Pharm - CAM
Terms
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- What are dietary supplements?
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- term used in the USA
- includes all natural health products (NHP) - What are functional foods?
- Foods eaten for a specific health purpose
- What are Natural Health Products?
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- term favoured in Canada
- includes complementary medicines, traditional remedies, etc. - What are conventional therapies?
- Therapies widely used by health professionals to diagnose and treat disease
- What are Alternative therapies?
- therapies outside of conventional care
- What are Complementary Therapies?
- Therapies that are used to "complement" conventional care
- What are some examples of oral formulations?
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- teas & decoctions
- tinctures & fluid extracts
- glycerites (same as tinctures but without alcohol)
- solid extracts
- What are the Canadian guidelines regarding Traditional Herbal Medicines (THM)?
- THMs are for self-medicating and require appropriate labelling
- What are the Canadian guidelines regarding Botanicals?
- not required to include cautions, contradictions or possible adverse effects on the label
- What are some regulation issues regarding CAM?
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- Packaging labels (health claims) - can state "promotes cardiovascular health"; cannot state, "reduces BP"
- Adverse Effects
- Impurities Adulterants and Variability (dosage can vary in each tablet) - Who uses CAM?
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Canada - 71% (lower in Atlantic provinces)
USA - 62%
Western Countries - average 50% - What is social validation?
- evidence commonly accepted by the general public about the use, safety and effectiveness of a medication
- What are 4 reasons why people use CAM?
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1. Responses or reactions to conventional medicine
2. Perceptions of CAM
3. Wanting to take control of one's health
4. Economic reasons (less costly) - Responses or reactions to conventional medicine (Reasons for using CAM)
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- concerns about safety and side effects of conventional medicines
- disillusionment over lack of treatment success
- advice from friends - Perceptions of CAM (Reasons for using CAM)
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- safety: "they don't hurt you and may help"
- that CAM practices are holistic
- practices are congruent with popular beliefs about health & disease - Wanting to take control of one's health. (Reasons for using CAM)
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- trying out new health ideas
- current CAM emphasis on wellness & prevention
- insurance coverage - Economic Reasons (Reasons for using CAM)
- inability to afford conventional care such as prescription drugs
- What are some barriers to CAM?
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1. Cost
2. overwhelmed with info
3. lack of accessible, relevant info
4. novice ability to critique info & credibility of sources of info
5. Relationship with health care provider (conversations about CAM "shutdown"
6. Fatigue & other side effects of conventional treatment (limit ability to search for credible CAM info and practitioners
6. Lack of time to investigate CAM before making other treatment decisions - How safe are NHPs?
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- little is known about the safety
- some can be safe and may provide some therapeutic benefits if used properly - What are some common side effects of NHPs?
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- allergic reactions
- toxic reactions
*kava - liver toxicity
*ephedra - cardiovascular toxicity
- mislabelling of product content
*Ayurvedic products - high levels of heavy metals (lead)
- drug interactions - What do NHPs from Ayurvedic (India) contain?
- highly contaminated with heavy metals such as lead
- What are the drug interactions related to Black Cohosh?
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may potentiate (increase):
- antihypertensive effect
- hypoglycemic effect (oral agents & insulin) - What are the adverse effects related to Black Cohosh?
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- GI (most common)
- rash
- headache
- dizziness
- weight gain
- cramps
- safe for routine use
***** increases BP and uterine contractions (pregnant women should NOT take this!) - What is Coenzyme Q-10?
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- potent antioxidant
- helps in ATP production (mitochondrial level) - What are the therapeutic uses of Coenzyme Q-10?
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- Mitochondrial encephalomyopathies
- Congestive Heart Failure (CHF)
- myopathies (muscular disease): due to HMG-CoA reductase inhibitors - What are the adverse effects of Coenzyme Q-10?
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- well tolerated
- may have GI symptoms - What are the drug interactions associated with Coenzyme Q-10?
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- structurally similar to Vitamin K2
- may antagonize effects of warafin - What is the therapeutic use of Cranberry Juice?
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- prevents UTIs
- proanthocyanidins interfere with bacterial adhesion to urinary tract - What is the effectiveness of Cranberry Juice?
- - daily intake helps prevent UTIs in women (teens, 20s and elderly women; NOT older adults or young girls)
- What are the adverse effects of Cranberry Juice?
- - contradictory evidence: may increase INR (international normalized ratio) of warafin patients
- What is Echinacea? (taken orally and topically)
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- antiviral
- anti-inflammatory
- immunostimulant
- What are the drug interactions associated with Echinacea?
- may interfere with immunosuppressant drugs
- What are the uses of Feverfew?
- - prophylaxis of migraine
- What are the adverse effects of Feverfew?
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- well-tolerated (no serious effects)
- mild GI reactions
(long-term safety studies are lacking)
- shown to be effective
- MOA not well understood - What are the uses of Flaxseed?
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- treat dyslipidemia
- constipation
- decrease total cholesterol & LDL - What is Flaxseed?
- Soluble plant fiber (only soluble if it is milled)
- What are the adverse effects of Flaxseed?
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GI related:
- bloating
- cramping
***should be taken 1 hour before or 2 hours after other medications (it increases peristalsis) - What are the uses of Garlic?
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-Cardiovascular system
*reduces TGs, LDLs and raises HDL
- reduces BP
- suppresses platelet aggregation
- increases arterial elasticity
- decreases formation of plaque
- antimicrobial
- anticancer effects - How should Garlic be taken?
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raw (not cooked because active ingredients become destroyed)
- active ingredients: allicin & allinase
- 1-2 cloves bid (twice daily) for effect
- only 5 of 18 common garlic products contain effective amounts of allicin - What are the uses of Ginger Root?
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- vertigo
- suppress N/V (caused by motion sickness or morning sickness)
- suppress post-op N/V
- cancer chemotherapy
- suppress platelet aggregation
- What 2 NHPs suppress platelet aggregation (anti-platelet effects)?
- Garlic & Ginger Root
- Ginko
- well-tolerated
- Glucosamine
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- use with caution in patients with shellfish allergy
- helps with arthritis
- increased risk for bleeding - Green Tea
- - overconsumption leads to caffeine overdose
- Probiotics
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well-tolerated
- some GI effects
- usually prescribed with an antibiotic
- produce growth of normal flora (good bacteria) - Saw Palmetto
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- may have anti platelet effects
- conflicting results in treatment of benign prostatic hyperplasia (BPH) - Soy
- should not be used with antiestrogenic medications (tamoxifen)
- What is the use of St. John's Wort?
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- treat depression (not severe) - limited clinical studies prove this
- What are the drug interactions of St. John's Wort?
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interacts adversely with MANY drugs:
- induction of cytochrome P450 enzymes
- induction of P-glycoprotein
- intensification of serotonin effects - What is Valerian?
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- a depressant
- used as a tranquilizer in WWII
- well-tolerated - What are 3 harmful NHPs?
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1. Comfrey - contains pyrrolizidine alkaloids (veno-occlusive disease)
2. Kava - severe liver damage
3. Ma Huang (Ephedra) - elevates BP, stimulate heart & CNS