Complimentary Therapies Flashcards
Give some examples of complementary and alternative medicine.
- Acupuncture.
- Alexander technique.
- Aromatherapy.
- Ayurveda.
- Chiropractic.
- Healing.
- Herbal medicine.
- Homoeopathy.
- Hypnosis.
- Massage.
- Meditation.
- Nutritional therapy.
- Reflexology.
- Reiki.
- Shiatsu.
- Yoga.
What proportion of people in England uses CAM per year?
1/4.
How is CAM often perceived by the general public?
It is often seen as safe and natural.
What is good evidence?
The gold standard in conventional medicine is the randomised control trial (RCT). Large RCTs are preferred and even stronger evidence are lots of RCTs together – a meta-analysis or systematic review. Published in peer-reviewed journals.
What are the difficulties faced by CAM researchers?
- Treatment often not just one intervention.
- Often difficult to have a comparator placebo.
- Difficult to blind, so clinician and patient bias.
- Lack of funding, so trials often small.
- CAM easily purchased, so how to control?
- Lack of standardisation of therapies.
What factors may affect the concentrations of plant constituents and their quality in herbal medicines?
The concentration of plant constituents may vary depending on environmental (climate, altitude, growing conditions) or genetic factors and harvesting and storage can affect quality.
Why is there a less robust system for reporting ADRs with herbal medicines?
Herbal medicines are patient purchased so there is a less robust system for reporting ADRs.
What reference sources can be used for looking for information on herbal medicines?
- Stockley’s Drug Interactions.
- Stockley’s Herbal Medicines Interactions.
- The Cochrane Collaboration.
- NICE Evidence Search.
- MHRA.
- Electronics Medicines Compendium (eMC).
What is St. John’s Wort and what is it indicated for?
This is an extract from the leaves and flowers of the plant Hypericum perforatum. Its main constituents are hypericin and hyperforin. It is ‘indicated’ for mild depression and lots of other claims.
What is the mechanism of action of the active compounds in St. John’s Wort?
The active components of SJW are serotonergic 5HT3 and 5HT4 receptor antagonists. Their action down regulates beta-adrenergic and serotonergic 5HT1 and 5HT2 receptors. Hyperforin also inhibits GABA and L-glutamate. Hypericin has an affinity for sigma receptors and acts as a receptor antagonist at adenosine, benzodiazepine, GABA-A, GABA-B and inositol trisphosphate receptors. It also inhibits COMT and MAO in vitro.
What are the side effects of SJW?
• GI discomfort – N&V, diarrhoea. • Insomnia. • Restlessness. • Dizziness. • Fatigue. • Dry mouth. There was also evidence that taking 2-4g daily can increase the risk of photosensitivity. Many of these side effects wear off after 2-3 weeks.
Describe interactions between SJW and other medicines?
SJW is a potent inducer of some CYP450 enzymes. Differences between preparations make interactions difficult to Predict. A full list of interactions can be found in Appendix 1 of the BNF.
How should one change their approach when counselling patients on SJW?
Because of the high risk of drug interactions, one should always ask about the patient’s full drug history. SJW should not be co-prescribed with a conventional antidepressant. If switching from SJW to or from a conventional anti-depressant, one should allow for a washout period.
What is glucosamine and what is it indicated for?
Glucosamine is an extract from marine exoskeletons (not-suitable for vegans) or made synthetically (more expensive). It is ‘indicated’ for joint pain in OA.
In what two forms is glucosamine available?
- Glucosamine sulphate.
* Glucosamine hydrochloride.
