COMPLEMENTARY THERAPY: Herbal Medicines Cannabis and other herbal medicines Flashcards

1
Q

what are the three types of cannabinoids?

A
–	Endocannabinoids
•	Anandamide (AEA)
•	2-arachidonoylglyerol (2-AG)
–	Phytocannabinoids
•	From plants
–	Synthetic cannabinoids
•	E.g. spice, nabilone, K2, dronabinol
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2
Q

what does endocannabinoid system regulate?

A
–	sleep
–	mood
–	appetite
–	memory
–	reproduction and fertility
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3
Q

what are the two neurotransmittera?

A

• 2-arachidonoylglyerol (2-AG)
– Present at relatively high levels within the central nervous system
– Responsible for basal endocannabinoid signalling
– Is a much more potent agonist (activator) of CB1 receptors
• Anandamide (AEA)
– Present at very low levels and has a very short half-life
– Formation is induced by stress
– Is much less effective at activating CB1 receptors and can sometimes anatgonise (block) the effects of 2-AG

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4
Q

what are the main ingredients in phytocannabinoids?

A

tetrahydrocannabindol (THC) and Cannabidiol (CBD)

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5
Q

what is THC?

A
•	Tetrahydrocannabinol 
–	Lipid soluble
•	Mechanism of action
–	Partial agonist at cannabinoid receptors
•	CB1 – CNS
CB2 – Immune system
•	Leads to decreased levels of cAMP
–	Mild antioxidant
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6
Q

what are the uses of THC/

A

– Licensed in US weight loss in patients with AIDS

– nausea and vomiting in people receiving chemotherapy

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7
Q

what is CBD?

A
•	Cannabidiol (CBD)
–	Lipid soluble
•	Mechanism of action:
–	alters the shape of CB1 recepto which prevents activation by endocannabinoids. 
–	It does not have any psychoactive effects 
•	Availability
–	Health food shops 
•	not regulated as a medicine
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8
Q

what are the uses of cbd?

A

– licensed in US for two rare and severe forms of childhood epilepsy

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9
Q

what are the pharmacokinetics of cannaniboids?

A
Absorption
–	Inhalation
•	Rapid onset and good bioavailability 
–	Oral
•	Slow onset and poor bioavailability
Distribution
–	Lipid soluble
•	Rapid accumulation in fatty tissues
Metabolism 
–	THC metabolites are active
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10
Q

what are the prescribing laws for cannabis in the UK?

A

• Prescribing is restricted to those on the GMC specialist register and within their speciality.
– Must have clear published evidence or UK guidelines to support treatment
– Only when clinical need cannot be met by a licensed medicine; and when established treatment options have been exhausted.
– Also need
• authorisation from the medical director
• agreement from the multidisciplinary team, using existing protocols on controlled drugs.

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11
Q

who is authorised to procure unlicensed CBPMs in the UK?

A

• a) Doctor on the GMC Specialist Register
• b) Specialist Importer with a Home Office import and Domestic licence and MHRA licence
• c) Registered pharmacies or retail pharmacy businesses (with Home Office Domestic licences, where appropriate)
– Some pharmacies will NOT need a domestic licence – as pharmacies and retail pharmacy business are able to produce / supply in accordance with their practice. However, if they are wholesale dealing the policy is that they do need a licence.
• d) Licensed wholesale dealers for supply

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12
Q

what is sativex?

A
  • Patented by GW pharmaceuticals
  • Licensed in the UK for moderate to severe spasticity in adult patients with MS
    • A natural cannabis product which contains a 1:1 ratio of THC and CBD, and many other cannibinoids
    • NICE does not recommend that patients are prescribed Sativex
  • The only natural cannabis product licensed for use in the UK
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13
Q

how much does a vial of sativex cost the NHS?

A

£120 per 10 mL vial

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14
Q

what is dronabinol?

A
  • Synthetic product which is identical to THC
  • Produced in UK
  • Unlicensed in the UK
  • Assigned to schedule 2, prescribed on a named patient basis
  • Can be prescribed for nausea and vomiting due to chemotherapy which is unresponsive to conventional antiemetics
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15
Q

what is nabilone?

A
  • Synthetic product structurally similar to THC
  • Produced in UK Licensed in the UK
  • Assigned to schedule 2,no restrictions on prescribing, GPs can continue prescriptions
  • Can be prescribed for nausea and vomiting due to chemotherapy which is unresponsive to conventional antiemetics
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16
Q

what are the adverse effects of cannabinoids?

A

Schizophrenia
• THC heavy cannabis such as skunk likely increases the risk of developing psychosis and causes an earlier emergence of symptoms. Cannabis alone is unlikely to be the sole cause.
• CBD heavy cannabis such as hash, may in fact be helpful in treating neuropsychiatric diseases
Memory loss
• Complex and multifactorial issue, but smoking regularly before the brain finishes developing (early twenties) may lead to poorer academic performance
Dependence
• Cannabis is thought to be addictive in about 9% of cases of heavy use
• Withdrawal symptoms, such as irritability, typically resolve within three days of cessation of use

17
Q

what is echinacea?

A

• It is claimed that this herbal remedy
– Improves natural immunity
– prevent colds
– shorten duration of colds
• Evidence for benefit - Cochrane
– 24 double-blind trials (n=4631)
– None of the 12 prevention studies reported a statistically significant difference between Echinacea and placebo. However a post hoc pooling of their results, suggests a relative risk reduction of 10% to 20%.
– Two of the six treatment trials reported a significant effect of Echinacea over placebo.
– The number of patients dropping out or reporting adverse effects did not differ significantly between treatment and control groups in prevention and treatment trials.
– Conclusion - have not shown benefit for treating colds, it is possible there is a weak benefit in prophylaxis

18
Q

what is the safety aspects of echinacea/

A
•	Do not use if 
–	pregnant
–	under 12 years of age 
–	suffer from: 
•	frequent allergic reactions
•	tuberculosis, multiple sclerosis, 
•	connective tissue disease
•	auto immune disease, HIV or AIDS, low white cell count, 
•	bone marrow disorders or blood cell cancer 
•	Receiving immunosupression
19
Q

what is valerian?

A

• It is claimed that this herbal remedy
– Aids sleep
– Stress relief
• Evidence for benefit
– RCT (n= 36) generalised anxiety disorder
– 4 week study of valerian, diazepam and placebo.
– no significant differences between the valerian and placebo groups and between the valerian and diazepam groups.
– no significant differences between the three groups in reporting side effects
– Authors - insufficient evidence to draw any conclusions about the efficacy or safety of valerian compared with placebo or diazepam for anxiety disorder

20
Q

what are the safety precautions behind valerian?

A
–	Safety not established in
•	Patients under 18 years 
•	Pregnant or breastfeeding
–	Don’t take with 
•	Other sleep or anxiety medication
•	Other medicines affected by alcohol