Chapter 69: Complementary and Alternative Therapy

Question 1

Regulation of Dietary Supplements​

Answer 1

Dietary Supplement Health and Education Act of 1994 (DSHEA) ​

Package labeling​

Adverse effects​

Impurities, adulterants, and variability​

National Center for Complementary and Alternative Medicine (NCCAM)​

Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006​

U.S. Food and Drug Administration (FDA) Current Good Manufacturing Practices (CGMPs) ruling, 2007 ​

Private quality certification programs​

Standardization of herbal products​

Adverse interactions with conventional drugs​
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Question 2

Harmful Supplements

Answer 2

Comfrey​

Kava​

Ma huang (ephedra)​

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Question 3

Natural Medicines Brand ​
Evidence-Based Rating ​

Answer 3

New subscription service​

Offers evidence-based ratings for more than 60,000 specific products​

NMBR system​

Available at http://naturaldatabase.therapeuticresearch.com​

Question 4

Black Cohosh

Answer 4

Cimicifuga racemosa​

Used to treat symptoms of menopause​

Mechanism of action (MOA) unknown​

Effectiveness​
Some studies have shown it to be as effective as estrogen​
Has not been evaluated for long-term use​

Question 5

Coenzyme Q-10 (CoQ-10)

Answer 5

Potent antioxidant in the body; participates in the production of adenosine triphosphate (ATP) at the mitochondrial level​

Therapeutic uses​
Mitochondrial encephalomyopathies, congestive heart failure (CHF), and myopathies due to 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins)​

Question 6

Cranberry Juice

Answer 6

therapeutic use​
Prevents urinary tract infection (UTI)​
Proanthocyanidins interfere with bacterial adhesion to urinary tract​

Effectiveness​
Daily intake helps prevent UTI in women in their teens or 20s and in elderly women, not in older adults or young girls​

Contradictory evidence that cranberry juice may increase the international normalized ratio (INR) of warfarin patients​

Question 7

Echinacea

Answer 7

Echinacea angustifolia, E. purpurea, ​
E. pallida​

Used orally and topically​
Produces antiviral, antiinflammatory, and immunostimulant effects​
widely taken, but effectiveness is highly questionable​

interactions​
May interfere with immunosuppressant drugs​

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Question 8

Feverfew

Answer 8

Used primarily for prophylaxis of migraine​

MOA is not well understood​

Has proved effective​

Adverse effects​
Well tolerated, no serious effects​
Mild GI reactions​

Drug interactions: By suppressing platelet aggregation, feverfew can increase the risk of bleeding in patients taking antiplatelet drugs (e.g., aspirin) or anticoagulants (e.g., warfarin or heparin)​

Question 9

Flaxseed

Answer 9

Used to treat dyslipidemia and constipation​

Soluble plant fiber​

Seems to reduce total cholesterol and low-density lipoprotein (LDL), similar to other fiber products​

Does not affect high-density lipoprotein (HDL) cholesterol or triglycerides​

Adverse effects are GI related (e.g., bloating, cramping)​

Should be taken 1 hour before or 2 hours after other medications​

Question 10

Garlic

Answer 10

Used primarily for cardiovascular system effects​
To reduce levels of triglyceride (TG) and LDL and to raise HDL​

Also used to reduce blood pressure, suppress platelet aggregation, increase arterial elasticity, and decrease formation of atherosclerotic plaque; antimicrobial and anticancer effects​

Can have favorable effects on blood pressure and plasma lipids​
Must be raw, not cooked (allicin and alliinase)​
One or two cloves twice daily for effect​
Only 5 of 18 common garlic products contain allicin in effective quantities​

Generally well tolerated except for strong taste and bad breath​

Has significant antiplatelet effects

Question 11

Ginger Root

Answer 11

Primary uses​
To treat vertigo and to suppress nausea and vomiting associated with motion sickness, morning sickness, seasickness, chemotherapy, and general anesthesia​
Antiinflammatory and analgesic properties that may help people with arthritis and other chronic inflammatory conditions​

Can suppress platelet aggregation​

Can lower blood sugar and therefore may potentiate the hypoglycemic effects of insulin and other drugs for diabetes​

Question 12

Ginkgo biloba

Answer 12

Can increase pain-free walking distance in patients with peripheral arterial disease​

Generally well tolerated ​

Interactions with conventional drugs​

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Question 13

Glucosamine

Answer 13

Used widely to treat osteoarthritis of the knee, hip, and wrist​

Use with caution in patients with shellfish allergy​

Increased risk of bleeding​

Adverse effects: GI disturbances, such as nausea and heartburn​

Interactions with conventional drugs: May increase risk of bleeding​

Question 14

Probiotics

Answer 14

Generally well tolerated, with some GI effects​

Question 15

Resveratrol

Answer 15

Antioxidant of plant origin promoted for antiaging effects and for protection against chronic diseases​

Question 16

Saw palmetto

Answer 16

Conflicting results in treatment of benign prostatic hyperplasia (BPH)​

May have antiplatelet effects​

Question 17

Soy

Answer 17

Should not be used with antiestrogenic medications (tamoxifen)​

Question 18

St. John’s Wort​

Answer 18

Widely used to treat depression​

Limited clinical studies show that St. John’s wort is useful for mild to moderate depression, not for severe depression​

No prescription needed in the United States​

Interacts adversely with many drugs​
Induction of cytochrome P450 enzymes​
Induction of P-glycoprotein ​
Intensification of serotonin effects​

Question 19

Valerian

Answer 19

Generally well tolerated​

Does not seem to potentiate central nervous system (CNS) depressant effects of alcohol, but this may occur​

Question 20

Comfrey

Answer 20

Contains pyrrolizidine alkaloids that are associated with veno-occlusive disease​

Question 21

Kava

Answer 21

Can result in severe hepatic damage​

Question 22

Ma huang (ephedra)​

Answer 22

Can elevate blood pressure (BP) and stimulate the heart and CNS​