CAM Part 1 Flashcards
1
Q
What does the abbreviation, CAM, mean?
A
Complementary and Alternative Medicine
2
Q
How is CAM defined?
A
A group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.
3
Q
How is complementary medicine defined?
A
As complementary medicine being used in conjunction with conventional medicine.
4
Q
Most CAM is considered to be what?
A
complementary
5
Q
What are some examples of CAM?
A
- Yoga (CAM) + citalopram (conventional) to treat anxiety
* Hypnosis (CAM) + Chantix (conventional) to quit smoking
6
Q
How is alternative medicine defined?
A
As the use of complementary medicine without the use of conventional medicine. It is using just CAM only, instead of conventional medicine.
7
Q
What are some examples of alternative medicine?
A
- glucosamine and chondroitin to treat osteoarthritis
- massage to treat chronic pain
- tai chi to treat fibromyalgia
8
Q
What does CAM include?
A
- Natural Products (herbal medicines, vitamins, minerals)
- Mind and Body Medicine (meditation, yoga, acupuncture)
- Manipulative and Body Based Practices (spinal manipulation, massage therapy)
- Other (pilates, magnet and light therapy, reiki, homeopathy, Chinese medicine)
9
Q
A group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine is?
A
CAM
10
Q
Massage to treat pain is a form of…
A
…alternative medicine.
11
Q
Percocet and acupuncture to treat neuropathy is a form of…
A
…complementary medicine.
12
Q
What is fish oil used for?
A
Hypertriglyceridemia (high triglycerides)
- Some evidence for cardiovascular disease
- Limited evidence for RA, hypertension, bipolar disorder, asthma, stroke, psoriasis, obesity, etc.
13
Q
Who is fish oil safe for?
A
Adults, children, and pregnancy
14
Q
What is the dose for fish oil? What dose of fish oil increases safety risks?
A
Ranges from 1 to 6 grams daily. Doses over 3 grams increase risk of safety concerns.
15
Q
What are the side effects of using fish oil?
A
- MAY INCREASE RISK OF BLEEDING (bruising, nose bleeds, bleeding gums, blood in stool)
- GI side effects are common (nausea, loose stools, belching)
- possible increase in glucose
- INCREASE IN LDL
- possible increased risk for prostate cancer
- possible immune response suppression (avoid in immune deficient patients)
16
Q
What counseling points should we tell patients about fish oil?
A
- do not use in people with fish allergies
- caution with nut allergies
- MAY FREEZE TO DECREASE FISHY TASTE
- SOME CAPSULES ARE LARGE (krill oil is smaller and easier to swallow, but expensive)
17
Q
What drug interactions are possible with fish oil?
A
- Drugs that can increase bleeding are warfarin, NSAIDs, and ASA
- May decrease vitamin E
18
Q
What are the names of prescription fish oil brands?
A
- Lovaza
- Vascepa
- Epanova
- Omtrya
19
Q
What dose are prescription fish oil?
A
Less than 6 grams
20
Q
What counseling points should patients know about Vascepa and Omtrya?
A
They must be taken with meals
21
Q
What is the status of Epanova and Omtrya?
A
- Both approved in 2014
* Availability is unknown; not on the market
22
Q
What is included in Omega-3 Fatty Acids?
A
- eicosapentaenoic (EPA)
- docosahexaenoic acid (DHA)
- alpha linolenic acid (ALA)
23
Q
What do you need to pay attention to in Omega-3 Fatty Acids?
A
You must look at the EPA and DHA components.
24
Q
What is the recommended amount of EPA and DHA?
A
0.3 to 0.5 grams daily in addition to two meals of fish per week
25
What is the common name for ALA?
flaxseed oil
26
What is more bioavailable than flaxseed oil?
Krill oil, so less intake may be needed. Usually EPA and DHA are listed on the label, so you may absorb more due to increased bioavailability.
27
What is the ingredient in Red Yeast Rice?
It contains monacolin K (mevinolin)
28
What statin is Red Yeast Rice equivalent to?
Lovastatin
29
Where is Red Yeast Rice grown?
It is a yeast that grows on fermented rice.
30
What is Red Yeast Rice used for?
Hyperlipidemia
| *Limited evidence for cardiovascular disease, HIV/AIDs related dementia
31
What is the dose of Red Yeast Rice?
1,200mg twice daily with food
32
What is the mechanism of action of Red Yeast Rice?
HMG-CoA reductase inhibitor
33
What counseling points are there for Red Yeast Rice?
