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 ?
Soon after arriving in England, the Hawthornes rented a large house in Rock Ferry from which Hawthorne could easily commute to the Liverpool consulate.
The happiness felt by the Hawthornes on their wedding in Boston on July 9, 1842 becomes a recurring theme throughout the biography, but as McFarland is wont to do, it is first contextualized with news stories from the weekly Concord Freeman the day before the nuptial, reporting on births, deaths, barn burnings, incidents of "lascivious cohabitation" and two teenage boys who fight a duel and are spanked by their mother--"an excellent medicine for unruly children" (6-7).
And of course, in addition to the novels and tales, Hawthorne left copious evidence of himself in the pages of his published volumes of notebooks, American, English, and Italian.
The sales achievement and standard of customer care at the Hawthornes has been excellent.
Italy, however, the great land of art, where the Hawthornes sojourned for one year and four months, receives 352 pages, and of those 352, Florence, birthplace of the Renaissance, occupies 163.
Despite his efforts to obscure the relationship between these two economies, in order to establish his romance as separate from the commercial marketplace, Hawthorne recognizes their intimate relationship: he insists upon the "coal-fire" as an "essential influence in producing" the moonlight's effect (CE 1:36) and he repeatedly describes the scarlet letter as a "rag" (CE 1:31), thereby emphasizing its relation to the raw materials of the writer's trade in the 1850s--paper made of reconstituted cotton fibers (CE 1:25).
Edwin Haviland Miller, Salem Is My Dwelling Place: A Life of Nathaniel Hawthorne (U Iowa P, 1991), xviii + 596 pp.
The son of a sea captain, Hawthorne was educated at Bowdoin College, where he knew Franklin Pierce and Henry Wadsworth Longfellow.
Emphasizing what she calls servants' "architectural ghosting," Baldwin examines how middle-class families like the Hawthornes struggled to develop domestic environs in which they would never need to come into contact with their servants even as they sympathized with their challenging work (65).
Nathaniel Hawthorne was born in Salem, Massachusetts, on July 4, 1804, twenty-eight years after America painfully and defiantly wrested itself from Great Britain.
Buttressed with a wealth of biographical and textual evidence, Hawthorne's Fuller Mystery weaves two argumentative threads: the compelling intimacy between Hawthorne and Fuller, and the "allegorical representation" (p.