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Pharmacology I > Botanicals and Dietary Supplements in Dentistry > Flashcards

Botanicals and Dietary Supplements in Dentistry Flashcards

1
Q

what are the motivations for dietary supplement use

A
  • safe = natural
  • optimal health
  • autonomy
  • access
  • cost
    -hope
  • quick fix
  • frustration/mistrust
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2
Q

why ask about CAM and DS use

A
  • assess potential beneift
  • minimize harm form drug induced nutrient depletion
  • identify and assess potential harm
  • adverse events, toxicities
  • potential drug interactions
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3
Q

how do you communicate about supplemtns

A
  • use specific terminology to avoid misunderstandings
  • avoid negative terminology or tone
  • stress importance of the information
  • display openness to hearing about use
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4
Q

what did Dr. Samuel Hahnemann do

A
  • dissatisfied with harm of standard therapies
  • devised hemopathy
  • almost replaced allopathic medicine by civil war
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5
Q

what are the two primary tenets of homeopathy

A
  • law of similars
  • law of infinitesimal dose
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6
Q

what is the law of similars

A
  • let like be cured by likes
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7
Q

what is the law of infinitesimal dose

A
  • the more dilute the stronger the remedy
  • substance imparts energy or resonance to solvent
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8
Q

what is done in true homeopathy

A

illness specific to person so treatment is indivudalized

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9
Q

what does it mean in practical terms for healthcare professionals

A
  • # 1 safety concerns
  • # 2 lack of or delay of effective treatment
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10
Q

what does X or D mean

A

dilution factor of 10

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11
Q

what does C mean

A

dilution factor of 100

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12
Q

what are the 4 G’s

A
  • garlic
  • ginger
  • ginkgo
  • ginseng
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13
Q

what are the supplements with increased bleeding risk

A
  • the 4 G’s
  • fish oil
  • feverfew, horse chestnut,
  • coumarin containing herbs
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14
Q

what are the concerns with garlic

A

definite effects
- absolutely stop 7-10 days before procedures/surgeries

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15
Q

what are the concerns with ginger

A

usually only seen with doses greater than 4g a day

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16
Q

what are the concerns with ginkgo

A

definite antiplatelet effects, stop 7-10 days before procedures/surgeries

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17
Q

what are the concerns with ginseng

A

variable effects, stop 7-10 days before procedures/surgeries

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18
Q

what is the concern with fish oil

A

only an issue with doses greater than 4g a day

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19
Q

what are the possible effects of DS

A

additive, synergistc or opposing

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20
Q

what are the examples of pharmacodynamic interactions

A
  • red yeast rice vs statins
  • saw palmetto vs finasteride
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21
Q

what are the pharmacokinetic interactions

A

DS affects the absorption, distribution, metabolism or elimination

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22
Q

what is the example for absorption - provide the interaction and outcome

A

piperine affects P-glycoprotein in gut to increase absorption
- higher drug levels (phenytoin, propranolol, theophylline)

23
Q

what is the example for distrubution

A
  • fennel increases tissue penetration and increase volume of distribution of ciprofloxacin
  • decreased blood concentration and activity of ciprofloxacin
24
Q

what is the example for metabolism

A
  • St. John’s wort induced CYP450 3A4
  • lower drug levels of 3A4 subtrates
25
Q

what is the example for elimination

A
  • kudzu inhibits active transport of methotrexate
  • increased blood concentration of methotrexate
26
Q

what are the inhibitors and inducers of 3A4

A
  • inhibitors: echinacea, ginkgo, goldenseal, grapefruit, kava
  • inducers: echinacea, garlic, St. John’s wort
27
Q

what does THC do to the liver enzymes

A

inducer of 1A2

28
Q

what does CBD do to liver enzymes

A
  • 2D6 inhibitor
  • 3A4 inhibitor
29
Q

what is the effect for warfarin on cannabis/cannabinoid

A
  • increased levels or THC or CBD
30
Q

what are the effects of alcohol on cannabis/cannabinoid

A

may increase THC levels

31
Q

what are the effects of theophylline on cannabid/cannabinoids

A

decreased levels of smoked things

32
Q

what are the effects of indinavir on cannabid/cannabinoids

A

no effect of smoked things

33
Q

what are the effects of docetaxel on cannabid/cannabinoids

A

no effect on infusions

34
Q

what are the effects of clobazam on cannabid/cannabinoids

A

increased clobazam with CBD in treated children

35
Q

what are the effects of CNS depressants on cannabid/cannabinoids

A

additive effects with alcohol, barbituates and benzos

36
Q

how should DS drug interactions be handled

A
  • determine signficance
  • pick course of action and educate patient
37
Q

what is are the options for clinical management of interactions

A
  • prime questions: what is the clincial significant of the interactions
  • avoid entirely
  • avoid temporarily
  • monitor and manage
38
Q

what are the uses of Co enzyme Q and where is it foudn

A
  • in toothpastes and mouth rinses
  • rinses and oral gels do NOT benefit plaque formation or gingivitis
  • 100mg orally per day increased salivary secretion in patients with dry mouth
  • most often used for CVD or to reduce adverse effects of statins
39
Q

what are the uses and effects of alpha-lipoic acid

A
  • 200mg three times daily orally improves burning mouth syndrome
  • usually used for diabetic neuropathy or to help control blood glucose
  • very well tolerated, reduced blood sugar is possible
  • tell patients with DM to monitor blood sugar more often when starting to take
40
Q

how is tumeric used and what is it used for

A
  • as a mouth rinse 400mg in 80mL water used to swish and spit 6x day versus iodine solution in patients undergoing radiation therapy for head and neck cancer
    -used for tolerable and intolerable oral mucositis
41
Q

what are the uses of chamomile

A
  • extract for recurrent aphthous stomatitis
  • oral rinse used prophylactically and after mucositis deveopment in radiotherapy and systemic chemotherapy
42
Q

what are the uses of tea tree oil

A
  • wide antibacterial and antifungal activity
  • more active against pathogenic than endogenous bacteria
  • used topically for toenail fugnus
  • used in mucosal and dental products
  • toxic if taken orally- 10mg
43
Q

what are the herbal blends used in toothpastes

A
  • neem oil
  • TTO, oregano, lavender, other essential oils
  • mulitple herbs with anti inflammatory action
44
Q

what is neem oil active against

A

strep mutans

45
Q

what does valerian do and what are the interactions of it

A
  • anxiolytic, smooth muscle relaxer
  • inhibition of GABA breakdown
  • 300-450mg extract given in three divided doses
  • additive effects with any CNS depressant
46
Q

what is Kava used for and what is the current recommendation for it

A
  • extremely effective in clinical trials for anxiety and insomnia
  • current recommendation is do NOT use- classified as WTB
47
Q

what does clove oil do

A

counterirritant/anesthetic effect, antibacterial; oil extract or 1-5% solution for mouthwaste, toxic when taken orally
- category III

48
Q

what does teat tree oil do

A

antibacterial/antifungal

49
Q

what does lavender oil do

A

antibacterial
- calming in aromatherapy usewh

50
Q

what does peppermint oil do

A

antibacteria/antiviral, 10% oil in ethanol solution topically for migraine headaches
- antispasmodic in smooth muscle: 1-2 enteric coated capsules TID

51
Q

what is the 2nd most prevalent cannabinoid in the cannabis plant

A

cannabidiol

52
Q

what are the dental uses for CBD

A

TMJ
- 10% CBD topical ointment with masseter muscle massage 2 times daily for 2 weeks

53
Q
A

Pharmacology I (12 decks)

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