Chapter 7 - The Role of Complementary and Alternative Therapies Flashcards

1
Q

Complementary & Alternative Medicine (CAM)

A

A diverse set of therapies that are considered to be outside of mainstream healthcare.

  • Have not been subjected to the same scientific scrutiny as pharmaceuticals
  • Most common
    • Biologic-based therapies - vitamins, minerals, herb
    • Alternative healthcare - homeopathy, Chiropractic
    • Manual healing - massage, pressure point therapy
    • Mind-body - yoga, pilates
    • Spiritual - shaman, faith healer
  • 4/10 Americans use some form of CAM
  • Focus on treating the whole individual

From a pharmaceutical perspective, their value lies in their ability to reduce the need for medications

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2
Q

Dietary Supplements

A

Products available over the counter (OTC) that are intended to add or supplement the nutritional value of a diet

  • Ask client to bring medications with them to be reviewed
  • Patients need to know CAMs can interact with other meds
  • Rationale for Use
    • Perceived to be safer than conventional drugs
    • Sense of control over care
    • Emotional comfort from taking action
    • Cultural Influence, Convenience
    • Uninsured with limited access to professional care
    • Media hype and aggressive marketing
    • Recommendations from family and friends
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3
Q

Herb

A
  • Technically - A botanical (plant-based substance) that does not contain woody tissue
  • Common use - refer to any plant product with some useful application either as a food enhancer or medicine
  • When the pharmaceutical industry introduced synthetic medications in the 1800s popularity decreased
    • Criticized as being unscientific and relics of the past
  • 1970s - alternative therapies experienced a resurgence
    • The majority to returned to taking herbal therapies
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4
Q

Standardization of Herbal Products

A
  • Herbal products are available in a variety of formulations some containing standardized extracts and others containing whole herbs
  • Active chemicals may be present in one part (leaves, stems) or the whole plant.
    • May contain many active chemicals
    • Not all have been isolated and studied
    • Strength varied from batch to batch
  • To achieve consistency scientists have attempted to standardize herbal products based on 2 methods:
    • Active ingredient extracts
    • Marker extracts
  • Allows consumers to compare products and know the strength of herb*59
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5
Q

Standardization of Herbal Products: Active Ingredient extracts

A

Standardize the amount of biologically active substances in the herb

  • Ex. Saw Palmetto is a fatty acid, therefore, used to standardize extracts of herb
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6
Q

Marker extracts

A

Standardize the potency of the herb based on a common substance in the whole herb that may nio be the active ingredient

  • Ex. Ginseng is standardized on the % of ginsenosides in the ecxtract
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7
Q

Dietary Supplement Regulation

A
  • Not regulated in the same manner as prescriptions
  • Dietary Supplement Health and Education Act (DSHEA) - exempts dietary supplements from the Food, Drug, and Cosmetic Act - not classified as drugs or approved by FDA
    • Gives the FDA authority to remove any dietary supplement that poses a “significant or reasonable” risk to the public
    • Action only when adverse effects already have occurred
    • Required to be labeled as dietary supplements that is not intended to treat, cure, or prevent disease
    • May make claims to effect body systems:
      • helps promote healthy immune systrem
      • reduce anxiety and stress
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8
Q

DSHEA flaws

A
  • The manufacturer does not need to test the safety prior to marketing
  • If removed from the market the FDA has the burden to prove unsafe
  • Effectiveness does not need to be demonstrated
  • Accuracy of the label is not regulated
    • Product may or may not contain the product listed
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9
Q

Dietary Supplement and Nonprescription Drug Consumer Protection Act

A
  • 2007
  • Companies required to provide their contact information to prevent adverse events
  • Must notify FDA of any serious adverse event within 15 days of receiving report
  • A serious adverse event is defined as any reaction resulting in death, a life-threatening experience, inpatient hospitalization, persistent or significant disability, congenital anomaly, birth defect
  • Companies must keep records of such events for at least 6 years
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10
Q

Current Good Manufacturing Practices

A
  • 2007
  • Current Good Manufacturing Practices
    • Purity, composition, and potency labeled accurately
    • Ingredients listed
    • Free of toxins, pesticides, glass or heavy metals
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11
Q

U.S Pharmacopeial Convention (USPC)

A

Non-profit public organization health organization that works to raise standards and quality of pharmaceuticals and dietary supplements

  • Publishes United States Pharmacopeia (USP)
  • Developed a voluntary process buy which manufacturers may submit a product for the USP Verification Program
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12
Q

USP Verification Program

A
  • Examines the manufacturer’s process used to create the product, tests for labeled ingredients, and measures bioavailability
  • if passes product can place USP verified on label
  • Does not indicate if the product is safe or effective
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13
Q

Privacy Quality Certification Programs

A

Test for quality and include U.S. Pharmacopeia (USP) whose standards are enforceable by FDA

Consumer Lab; Natural Products Association; and National Sanitation Foundation - all require manufacturers to pay for tests and report on following:

  • Current Good Manufacturing Practices
  • Purity
  • Identity
  • (strength)
  • Dissolution
  • Accuracy of Labeling
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14
Q

Herb-Drug Interactions

A
  • Herbal medication can interact with conventional drugs
  • May cause additive, synergistic or antagonistic interactions with prescriptions or OTC drugs
    • Ginkgo biloba and ginger can increase bleeding time especially with anticoagulants
    • St. John’s Wart, kava, and valerian cause relaxation and may result in excessive sedation if taken with depressants
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15
Q

Specialty Supplements

A

Dietary supplements used to enhance or complement a specific function in the body

  • Supporting joint health and immune function
    • probiotics, fish oils, amino acids, and enzymes
  • Widely used OTC The enhance wellness
  • Typically have a legitimate rationale for use
    • ex. amino acids are natural building blocks of muscle protein
  • Link to intended benefits is unclear and in most cases the body already have sufficient quantities
  • Generally harmless unless taken in large amounts, but may provide false hope
  • Be cautious of claims
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16
Q

Common Herbs

A
  • Black Cohosh - menopause s/s, effective hormone Rx, SE - GI upset, rarely liver toxicity, Interacts with B/P meds
  • Coenzyme Q-10 - rx muscle injury with statins; SE - N/V/D, decreased appetite; antagonizes warfarin
  • Feverfew - migraine, works better as prophylactic rx; SE - GI; Interactions - suppress platelet aggregation - HR bleeding
  • St. John’s Wart - depression rx, may help with mild s/s; SE - skin rxn, vivid dreams; decreased effect many drugs (OCP, Antivirals, anticoagulants), accelerate drug elimination (digoxin, CCB)
  • Valerian Root - sleep rx, may help sleep, SE - drowsiness Interaction - can potentiate CNS depressants (alcohol, benzodiazepines)
  • Fish Oil - FDA approved to lower cholesterol, brain food - neuroprotective Omega 3 fatty acid, good for eyes, GI tract, heart, diabetes, menstrual pain