–3 divided doses daily. Hawthorne fluid extract (1:1 in 25% alcohol)—0.5–1 mL tid; hawthorne fruit tincture (1:5 in 45% alcohol)—1–2 mL tid; dried hawthorne berries—300–1000 mg tid.

Availability (generic available)

Dried fruit: OTC
Liquid extract of the fruit or leaf: OTC
Tincture of the fruit or leaf: OTC

Nursing implications

Nursing assessment

  • Monitor intake and output rations and daily weight. Assess for peripheral edema, auscultate lungs for rales and crackles during therapy.
  • Assess BP and pulse periodically during therapy.

Potential Nursing Diagnoses

Decreased cardiac output (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Administered as 2–3 divided doses daily at the same time.
  • May be taken without regard to food.

Patient/Family Teaching

  • Advise patients that there are other proven therapies available for treatment of heart failure. These therapies should be employed prior to initiating treatment with hawthorne.
  • Tell patient not to take hawthorne without the advice of health care professional.
  • Instruct patients in the symptoms of a heart attack (pain in the region of the heart, jaw, arm, or upper abdomen; sweating; chest tightness) and heart failure (shortness of breath, chest tightness, dizziness, sweating) and to promptly contact health care professional if they occur.
  • Advise patient to report weight gain or persistent swelling of the feet to health care professional.
  • May cause dizziness and fatigue. Patients should avoid driving or other activities that require mental alertness until response to herb is known.
  • Avoid alcohol and other CNS depressants while taking hawthorne without consulting health care professional.
  • Profuse sweating and dehydration under extreme heat may increase the BP-lowering properties of hawthorne, leading to severe hypotension. Warn patients to avoid exertion in hot weather to minimize the risk of side effects.
  • Instruct patients that hawthorne helps control the symptoms of heart failure but does not cure the disease. Lifestyle changes (salt restriction, weight management, exercise as tolerated, adherence to medication regimens) still need to be followed.
  • Instruct patient to consult health care professional before taking Rx, OTC, or other herbal products concurrently with hawthorne.
  • Advise female patients to use contraception during therapy and to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

  • Decrease in symptoms of HF. Effects may not be seen for 6 wks.
  • Improved cardiac output as evidenced by improved activity tolerance.
References in periodicals archive ?
We invite submissions for a special issue of the Nathaniel Hawthorne Review, dedicated to fresh examinations of Hawthorne's representations of nature and environment from an ecocritical perspective.
In Hawthorne's era, the contentious, radical spirit of 1776 seemed regenerated in Concord once again, in the writers and thinkers who dwelled in or flowed through its borders--Thoreau, Emerson, Fuller, Alcott, Mann, the Peabody sisters, and, of course, the ever so shy, socially reluctant recluse, Nathaniel Hawthorne, living in this nest of literary illuminati off and on for seven short but significant years.
Though it seems apparent that both Horace Mann and Nathaniel Hawthorne loved her, both men ended up favoring Elizabeth's less assertive younger sisters.
Nathaniel Hawthorne was born on July 4, 1804 in Salem, Massachusetts, the descendant of a long line of Puritan ancestors.
In his famous 1884 biography of his parents, Nathaniel Hawthorne and His Wife, Julian Hawthorne drew the outlines of a life from which few have departed.
This modern version of the Nathaniel Hawthorne House boasts a library, formal living and dining rooms, and a family-pleasing country kitchen with an island and a built-in desk.
This collection of essays had its origin and takes its title from the biannual summer meeting of the Nathaniel Hawthorne Society held in Boston in June of 2000.
Nathaniel Hawthorne (1804-64) was merciless in his fictional portrayals of merciless Puritans, those upholders of dour orthodoxy, hot in pursuit of witches and heretics.
Professor Tellefsen has an article on Willa Cather forthcoming in Studies in American Fiction, and one on Nathaniel Hawthorne appearing in Nineteenth-Century Literature.
He lived, as the proverb states, in interesting times: his con temporaries included such literary luminaries as Herman Melville, Nathaniel Hawthorne, Louisa May Alcott, Walt Whitman, Edgar Allan Poe, and Emily Dickinson.
Nathaniel Hawthorne agreed in principle, and that is why he decided to make his story The Marble Faun, set in Italy, a fantasy and why he took great pains to sidestep a realistic portrait of his Italian characters.