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4.19 Integrative Pharmacology
By Dr. Leblanc
85
Pharmacology
Professional
04/25/2012

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Cards

Term
What is complementary medicine?
Definition
used together with conventional medicine
Term
What is alternative medicine?
Definition
used in place of conventional medicine
Term
What is integrative medicine?
Definition
combines treatments from conventional medicine and CAM; high-quality evidence of safety and efficacy
Term
What percent of out-of-pocket health care dollars are spent on alternative medicine?
Definition
11%
Term
How are dietary supplements regulated?
Definition
as foods not as drugs (no FDA oversight); as long as they don't claim to treat a disease and haven't been proven to cause harm, they don't need FDA oversight
Term
What organization does most of the legitimate research on complementery medicine?
Definition
National Center for Complementary adn Alternative Medicine; a compoenent of the National Institutes of Health
Term
What percent of U.S. adults have ever used CAM?
Definition
74.6%
Term
What is the most commonly used natural product?
Definition
fish oils/omega 3
Term
What is the disease for which CAM is most frequently used among adults?
Definition
back pain
Term
Where in your diet do omega-3 fatty acids come from?
Definition
fish oil and certain plants or nut oils
Term
Why are fish oils so important to have in your diet?
Definition
humans do not produce omega-3 FA
Term
Name the omega 3s in fish oils.
Definition
Docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA)
Term
What is the omega 3 fatty acid in english walnuts and vegetable oils (canola, soybeen, flaxseed/linseed, olive)?
Definition
alpha-linolenic acid (ALA)
Term
Whey should omega 6 fatty acids be avoided?
Definition
cause vasoconstriciton
Term
What are the positive effects of taking fish oils/omega 3s?
Definition
effective for high triglycerides (may reduce levels by 20-50%); may reduce death due to heart disease
Term
Fish oils/omega 3 fatty acids are possibly effective for what kinds of diseases?
Definition
elevated cholesterol, atherosclerosis, high blood pressure, stroke, rheumatoid arthritis, osteoporosis, Raynaud's syndrome ADHD, endometrial cancer, ADHD, IgA nephropathy, reducing renal injury by cyclosporine, bipolar disease, age-related macular degeneration
Term
How often should you eat fish?
Definition
twice a week
Term
What is the minimal effective dose of EPA + DHA for TG reduction?
Definition
1 gram/day
Term
2-4 grams of omega 3/day decreases TGs by ____%.
Definition
25-50%
Term
How much is in each pill of omega 3s?
Definition
usually 120 DHA and 180 EPA/1 gm caps; would need 7-13 caps/day for 2-4 gms per day
Term
Should Cod liver oil be recommended to help patients reduce their TGs?
Definition
not really; need a large amount to achieve effective doses and this could lead to toxic levels of vitamin A
Term
What are the side effects of taking omega 3s?
Definition
allergies to fish or fish products (nuts), increases in blood sugar, bleeding potential, increasing levels of low-density lipoproteins, potentially harmful contaminants (dioxins, mercury, polychlorinated biphenyls [PCBs]), GI upset (common), diarrhea, reflux, burping, small reductions in BP, vitamin E deficiency potential with long-term use
Term
What is glucosamine?
Definition
substrate for glycoaminoglycans and hyaluronic acid backbone for proteoglycans
Term
What is chondroitin sulfate?
Definition
a glycoaminoglycan that has a role in cartialge formation through stimulation of chondrocyte metabolism and synthesis of collagen and proteoglycan; inhibits destructive synovial enzymes
Term
What is glucosamine and condroitin used for?
Definition
osteoarthritis (knee and hip), chronic venous insufficiency, inflammatory, bowel disease, leg pain, rheumatoid arthritis, temporomandibular joint disorders
Term
Is glucosamine and chondroitin effective for treating osteoarthritis of the knee?
Definition
no but combination may be effective in some patients with moderate to severe knee pain
Term
Patient should not take glucosamine if they have allergies to...
Definition
shellfish or iodine because glucosamine may be made from shells of shrimp, crabs, and other shellfish
Term
What are the side effects/cautions of glucosamine/chondroitin?
