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Exam Flashcards

1
Q

Original definition of unconventional therapies

A

Lack of inclusion in medical schools or availability in US hospitals

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2
Q

What is the purpose of National Center for Complementary and Integrative Health (NCCIH)

A

Oversees and funds research in the area of unconventional medicine

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3
Q

Is alternative common or rare in the US?

A

Very rare

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4
Q

What is alternative medicine?

A

The use of unconventional therapies as a substitute for conventional medical treatments

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5
Q

Why do many people use unconventional treatments?

A

They are a way to reject, and challenge, the mainstream medical establishment

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6
Q

What is complementary medicine?

A

The use of unconventional therapies in conjunction with conventional medical treatments

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7
Q

What is integrative medicine?

A

Comprehensive, often interdisciplinary approach to treatment, prevention and health promotion that brings together both CAM and conventional therapies in a coordinated way to ensure positive clinical outcomes

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8
Q

What are self-administered unconventional therapies?

A

Dietary supplements

Aroma therapy

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9
Q

What are practitioner based therapies?

A

Chiropractic
Acupuncture
Hypnotherapy
Massage therapy

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10
Q

What is the largest, most regulated, and best recognized of the health care professions that functions outside of mainstream medicine?

A

Chirpractic

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11
Q

What is the most used CAM product in the US?

A

Natural products

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12
Q

What are natural products?

A

All of the supplements except for vitamins and minerals

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13
Q

Which CAM therapy is the most widely disseminated indigenous US system of healing?

A

Chiropractic

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14
Q

Are Chiropractors licensed or regulated?

A

Yes, both

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15
Q

What is the core clinical procedure of chirpractic health care?

A

Spinal manipulation

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16
Q

Is chiropractic care conventional or unconventional?

A

Unconventional

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17
Q

What is the most common reason to see a chiropractor?

A

Musculoskeletal problems

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18
Q

What premise is chiropractic care based on?

A

Neurologic dysfunction caused by impinged nerves at the spinal level is the cause of most diseases and that spinal manipulation removes the interference

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19
Q

What is a subluxation?

A

A form of joint strain or sprain with clinically associated hypomobility, malalignment, local and referred pain, inflammation, and muscle tension

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20
Q

What advice do chiropractors give to patients?

A 
Nutrition
Vitamins
Weight loss
Smoking cessation
Relaxation techniques
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21
Q

What are other treatments and services chiropractors preform?

A

Physical therapies

Therapeutic and general fitness exercises and other forms of CAM

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22
Q

What are nonserious adverse effects of spinal manipulation?

A

Localized discomfort
HA
Fatigue

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23
Q

What are serious complications of spinal manipulation?

A

Cauda equina syndrome (paralysis)
Cerebrovascular artery dissection
Death

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24
Q

What is the basic principle of hemopathy?

A

Treating the cause of the disease
Like cures like
Inverse Dose-response relationship

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25
Q

What are other names for herbal medicine?

A

Botanical medicine
Phytomedicine
Phytotherapy
Herbalism

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26
Q

What type of energy in homeopathy based on?

A

Innate healing energy

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27
Q

Homeopaths believe that sickness occurs when…

A

The innate healing energy and the body are not in harmoney

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28
Q

What is the innate healing energy known as?

A

Vital force

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29
Q

Are homeopathic remedies high or low dose?

A

Low dose to assity the attenuated Vital force in promoting self-healing

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30
Q

What are botanicals?

A

plants (woody or non-woody stems) or crude substances derived from plants

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31
Q

What are herbs?

A

Only plants with non-woods stems that die in winter

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32
Q

What is the botanical/herb relationship

A

Herbs are botanicals, but not all botanicals are herbs

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33
Q

What are the two different types of herbal modalities?

A

Paraherbalism

Rational herbalism

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34
Q

What is paraherbalism?

A

Irrational, non-scientific practice of herbal medicine. Have mystical/magical properties that cannot harm humans

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35
Q

What is rational herbalism?

A

Scientific and sensible use for the treatment/prevention of disease
Evidence based

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36
Q

What is the gold standard for public health and safety?

A

Placebo-controlled, randomized human clinical trials with adequate sample size

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37
Q

What is the gold standard for assessing value of therapies?

A

PCRCT

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38
Q

What is arnica indicated for?

A

Bruising and swelling

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39
Q

What are the AEs for topical arnica?

A 
Itching
Rash
Petechiae
Dry skin
At high doses: skin vesicles/necrosis
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40
Q

What are the AEs for oral arnica?