* may cause muscle pain (in the thighs), mild GI upset, headache, if you have dark urine call the MD
* Don't use in pregnancy (X)
34
What drug-drug interactions are there with Red Yeast Rice?
It works like a statin, so there is increased risk of myopathy. It is also a CYP3A4 inhibitor. Avoid in liver disease and people who are heavy drinkers. Improperly fermented Red Yeast Rice may contain citrinin which is nephrotoxic.
35
What is considered to be heavy drinking?
At least 3 drinks per day
36
What legal issues are there with Red Yeast Rice?
* A component of RYR is the same compound as lovastatin and was pulled off the market in 1998
* overturned in 2000 and upheld in 2001
* manufacturers had to remove all monacolin K from supplement, but if there is less than 5mg of it the FDA is allowing it
37
What is the normal dose of monacolin K?
20 mg per day
38
What is the better option, lovastatin or Red Yeast Rice?
Lovastatin due to the rigorous testing by the FDA and if it is insured, it will be cheaper.
39
CASE
Middle aged male, takes fiber and fexofenadine daily, MD told him to take something for high cholesterol. He has high triglycerides.
2 grams of fish oil is a good start (1 gram bid) and tell him to eat better
40
What is garlic used for?
Atherosclerosis, various cancers, hypertension, topical fungal disorders, tick bites
41
What makes garlic effective?
The amount of allicin and ajoene (smelly)
* alliin is odorless
* crushed allin releases allinase
* allinase converts alliin to allicin
42
What safety measures should be used when taking garlic?
* Safe if taken orally
| * Possibly unsafe if used topically
43
What is the dose for garlic?
* 200 to 400mg bid to tid
| * 3 to 5mg of allicin per day (most products contain 1 to 1.6%)
44
What is the mechanism of action for garlic regarding cholesterol?
Works like an HMG-CoA reductase inhibitor to decrease cholesterol absorption
45
What is the mechanism of action for garlic regarding blood pressure?
Causes vasodilation by inhibiting angiotensin converting enzyme
46
What are the side effects and warning with taking garlic?
* may increase bleeding
* may cause bad breath and body odor (even odorless products)
* may cause GI upset (nausea, vomiting, gas, weight loss)
* may cause facial flushing, insomnia, tachycardia, and dizziness
* may decrease glucose
* topical use, caution of burns and severe dermatitis
47
Supplements that start with the letter G usually what what side effect?
Increase the risk of bleeding
48
What counseling points are there for garlic?
* don't use if you have an allergy to lily family (tulip, onion, leek, chives
* avoid supplements in pregnancy and lactation
* difficult to determine efficacy due to the wide variety of strengths
* avoid using odorless products (have decreased efficacy)
49
What is the other name for CoQ10?
ubiquinone
50
Where does CoQ10 come from?
* bovine heart tissue in the past
* now made from beet and sugarcane fermentation
* natural sources in heart, liver, kidneys
51
How does CoQ10 work?
* Cofactor in many reactions in the body; the rate limiting step in the formation of mitochondrial ATP
* Strong antioxidant activity
52
What is CoQ10 used for?
* Mitochondrial disorders and CoQ10 deficiency
* Some evidence for age related macular degeneration, CHF, HTN, migraine, Parkinson's disease
* Unclear evidence of adjunct to statin therapy
53
What is the dose of CoQ10?
50 to 1,200mg in divided doses (generally 22 to 400mg daily)
54
What are the counseling points for CoQ10?
* generally well tolerated
* may cause GI upset
* rarely causes anorexia, headache, irritability, dizziness, liver enzyme increase, rash, fatigue
* avoid in lactation
* expensive: 30 caps of 400mg are $42
* safe in pregnancy and children
55
What are the drug-drug interactions of CoQ10?
* drugs that decrease blood pressure
| * structurally similar to vitamin K (may decrease the blood thinning properties of warfarin)
56
If a patient is taking a statin and is having adverse side effects, what can you recommend?
CoQ10
57
What are the brand names of grape seed?
* Endotelon
| * Pycnogenol (top selling dietary supplement)
58
What is the active constituent in grape seed?
Oligomeric proanthrocyanidins (OPCs)
59
What is grape seed used for?
* Some evidence for chronic venous insufficiency and ocular stress
* Unclear evidence for high cholesterol, PMS, HTN
60
What is the dose of grape seed?
150 to 300mg daily
61
What are the counseling points for grape seed?
* do not use in patients that are pregnant or breastfeeding
* may increase risk of bleeding (caution in drugs that increase bleeding)
* do not use if allergic to grapes
* may cause dizziness, HTN, nausea, and indigestion
62
What are the two types of cinnamon?