Definition
dyspepsia, nausea, H/A, drowsiness, insomnia, skin reactions, sun sensitivity, temporary increases in BP and heart rate (palpitations), increased risk of cateract formation in animals, may increase risk of bleeding, may cause proteinuria
Term
Which patients should be monitored if they are on glucosamine/chondroitin?
Definition
type 2 diabetics because it can increase their blood sugar
Term
What drug interactions occur with glucosamine/chondroitin?
Definition
may decrease effectiveness of all hypoglycemics, NSAIDS bleeding risk, diuretics may increase side effects
Term
What's another common name for echinacea?
Definition
purple or american coneflower
Term
What is the most commonly used species of echinacea?
Definition
echinacea purpurea (not angustifolia or pallida)
Term
What is echinacea used for?
Definition
stimulate the immune system to fight infections; traditionally used to treat or prevent colds, flu or other infections; less commonly used for treating wounds and skin problesm like acne and superficial skin abscesses
Term
What part of the purple coneflower are used?
Definition
above ground parts and roots
Term
Does echinacea work to prevent or shorten the course of URIs?
Definition
probably not
Term
What are the side effects of taking echinacea?
Definition
GI side effects; some experience alelrgic reactions such as rashes, increased asthma, and anaphylaxis
Term
Why should you not use echinacea for more than 8 weeks at a time?
Definition
can possibly supress the immune system
Term
What's another name for flaxseed?
Definition
linseed
Term
What is 5-50 mg flaxseed oil used for?
Definition
laxative; tx of hot flashes and mastalgia; hyperlipidemia
Term
Wat is 3-10 grams of flaxseed oil per day used for?
Definition
topical demulcent and emollient, coughs, colds, arthritis and hyperlipidemia
Term
What's the difference between flaxseed oil and flaxseed posder?
Definition
flaxseed oil does NOT contain lignans which are phytoestrogens
Term
How does flaxseed act as a laxative?
Definition
contains soluble fiber
Term
Does flaxseed oil lower cholesterol?
Definition
mixed results; it contains alpha linolenic acid which may benefit heart disease but there is not enough reliable data
Term
T/F Flaxseed oil/pills helps treat hotflashes.
Definition
we don't know; there have been mixed results
Term
What are the side effects of flaxseed oil/pills?
Definition
should be taken with plenty of water otherwise will worsen constipation and there have been rare cases of intestinal obstruction; fiber may also reduce medication absorption
Term
Which ginseng is not a true ginseng?
Definition
siberian ginseng
Term
What is Ginseng used for?
Definition
supporting overall health, boosting immune system, increasing sense of well-being and stamina, improving mental and physical eprformance, treating erectile dysfunction, menopausal symptoms, hep C, lower blood glucose and controlling hypertension
Term
Which part of the ginseng plant is used?
Definition
the root is dried and used in various products such as tablets or capsules; extracts and teas and creams
Term
Is ginseng effective?
Definition
it may lower blood glucose or help immunity; most research is inconclusive
Term
What should you tell patients to avoid side effects of ginseng?
Definition
limit use to 3 months because of development of side effects
Term
What are the most common side effects of taking ginseng?
Definition
headaches, sleep and GI problems, allergic reactions, breast tenderness, menstrual irregularities, HBP, low blood sugar
Term
Diabetics on ginseng should use extra caution when taking Ginseng with other herbs that lower blood sugar such as...
Definition
bitter melon and fenogreek
Term
What is ginkgo biloba used to treat?
Definition
asthma, bronchitis, fatigue, tinnitus, improve memory, Alzheimers (treatment and prevention), other dimentia, decrease intermittent claudication, sexual dysfunction, multiple sclerosis
Term
Ginkgo biloba has shown promising results in treating...
Definition
Alzheimer's, dementia, claudication, tinnitus, memory enhancement
Term
What are the side effects and cautions to take when using ginkgo biloba?
Definition
headache, nausea, GI upset, diarrhea, dizziness, allergic skin reactions, may increase bleeding risk
Term
Ginkgo biloba should be used with caution with what other drugs/medical situations?
Definition
caution with anticoagulants, bleeding disorder, surgery or dental procedures
Term
Why must care be taken in the preparation of ginkgo biloba?