A 
Stomach irritaton
Dry mouth
HA
Drowsiness
Sore tongue
Lethargy
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41
Q

What are the DDIs for arnica?

A

Enhances effects of anticoagus and antiplatelets with increased risk of bleeding
Potentially decrease the efficacy of antihypertensives

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42
Q

What are CIs for arnica?

A

External use on broken or damaged skin

Allergy to any herb in the asteraceae family

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43
Q

What are cautions for arnica?

A

Those on NSAID, anticoag, oral corticosteroids, use of other homeopathic remedies, bleeding/bruising disorders, pregnancy, lactation, severe liver or kidney disease, malignancy, infection, immunodeficiency and metabolic syndrome

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44
Q

What is the active ingredient in arnica?

A

Arnica lactones

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45
Q

What is the MOA of arnica?

A

Directly inhibit nuclear factor kappa B which reduces synthesis of proinflammatory cytokines, cox2 and NO synthesis, which results in a diminished inflammation response

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46
Q

What is Butterbur indication?

A

Migraine prevention

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47
Q

What are the AEs of butterbur?

A 
GI effects (belching)
Dermal sx 
Dizziness
HA
Drowsiness
Fatigue
N/V/D
Stomach pain
Flatulence
Allergic conjunctivitis
Eye and skin discoloration
Sneezing
Mild elevations in liver enzymes
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48
Q

What are butterbur’s DDIs?

A

Don’t use with any other herb/supplement containing pyrrolizidine alkaloids
Don’t use with 3A4 inducts (St John’s wort, carbamazepine, phenytoin, rifampin, phenobarbitol)
Don’t use with meds that are anticholinergic

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49
Q

What are the CIs for butterbur?

A

Those with hypersensitivity or are allergic to plants in the Asteraceae family
Don’t take if pregnant/breastfeeding

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50
Q

What is the active ingredient in butterbur?

A

Iso-petasin for anti-inflammatory and petasin for the antispasmodic and smooth muscle relaxation

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51
Q

What is the MOA of butterbur?

A

Anti-inflammatory properties
Inhibits the lipooxygenase pathway and leukotriene synthesis
Also has antispasmodic properties that cause smooth muscle and vascular wall relaxation
Petasins have a high affinity for cerebral blood vessels

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52
Q

What is fenugreek used for?

A

DM

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53
Q

What are the ADRs of FenuGreek?

A 
Diarrhea
Dyspepsia
Ab distention
Flatulence
May cause hypoglycemia
In healthy males, decreased serum potassium, dizziness, hunger, and increase frequency of urination
54
Q

What are the DDIs for FenuGreek?

A

May impair absorption of other PO meds and concomitant administration should be avoided
May enhance the hypoprothrombinemic effects of anticoagulants

55
Q

What are the contraindications for FenuGreek?

A

Should not be consumed during pregnancy
Avoid in pts with allergy/hypersensitivity to fenugreek or plants in the Fabaceae family
Avoid in pts with allergy to peanuts, chickpeas, and coriander d/t cross reactivity

56
Q

What is the active ingredient in FenuGreek?

A

4-hydroxyisoleucine

57
Q

What is the MOA of FenuGreek?

A

Stimulate insulin secretion and improve glucose tolerance by direct stimulation of pancreatic beta cells
On cellular levels, its actions are very similar to that of insulin

58
Q

What is guggul indicated for?

A

Hypercholesterolemia

59
Q

What are the AEs for guggul?

A 
Rhabdomyolysis
Rash
Ab pain
Diarrhea
HA
Restlessness
Hiccups
60
Q

What are the DDIs for guggul?

A

Decreased bioavailability of propranolol or diltiazem used concurrently
Increased risk of bleeding in patients taking anticoagulants or antiplatelet medications

61
Q

What are the CIs for guggul?

A

Avoid in patients with thyroid disorder

Pregnant patients should avoid guggul since it stimulates menstrual flow

62
Q

What is the active ingredient in guggul?

A

Guggulsterones E and Z

63
Q

What is the MOA of guggul?

A

May decrease hepatic steroid production, ultimately increasing the catabolism of plasma LDL cholesterol
Active components may increase hepatic binding sites for LDL cholesterol thus increasing LDL clearance

64
Q

What is the indication for melatonin?

A

Managing sleep disorders in children with autism spectrum disorder

65
Q

What are the AEs of melatonin?

A 
Morning drowsiness
Increased enuresis
HA
Dizziness
Diarrhea
Rash
Hypothermia
66
Q

What are the DDIs of melatonin?