1. Ceylon (cinnamomum verum)
| 2. Cassia or Chinese (cinnamomum aromatic)
63
Which type of cinnamon has been shown to decrease blood glucose?
Cinnamomum aromatic (Cassia or Chinese cinnamon)
64
What are the 2 uses for cinnamon?
* DIABETES
| * mosquito repellant
65
What is the dose of cinnamon?
1 to 6 grams daily
66
What is the safety information for cinnamon?
* no side effects reported with use
* contains coumarin which may cause HEPATOTOXICITY at high doses
* likely safe in children
* avoid in pregnancy and lactation
67
What are the uses of ginkgo biloba?
* Good evidence: PERIPHERAL ARTERY DISEASE
| * Some evidence: DEMENTIA, anxiety, macular degeneration, diabetic retinopathy, glaucoma, PMS, vertigo
68
What is the dose for ginkgo biloba?
240 to 600mg of gingko leaf extract in three divided doses
69
What is the safety information for gingko biloba?
* EATING THE SEEDS IS POTENTIALLY FATAL
* oral leaf extract is likely safe
* may be safe in children
70
What is the mechanism of action for ginkgo biloba?
May increase blood vessel dilation, change neurotransmitters, or decrease oxygen free radicals
71
What are the counseling points for gingko biloba?
* MAY INCREASE BLEEDING
* MAY DECREASE SEIZURE THRESHOLD
* CAUTION IN PATIENTS ALLERGIC TO URUSHIOLS: mango rind, sumac, poison ivy, poison oak, cashew shell oil
* may cause dizziness, tinnitus, headache, allergic reactions
* avoid use in pregnancy and lactation
72
What drug interactions are there with ginkgo biloba?
* decreases concentration of xanax
* DRUGS THAT INCREASE BLEEDING
* ANTICONVULSANT MEDICATIONS
* DECREASED CONCENTRATION OF SUSTIVA (EFAVIRENZ--HIV MED)--DON'T TAKE TOGETHER
73
What is the antidote for ginkgo toxin poisoning?
Pyridoxine (vitamin B6)
74
What is the longest living tree species?
Ginkgo biloba
75
What are the 3 types of ginseng?
* Asian
* American
* Siberian
76
Describe Asian ginseng.
Most evidence supporting efficacy for this type of ginseng. It is also called panax.
77
Which is more effective, American or Asian ginseng?
Asian
78
Describe Siberian ginseng.
Different genus with different uses. It is also called eleuthero.
79
What is ginseng used for?
* Limited evidence: dementia, ERECTILE DYSFUNCTION
| * Unclear evidence: TYPE 2 DIABETES, FATIGUE, MENTAL PERFORMANCE
80
What is the dose for ginseng?
100 to 900mg TID
81
What are the safety precautions for ginseng?
* limit use to 6 months
| * do not use in infants
82
What are the counseling points for ginseng?
* avoid use in pregnancy, lactation, children
* MAY INCREASE BLEEDING
* MAY CAUSE INSOMNIA
83
What can happen when a person has ginseng abuse syndrome?
* diarrhea
* increased blood pressure
* nervousness
84
What is the other name for St. John's Wort?
Hypericum perforata
85
What are the uses for St. John's Wort?
* Good evidence: MILD TO MODERATE DEPRESSION
* Some evidence: MENOPAUSE SYMPTOMS, wound healing
* Unclear evidence: ANXIETY, pms, SAD, OCD
86
What is the dose for St. John's Wort?
900 to 1,800mg daily (typically 300mg TID)
87
What are the safety precautions for St. John's Wort?
* likely safe in adults
* possibly safe in children
* possibly unsafe at high doses (2 to 4 grams daily)
88
What is the mechanism of action of St. John's Wort?
WORKS BY INCREASING LEVELS OF 5-HT, NE, AND DA
89
What are the active components of St. John's Wort?
* HYPERFORIN
| * HYPERICIN
90
What are the counseling points for St. John's Wort?
* MAY CAUSE GI UPSET, PHOTOSENSITIVITY, ANXIETY, SEXUAL DYSFUNCTION, dry mouth, sedation, headache, INSOMNIA
* may increase the risk of suicidal and homicidal thoughts
91
How long does it take to see an effect of St. John's Wort?
IT TAKES 4 TO 6 WEEKS TO SEE EFFECT
92
Can St. John's Wort be used in pregnancy and lactation?
NO, IT CAN'T BE USED IN EITHER PREGNANCY OR LACTATION
93
What will happen to a person withdrawing from St. John's Wort?
