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Dr Roberts Flashcards

1
Q

Who can be a herbal practitioner?

A

In theory, anyone, there are no legal requirements or regulatory bodies but some do voluntarily join

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2
Q

Can an acupuncture clinical be shut down?

A

The local council can shut down acupuncture clinics if the hygiene is not good (similar to a tattoo parlor). It is just like food hygiene standards but it is not a legal requirement.

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3
Q

What are herbal medicines classed as?

A

More of a product - can’t claim to cure, treat or prevent disease but can have health claims as in ‘for a healthy nervous system’ or ‘for a healthy cardiovascular system’

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4
Q

Can herbal medicines be registered?

A

Traditional medicines can have a “use based on traditional use” so they have a license through traditional herbal medicine so it tightens regulation through the MHRA. No traditional herbal medicinal product shall be: placed on the market, or distributed by way of wholesale dealing unless a traditional herbal registration has been granted by the licensing authority (which is in force and has been granted in accordance with the community provisions).

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5
Q

What are the new controls for herbal medicines from the MHRA?

A

Herbal medicines to be marketed in the UK are now required to be registered as a traditional herbal medicines or have marketing authorisation from the MHRA

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6
Q

Are there any exemptions to the MHRA control of herbal medicines?

A

It only applies to industrially-produced herbal medicines so small, made on-site herbal shops are classed as ingredients so are exempt. There are also ways around this, for example, turmeric is an ingredient but is claimed to reduce inflammation and enhance health.

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7
Q

How can medicines be licensed under the traditional medicines regulation (TMR)?

A

Produce bibliographic or expert evidence of traditional use
They should have been in medicinal use for at least 30 years (most don’t have this)
At least 15 of the 30 years use must relate to the EU (unsure of BREXIT rule changes)
This replaces the requirement to demonstrate efficacy in the case of medicines to be given Marketing Authority

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8
Q

What are the monitoring/manufacturing requirements for herbal medicines?

A

Manufacturing under GMP (good manufacturing practice)
Safety monitoring and quality must be carried out (fewer herbal products will be contaminated)
Patient information is required - ie dose, side effects etc

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9
Q

How can herbal medicines receive an MHRA license?

A

Given Marketing Authorisation by MHRA jsut like any other medicine
Required to demonstrate safety, quality, efficacy, and accompanied by product information sheet
e.g. digitalis leaf, digitalis prepared. POM. Can only be made available via a prescription from a registered doctor or dentist

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10
Q

What are the difficulties with unlicensed herbal medicines?

A

No specific standards of safety or quality
doesn’t require product information e.g. dose, ADRs etc
No assessed by the MHRA as to their safety, quality or patient information
Manufacturing quality varied greatly
The strength and dose may vary widely e.g. picked, stored, this may change level or active ingredient
An unlicensed product may have fewer side effect warnings but ut is not to be assumed that it is safer (assume none is false)
The internet is difficult to police so MHRA has little control over sale.

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11
Q

Why do people use herbal medicines?

A

natural and therefore must be safer than conventional medicines
Worry regarding animal testing
Perceptions that there are no side effects because they are natural
40% of people think herbal medicines are safe because they are natural

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12
Q

What are the top selling herbal ingredients?

A 
Ginkgo biloba
St.John's wort
Ginseng
Garlic
Echinacea
Saw palmetto
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13
Q

How does st.johns work (hypericum) work?

A

Anti-depressant
Treats mild to moderate depression
Assume anti-depressed action is due to hyperforin as pure hyperforin has anti-depressant actions
Inhibits NA & 5-HT reuptake - similar to other anti-depressants

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14
Q

What are the issues with St. John’s wort?

A
  • Drug interactions: induces CYP450, increase in P-glycoprotein drug transporter. Decrease in drug levels (e.g. digoxin) through reduced efflux.
    Serotonin syndrome: report of a women taking SJW for 10 days and then took 20mg paroxetine - complained of nausea, weakness, fatigue and became incoherent
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15
Q

Side effects of SJW?

A

Hypericin causes photosensitivity - skin irritation

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16
Q

What is ginkgo biloba used for?

A
  • leaf extract used
  • used for memory/concentration problems
  • dizziness, tinnitys, headaches, storke
  • relaxes blood vessels - evidence??
  • reduces blood viscoocity - anti-platelet? - soe=me suggest it reduces platelet aggregation
    If haemorrhagic stroke - could worsen symptoms
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17
Q

Bilobalide?

A

Neuroprotective effects in ischaemia reperfusion reported

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18
Q

Ginkgolides A,B,C

A

Platelet activating factor antagonists?

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19
Q

What did a recent study for dementia and ginkgo show?