Definition
uncooked seeds cotain ginkgotoxin which can cause seizures (roasted seeds can be dangerous); leaf and leaf extracts contain little ginkgotoxin
Term
What is the latin name for garlic?
Definition
allium sativum
Term
What are garlic supplements used to treat?
Definition
hypercholesterolemia, heart disease (CAD), hypertenion, prevention of stomach and colon cancer
Term
Is garlic useful in treating high cholesterol, high blood pressure, and cancers?
Definition
maybe slightly
Term
In what form does garlic have the worse side effects?
Definition
raw
Term
What are the side effects of garlic supplements?
Definition
breath and body odor, dyspepsia, GI upset, allergic reactions, similar effects as aspirin in platelet function
Term
In what clinical situations does it matter if a patient is taking garlic?
Definition
during surgery, post-operative, dental procedure or if they have a bleeding disorder; discontinue at least one week prior to surgery; interferes with efficacy of saquinavir
Term
What is the funciton of coenzyme Q-10?
Definition
involved in mitochondrial electron transport and oxidative phosphorylation (endogenous antioxidant)
Term
Where are concentrations of coenzyme Q-10 highest and lowest in the body?
Definition
highest in the heart, liver, kidney and pancreas; lowest in the lung
Term
What is the scientific name for coenzyme Q-10?
Definition
ubiquinone
Term
What is coenzyme Q-10 used for?
Definition
ischemic heart disease including intra-operative cardiac ischemia, congestive heart failure, toxin induced cardiomyopathy, hypertension and to stimulate the immune system
Term
What are the benefits of taking coenzyme Q-10?
Definition
improves symptoms and status of patients with CHF; improved symptomatic mitral valve prolapse, some benefit in patients with drug-induced cardiotoxicity, some improvement in immune function
Term
What supplement is thought to be helpful in preventing/reversing statin-associated myopathy?
Definition
coenzyme Q-10 but studies are not conclusive
Term
What are the side effects of coenzyme Q-10?
Definition
insomnia, nausea, upper abdominal pain, elevated liver enzymes
Term
Which patients should not take coenzyme Q-10?
Definition
those that are pregnnat or nursing because it has not been studied in those situations
Term
What are the drug interactions of coenzyme Q-10?
Definition
may decreasethe effects of warfarin
Term
What are some other names for St. John's wort?
Definition
hypericum, klamath weed, goat weed, hypericum perforatum
Term
What is St. Johns wort used to treat?
Definition
ancient times= sedative, malaria, balm for wounds, burns, and insect bites
now= depression, anxiety, sleep disorders
Term
Is St. Johns wort effective in treating depression?
Definition
may treat mild to moderate depession but no more effective than placebo in treating major depression of moderate severity
Term
What are the side effects of St. John's wort?
Definition
increased sensitivity to sunlight, anxiety, dry mouth, dizziness, GI symptoms fatigue, headache, sexual dysfunction,
Term
By what mechanism does St. John's wort intefere with other drugs?
Definition
may speed or slow other drugs metabolism through the induction of cytochrome P450 3A4 and drug pump P-glycoprotein
Term
What drugs interact with St. John's wort?
Definition
combined with SSRIs may increase side effects, indanavir and other HIV drugs, trinotecan and other anti-cancer drugs, cyclosporin for preventing transplant rejection, digoxin, warfarin and related anticoagulants, oral contraceptives
Term
What are other names for saw palmetto?
Definition
american dwarf palm tree, cabbage palm, serenoa repens, sabal serrulata
Term
What is saw palmetto used for?
Definition
mainly for urinary symptoms associated with BPH, chronic eplvic pain, prostate cancer, bladder disorders, decreased libido, hair loss, hormone imbalances
Term
Is saw palmetto effective?
Definition
not really
Term
What are the side effects of saw palmetto?
Definition
mild stomach discomfort, tender breasts and decline in sexual desire
Term
What is the MOA of red yeast rice?
Definition
contain monacolins with inhibits cholesterol synthesis
Term
How effective is red yeast rice?
Definition
10-33% LDL reduction
Term
What are the side effects of red yeast rice?
Definition
dyspepsia, muscle pain injury
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