Botanicals Flashcards
Who started exploring homeopathic medicine first?
Dr. Hahnemann
•Similia similibus curentur (Let Likes be cured by Likes) •“like regenerates/heals/ recharges like” • “Medical Aikido” • “Sympathetic magic...” • Immunizations?
Law of Similars
•The more dilute, the stronger the remedy •Substance imparts energy or resonance to solvent •Can homeopathy be classified as an energy therapy?
Law of Infinitesimal Dose
________: illness specific to person, so treatment is
individualized
•“Standard” therapies – “OTCs” - hybrid therapies
•Evidence?
•Clinical trials: adults, animals, infants
•What does it mean in practical terms for healthcare professionals?
#1 - safety concerns
#2 – lack of or delay of effective treatment
•“True” homeopathy:
What are the 4 Gs?
- Cause bleeding
garlic
Ginger
Ginko
Ginseng
If a pt is using one of the 4g s of increasing bleeding risk, what should you advise the pt before procedures/surgery?
Stop 7-10 days before
\_\_\_\_\_\_\_ interactions •Actions of the DS and the drug have additive effects, synergistic effects, or opposing effects •Examples •red yeast rice vs statins •saw palmetto vs finasteride
Pharmacodynamic
_______ interactions
•DS or drug affects the absorption, distribution, metabolism, or
elimination of the other
Pharmacokinetic
(Absorption) \_\_\_\_\_\_ affects P-glycoprotein in gut to increase absorption Higher drug levels (phenytoin, nevirapine, propranolol, theophylline)
Piperine*
(Distribution) \_\_\_\_\_\_ increases tissue penetration and increase volume of distribution of ciprofloxacin Decreased blood concentration and activity of ciprofloxacin
Fennel
(Metabolism)
________ induces CYP450 3A4 Lower drug levels of 3A4
substrates
St. John’s wort
(Excretion) \_\_\_\_\_ inhibits active transport of methotrexate Increased blood concentration of methotrexate
Kudzu
Does Cannabis induce or inhibit the following?
1A2
Induce
Does Cannabis induce or inhibit the following?
2D6
3A4
Inhibitors
\_\_\_\_\_\_ plus the following cause increased bleeding? •Cranberry •Devil’s claw •Ginkgo •Garlic •Ginseng •Green tea •Red clover• Yada, yada, yada....
•Warfarin
•Commonly appears in toothpastes and mouth
rinses
•Rinses/oral gels do NOT seem to benefit plaque
formation or gingivitis
•100 mg/day orally salivary secretion in
patients with dry mouth
•Most often used for CVD (100-800 mg/day) or to
reduce adverse effects of statins (50-100 mg/day)
Co-enzyme Q10 (CoQ10)
What DS has lovastatin in it?
Red yeast rice
•200 mg three times daily orally improves burning mouth syndrome
•Usually used for diabetic neuropathy or to help control blood
glucose (600-900 mg/day)
•Very well tolerated; reduced blood sugar is possible
•Tell diabetic patients to monitor their blood
sugar more frequently when starting to take
Alpha-lipoic acid
•Mouth rinse (400 mg in 80 ml water) used swish-and-spit 6 x day versus
povidone/iodine solution in patients undergoing radiation therapy
for head/neck cancer
•Tolerable oral mucositis: delayed development in all turmeric pts
•Intolerable mucositis: 14/39 developed in turmeric group, 39/40 in
povidone-iodine
Turmeric/curcumin (Curcuma longa)
Which DS can be used with similar effects as CHX?
Tumeric
•Extract in Orabase vs triamcinolone in Orabase vs
placebo for recurrent aphthous stomatitis
•Triamcinolone healed fastest, chamomile healing
similar at 3 days, patient satisfaction at end similar
•Oral rinse used prophylactically and after mucositis
development in radiotherapy and systemic
chemotherapy
•Only 1 of 20 radiotherapy patients developed stage
3 mucositis
•36/46 chemotherapy patients did NOT develop
“clinically noticeable” mucositis
Chamomile (Matricaria recutita)
•Wide antibacterial and antifungal activity •More active against pathogenic than “endogenous” bacteria •Used topically for toenail fungus •Used in mucosal and dental products, BUT.... •...toxic if taken orally •As little as 10 ml has been fatal to a toddler
Tea tree oil (TTO; Melaleuca alternafolia)
Mouthwash Trial •0.2% TTO, 2.5% garlic, 0.12% chlorhexidine •All Streptococci mutans •TTO and garlic other microbes •TTO and garlic had residual effect; suppressed bacteria 1-2 weeks •Garlic tasted worst, caused bad breath, and had more “burning sensation” than chlorhexidine Dental Gel Trial •0.5/5% TTO vs Colgate Total; fixed orthodontics; 28 days •Biofilm index: •-0.67 vs -0.21 (TTO vs CT) •Bacterial colonies: •2558 vs 12,796 (TTO vs CT)
Tea tree oil
•“herbal Valium”
•Anxiolytic; smooth muscle relaxer
•inhibition of enzymatic GABA breakdown, stimulates GABA
release
•300-450 mg extract given in three divided doses
•Additive effects with any CNS depressant
•Alcohol, pain medication,…nitrous oxide?
Valerian
•2nd most prevalent cannabinoid in the cannabis plant •Is it really “not psychoactive?” •Depends on what you mean... •Is it legal? •2018 Farm Bill •Is it a dietary supplement? •TMJ •20% CBD topical ointment with masseter muscle massage 2 times daily for 2 weeks •Pain VAS reduced 70.2% vs placebo, 9.81%
Cannabidiol (CBD)
Is CBD a dietary supplement?
No
•Ceremonial and social use in Micronesian islands
•Some abuse, but adverse effects seen only in severe cases
•Extremely effective in clinical trials for anxiety; also used for
insomnia
•Use exploded world-wide
•Reports of hepatotoxicity and death – why?!
•Current recommendation: do NOT use – classified as “WTB”
Kava (Piper methysticum)
counterirritant/“anesthetic” effect, antibacterial; oil extract
or 1-5% solution for mouthwash; toxic when taken orally
•FDA reclassified OTC to Category III
Clove:
: antibacterial/antifungal; 100% oil is ONLY external use;
ADE and toxic when taken orally
•Tea tree oil
: antibacterial; calming in aromatherapy uses
Lavender
: antibacterial/antiviral; 10% oil in ethanol solution
topically for migraine headaches
•antispasmodic in smooth muscle; 1-2 enteric-coated capsules (0.2
mL) TID
Peppermint
What does DSHEA stand for?
Dietary Supplement Health and Education Act
Which informational resource about dietary supplements is the highly recommended one by the Pharm school but is the most expensive?
Natural Med Database
What informational resource about DS mainly is used to test quality and is less expensive?
Consumer Lab