A
  • given an extract to patients with mild to moderate dementia over 6 months
  • no evidence that it produces a beneficial effect in this 6 month period
  • 1 fatal cerebral haemorrhage in GB group
  • no sig. difference in blood clotting time between groups
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20
Q

Benefits of garlic?

A
  • anti-hypertensive, antithrombotic, anti-microbial, cancer-preventing, lipid-lowering
  • some evidence to support these
  • active compound = allicin
  • sulfides - garlic (diallyl trisulphide): release H2S, antiinflammatory, vasodilator - high conc needed to show this
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21
Q

Use of saw palmetto - fruit

A

0 benign prostatic hyperplasia

-evidence that it improves urinary flow in mild to moderate BPH

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22
Q

Use of black cohosh?

A
  • menopausal symptoms
  • no evidence that it reduces symptoms
  • need for further well conducted trials
  • hepatoxicity reported
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23
Q

How was black cohosh standardised?

A
  • phytochemicals
  • black cohosh standardised to deoxyactein, but no evidence for effect on menopausal symptoms
  • does methylserotonin -5-HT receptor antagonist have a role?
24
Q

What is resveratrol found in?

A

red wine and chocolate

25
Q

Benefit of resveratrol?

A
  • anti-inflammatory
  • Anti-cancer
  • Anti-oxidant
26
Q

What did studies on resveratrol levels show?

A

Suggests increasing resveratrol in diet has no effects on inflammation or CV RISK AND DOESN’T ALTER LONGEVITY (LIFE)

27
Q

Problems with herbal meds?

A
  • poor manufacturing quality
  • different levels of active ingredients
  • misidentification of herbs
  • high bacteria content
  • presence of herbicides
  • contamination with toxic substances
  • differences between label and actual ingredients
28
Q

What are the causes/sources of contamination or variability?

A
  • different levels of ingredients between species
  • growth of her - poor growth caused by weather could lead to changes in constutuents
  • different parts of the plant likely to contain different constituents
  • storage conditions could lead to bacteria or fungal contamination
  • traditional herbal medicines registration should help to prevent some of these problems as the herbs should be prepared using GMP
29
Q

Name a drug-herb interaction

A

Furanocoumarins: e.g. Bergamottin in grapefruit.
Dihydroxybergamottin probably the inhibitor of CYP3A4
Present in other herbs so unknown interactions are occurring as we don’t know if they’re present

30
Q

Which herbs can impact phase 2 metabolism?

A

Epimedii, fructus ligustri lucidi and fructus psoraleae

31
Q

Definition of a dietary supplement?

A

‘Products which contain nutrients or other ingredients which consumers believe to have particularly beneficial effects on their health’

32
Q

What classification can dietary supplements be sectioned into?

A
  1. Vitamins and minerals
  2. ‘unofficial’ vitamins and minerals - no evidence for requirement or deficiency e.g. choline
  3. Natural oils with fatty acids e.g. fish liver oil
  4. Natural substances (herbal ingredients)
  5. Enzymes e.g. superoxide dismutase
  6. Amino acids or derivatives e.g. carnitine, N-acetyl cysteine
  7. Food supplements e.g. build-up and complan
  8. Slimming products
33
Q

What are the licensing issues for these products?

A
  • classified as foods and therefore food law applies
  • not controlled under the medicines act
  • no sale restrictions
  • product licence not required
  • cannot make medicinal claims like herbal meds
34
Q

Who may need vitamins and minerals?

A
  • with a healthy and varied diet vitamin supplements should not be needed
  • at risk groups may need it: vegetarians, elderly, malnutrition, malabsorption, alcoholics
  • caution with mega doses and toxicity (vitamin A in pregnancy)
35
Q

What is the evidence for vitamins and minerals?

A
  • high dose vitamin C for colds: no evidence that it reduces severity or shortens duration of the common cold
36
Q

What does cochrane review say for vitamins and minerals?

A
  • review of 67 clinical trials
  • no evidence that supplements containing antioxidants (vit A, C, E and selenium) decrease mortality rate
  • some evidence that vit A & E supplements may increase mortality
37
Q

Give some examples of vitamin and mineral toxicity

A
  • vitamin B6, safe dose 10mg od; high doses or chronic dosing risks peripheral neuropathy
  • zinc safe dose 25mg day; GI effects, anaemia with long-term use >25mg
38
Q

What is co-enzyme Q10?

A
  • “popularly taken to support a healthy heart and boost energy levels. Involved in the production of cellular energy, supports healthy heart function, EasyGest capsules for fast and easy digestion”
  • Facilitates transfer of electrons through mitochondrial ETC, required for generation of ATP
  • Co-enzyme Q10 supplements to protect cells from ageing by preserving mitochondrial function
  • Cochrane: no evidence for effect on hypertension or heart failure
39
Q

Tell me a little bit about the co-enzyme Q10 bioavailability

A
  • hydrophobic
  • high MW
  • Absorption from GIT slow and low
  • High plasma concentrations required for uptake into tissues
40
Q

What is choline or cytidinediphosphocholine (CDP -choline)?