* headache
* tremor
* cold sweat
You have to taper off the medication, not stop immediately.
94
What type of drug does St. John's Wort work similar to?
SSRI
95
What are the drug interactions with St. John's Wort?
* MANY
* DRUGS THAT INCREASE RISK OF SEROTONIN SYNDROME
* CYP1A2, 2C9, 3A4 INDUCER (decreased oral contraceptive effectiveness)
* INDUCER OF PGP TRANSPORTER
* increased effects from narcotics and photosensitizing medications
96
What is melatonin? Where is it produced in the body?
It is a hormone produced by the pineal gland from tryptophan.
97
What is synthesis and release of melatonin stimulated by?
STIMULATED BY DARKNESS AND SUPPRESSED BY LIGHT
98
What is melatonin involved with? When is its highest level?
circadian rhythm with its highest level at 3 to 5 hours after sleep onset
99
What is the use for melatonin?
* some evidence: SLEEP DISORDERS
| * limited evidence: insomnia, jet lag, hypertension, endometriosis
100
What is the dosing for melatonin?
* TYPICALLY 3 TO 10MG QHS
| * TAKE AT DUSK OR 1 TO 2 HOURS BEFORE BEDTIME
101
What are the drug interactions for melatonin?
* CAUTION WITH WARFARIN (MAY INCREASE BLEEDING)
* may decrease blood pressure, use caution in patients that use blood pressure meds
* may increase the effects of other CNS meds
102
What are the counseling points for melatonin?
* avoid use in pregnancy and in children
* MAY CAUSE nausea, DAYTIME DROWSINESS, DIZZINESS, HEADACHE
* RARELY CAUSES SLEEPWALKING, VIVID DREAMS, AND NIGHTMARES
* SEIZURE RISK
* do not drive or operate heavy machinery
103
What part of the Valerian plan gives it activity?
The ROOT
104
What are the uses of Valerian?
* some evidence: INSOMNIA
| * unclear evidence: ANXIETY, depression, dysmenorrhea, dyssomnia, stress
105
What are the safety precautions for Valerian?
* likely safe in adults
* possible safe in children for 4 to 6 weeks
* unclear evidence in pregnancy and lactation, so avoid it
106
What is the usual dose of Valerian?
*400 to 900mg taken 30 TO 60 MINUTES BEFORE BED
107
What are the drug interactions with Valerian?
* USE CAUTION WITH OTHER DRUGS THAT CAUSE SEDATION
| * INCREASES EFFECTS OF ANESTHESIA--ALERT DOCTOR
108
What are the counseling points for Valerian?
* DO NOT DRIVE AFTER USE
* RARELY CAUSES SEDATION THE NEXT DAY (MOST COMMON IN HIGH DOSES)
* WATCH FOR VALERIAN WITHDRAWAL
* may cause headache, insomnia, anxiety
* HEPATOTOXICITY
* CHRONIC USE MAY CAUSE INSOMNIA (MORE THAN 2 TO 4 MONTHS)
109
What is thought to be the active ingredient in Valerian?
Valerenic acid 0.3%
110
The mechanism of Kava kava is similar to what type of medication?
benzodiazepines
111
What are the uses for Kava kava?
* good evidence: ANXIETY
| * unclear evidence: INSOMNIA, benzodiazepine withdrawal, stress
112
What is the dosing of Kava kava?
50 to 280mg of kavalactones every night at bedtime
113
What are the side effects of Kava kava?
* SEVER LIVER PROBLEMS (WAS PULLED OFF SHELF BEFORE--AVOID IN PATIENTS WITH PREVIOUS LIVER PROBLEMS)
* chronic or heavy use: skin disorders, seizures, kidney damage, psychotic syndromes, pulmonary hypertension
* mild side effects: GI upset, rash, headache, sedation
114
What are the drug interactions with Kava kava?
* MAOIs
* drugs that cause liver damage
* may increase CNS effects of other drugs
115
What are the counseling points for Kava kava?
* do not drive or operate heavy machinery
* avoid in pregnancy and lactation
* discontinue 2 weeks prior to surgery
116
What are the uses for Feverfew?
* good evidence: MIGRAINE PREVENTION
| * limited evidence: RA
117
What is the dose of Feverfew?
50 to 143mg daily
118
What are the side effects of Feverfew?
* increased risk of bleeding
* GI upset
* chewing leaves can cause oral ulcers
119
What are the counseling points for Feverfew?