A
  • grouped under B vitamins
  • required for synthesis of acetylcholine
  • used for: liver disease, dementia, body building, pregnancy
  • cochrane: some evidence that CDP-choline has benefits on memory & behaviour in medium term
  • Lecithin: dietary source of choline (phosphatidylcholine), no evidence for effect in dementia (cochrane)
41
Q

What is glucosamine & chondroitin sulphate?

A
  • component of cartilage
  • used for osteoarthritis
  • in vitro studies in cells suggest increases rate of cartilage synthesis - does this happen in vivo?
42
Q

Why would you take amino acids?

A
  • People with healthy diets shouldn’t require amino acid supplements
  • Foods of animal origin: high biological value and contain all essential AA from which other AA can be synthesised
  • Foods of plant origin: low biological value, not all AA but combinations of foods will provide all essential AAs.
43
Q

What is creatine?

A
  • non-essential AA
  • short-term energy store in skeletal muscle
  • used the generate ATP during short energy bursts
44
Q

What are functional foods?

A
  • pre and probiotics, stanol esters
  • compounds sold as foods to benefit health e.g.
  • prevention and treatment of diarrhoea
  • enhancement of the immune system
  • treatment of allergic conditions
  • prevention of cancer and tumour growth (colon)
  • lowering serum cholesterol
45
Q

What are prebiotics?

A
  • don’t contain live bacteria, but contain substances to stimulate the growth of colonic bacteria e.g.
    Fructo-oligosaccahrides, inulin, lactulose
46
Q

What are probiotics?

A

” live microorganisms that, when administered in adequate amounts, confer a health benefit on the host”

  • sources: fermented foods (yoghurts, milks),
  • beneficially affects the host animal by improving intestinal microbial balance
  • a number of potential/established effects
47
Q

What are synbiotis?

A
  • mix of pre and pro

- pre-biotic favours growth of pro-biotic

48
Q

What is the benefit of stanol esters? (and plant sterols)

A

e. g. benecol, flora proactive contain plant stanol esters
- stanols are not absorbed, but inhibit cholesterol absorption (2g/day of free stanol reduces serum cholesterol 5-10% and LDL 13% - considerable variation is seen between individuals)
- safe and effective - effect in addition to lipid-lowering diet and drug treatment

49
Q

Where can we get fish oils?

A

n-3 PUFAs can be plant derived (alpha-linolenic acid) or marine derived (EPA and DHA)

50
Q

Benefit of fish oils?

A 
No. studies demonstrated link between fish consumption and reduced cardiovascular disease.
Other uses: 
Asthma: no evidence 
Cognitive decline: no evidence
Ulcerative colitis: no evidence 
- Some evidence for rheumatoid arthritis
51
Q

Why do people use traditional medicines?

A
  • used in countries where TM is one of the primary sources of healthcare perhaps as accessibility or availability of conventional medicines is limited, TM is readily available and affordable. Ratio of traditional healers in Africa is 1:500 compared to medical doctors is 1:40,000
  • use of TM due to cultural and historical influences
  • use of TM as complementary therapy
52
Q

What does chinese medicine believe is the cause of sickness?

A

there’s harmony between yin and yang - disease results from an imbalance of these forces

  • 5 elements: fire, earth, wood, metal, and water - involved in the function of the body. Changes in these lead to disease
  • Qi, energy that flows through the body, maintaining health
53
Q

What are the four classifications of naturopathy?

A
  • food, mud, water and massage therapies
  • eg eating correct foods in correct proportions
  • mud baths
  • hot and cold baths
54
Q

What is unami?

A

Health is maintained by the harmonious arrangement of seven basic physiological principle:

  • arkan, or elements
  • mizaj, or temp
  • akhlat, or bodily humours
  • aaza, or organs and systems
  • arwah, or vital spirit
  • quwa, or facilities or powers
  • afaal, or functions
55
Q

What is siddha?

A 
Based on seven elements:
-Ooneer: plasma
- Cheneer: blood
- Oon: muslce
-Koluppa: fatty tissue
-Elumba: bone
- Elumba majjai: bone marrow
-Sukkilam: semen
Disease is caused by disturbances of humours: air, fire, earth & water - similar to Ayurvedic
56
Q

What treatments are involved in Siddha?

A

Herbal products, inorganic substances, animal products, manipulation

57
Q

What is Varmam therapy?

A
  • Applying pressure on specific areas of the body to improve varman energy flow
    Thokkanam: physical manipulation
    Attai Vidal: leech therapy
    Suttigai: Cauterization
    Patru: Poultice
    Pottanam: medicated pouch/packs (heated packs of herbs)

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