* AVOID USE IN PATIENTS ALLERGIC TO RAGWEED, CHRYSANTHEMUMS, DAISIES, MARIGOLDS
* TAKES 4 TO 8 WEEKS TO START WORKING
* abrupt discontinuation can cause POST FEVERFEW SYNDROME
* DO NOT USE DURING PREGNANCY and lactation
* THEORETICAL CONCERN OF BLEEDING RISK
120
What are the symptoms of Feverfew Syndrome?
* anxiety
* joint stiffness
* rebound headaches
* insomnia
121
What are the uses for ginger?
* Dysmenorrhea
* MORNING SICKNESS
* osteoarthritis
* POSTOPERATIVE NAUSEA AND VOMITING
* VERTIGO
122
What is the dose for ginger?
250mg QID or 500mg to 1000mg BID
* For motion sickness, take 30 minutes before travel and every 4 hours after
* Max dose is 4 grams daily
* Max dose for pregnancy is 1 gram daily
123
Who can take ginger safely?
* adults
| * probably safe in pregnancy
124
What are the counseling points for ginger?
* MAY CAUSE UPSET STOMACH
* HEARTBURN
* belching
* diarrhea
* possible increase in BLEEDING
* may cause hypoglycemia in diabetics
125
Does ginger ale contain real ginger?
Yes
126
What are probiotics? (Dr. Tromp's definition)
Friendly germs that keep the digestive system healthy and aide in digestion
127
What is the official definition of probiotics?
Live microorganisms, which when administered in adequate amounts, confer a health benefit on the host
128
Are probiotics and pre-biotics the same thing? If not, what is the difference?
No, they are different. Pre-biotics are complex sugars that bacteria use for energy.
129
What are the uses for probiotics?
* ADJUNCT TO ANTIBIOTICS
* eczema
* H. PYLORI
* Some evidence: cirrhosis, colon cancer, dental caries, diarrhea in children, diarrhea prevention, growth, immune enhancement, GI INFECTIONS, respiratory infections, INFECTIOUS DIARRHEA, IBS SYNDROME, acute pancreatitis, radiation induced diarrhea, sinusitis, UC
* Limited evidence: allergies, asthma, bacterial vaginosis, cardiovascular disease, CONSTIPATION, ACUTE DIARRHEA, UTI
130
What are the 3 types of probiotics?
* Lactobacillus
* Saccharomyces
* Bifidobacterium
131
What is the dosing for probiotics?
* depend on type used
* average capsule has 1 to 16 x 10^9 bacteria
* general treatment is 14 days, if no benefit try another one
132
What dosage forms do probiotics come in?
* yogurts
* capsules
* powder
* dairy products
133
What is the mechanism of action for probiotics?
Grow in small intestine and crowd out harmful bacteria. Also, increases mucosal defense in GI tract.
134
Who can take probiotics safely?
* generally considered safe
| * okay in adults and children
135
Who should avoid probiotics, especially saccharomyces?
Patients that are immune compromised
136
What are the counseling points for probiotics?
* may produce excessive gas, which decreases over time
* probiotics in dairy products and yogurts are likely safe in pregnancy
* SEPARATE DOSE OF PROBIOTICS AND ANTIBIOTICS BY SEVERAL HOURS
* must be alive to be active
* useful in animals too
137
What type of bacteria is in Culturelle?
Lactobacillus
138
What type of bacteria is in Pearls?
* Lactobacillus
| * Bifidobacterium
139
What type of bacteria is in Align?
* Bifidobacterium
| * Note: align has a lot of evidence supporting its affects
140
What type of bacteria is in Florastor?
Saccharomyces
141
What type of bacteria is in Sustenex?
Bacillus coagulans
142
What type of bacteria is in Activia?
Bifidobacterium
143
What are the 4 probiotic misconceptions?
1. Not all probiotics are normal, healthy bacteria (some were not isolated from humans).
2. Dried probiotics are not necessarily dead (freeze dried products are dormant, but may still be alive)
3. More is not always better
4. 100% of probiotics do not need to survive intestinal transit
144
What type of bacteria is in Align?
* Bifidobacterium
| * Note: align has a lot of evidence supporting its affects
145
What type of bacteria is in Florastor?
Saccharomyces
146
What type of bacteria is in Sustenex?
Bacillus coagulans
147
What type of bacteria is in Activia?
Bifidobacterium
148
What are the 4 probiotic misconceptions?
1. Not all probiotics are normal, healthy bacteria (some were not isolated from humans).
2. Dried probiotics are not necessarily dead (freeze dried products are dormant, but may still be alive)
3. More is not always better
4. 100% of probiotics do not need to survive intestinal transit.