A

Inhibitors of 1A2 (TCAs, fluvoxamine, cimetidine) may increase melatonin concentratoin.
Patients who take BP or DM drugs should be monitored since melatonin may decreased BP or serum glucose

67
Q

What are the MOAs of melatonin?

A

Production stimulated by darkness

Biosynthesized from tryptophan which is converted to serotonin and ultimately to melatonin

68
Q

Pycnogenol is used for what?

A

Chronic venous insufficiency

69
Q

What are the AEs of pycnogenol?

A 
GI upset (use w/ or after meals)
Dizziness
HA
N/D
Acne in women
Dysfunction of uterine bleeding in women
70
Q

What are the DDIs of Pycnogenol?

A

Potential to interfere with immunosuppressant therapy

Avoided in patients with MS, SLE, RA, or autoimmune disorders

71
Q

What is the CI for pycnogenol?

A

Pregnant/lactating pts

Children <6yo

72
Q

What are precautions for pycnogenol?

A

Pts on meds for CV disorders, DM, bone/joint disorders, and confirmed or suspected h/o thrombosis

73
Q

What is the active ingredient in pycnogenol?

A

Procyanidins

74
Q

What is the MOA of pycnogenol?

A

Enhance vascular endothelial function, reduce capillary permeability, and improve microcirculation

75
Q

What are the criteria for dietary supplements

A

Contain vitamin, mineral, herb, amino acid, dietary substance, concentrate, metabolite, constituent, extract or combination
Intended for ingestion
Labeled as dietary supplement
Cannot be represented for use as conventional food

76
Q

What are nutraceuticals?

A

Dietary supplements that deliver a concentrated form of a bioactive agent from a food in dosages that exceed those that could be obtained from normal foods

77
Q

Examples of nutraceuticals

A

L-tryptophan

Genistein (soybean)

78
Q

What are functional foods?

A

Similar in appearance to conventional foods and are consumed as part of a normal diet
Have high levels of one or more bioactive ingredients

79
Q

Examples of functional foods

A

Cholesterol-reducing margarines (Benecol)
Cereal fortified with folic acid/psyllium
Soy products prepared from genetically-altered soybeans
Pasta enriched in fiber, antioxidants and vitamin E

80
Q

When was the dietary supplements health and education act (DSHEA) created?

A

1994

81
Q

Who controlled supplements before the DSHEA?

A

FDA

82
Q

What kind of claims dose DSHEA allow companies to market on their supplements?

A

Structure/Function claims:

Health claims or claims describing their effect on the structure/function of the human body

83
Q

What disclaimer must be on the bottle if the product makes an SFC?

A

This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease

84
Q

What responsibilities does the FDA still have?

A

Overseeing safety of supplements
Establishing/enforcing good manufacturing practices (GMPs)
Ensuring that product information is truthful

85
Q

When is the FDA able to take action?

A

If it determines that a product is unsafe or mislabeled

86
Q

Who regulates the advertising of dietary supplements?

A

FTC

87
Q

When does a manufacturer not require evidence before distribution?

A

if the ingredient is on the Generally Recognized as Safe List

88
Q

Under the Dietary Supplement and Nonprescription Drug Consumer Protection Act, what are manufacturers require to document?

A

All adverse events reported - these must be submitted to the FDA

89
Q

What is required on the label to report ADRs?

A

Full domestic mailing address or phone number

90
Q

What are health claims regulated under?

A

Nutritional Labeling and Education Act

91
Q

Who approves health claims?

A

FDA

92
Q

What are examples of SFCs?

A 
Helps maintain CV health
Builds strong bones
Helps maintain a healthy cholesterol level
Helps promote urinary tract health
Promotes relaxation
93
Q

What type of product is allowed for disease/drug claims?

A

Drugs

94
Q

What do all supplement labels require per the FDA?

A 
Statement of identity
Name of each ingredient
Total quantity of all dietary ingredients
Words dietary supplement
If standardized must be labeled such
Directions for use
"Supplement facts"
95
Q

What are supplement facts?

A 
Net quantity of ingredients
Active ingredients
Other ingredients
Serving size
Quantity and percent daily value
Amount per serving
Warnings
Storage
Lot number/exp
Name and place of business of the manufacturer, packager, and/or distributor
96
Q

When can the term high potency be used?

A

When products contain 100% or more of the established RDI for a vitamin or mineral

97
Q

Who has the authority to establish and enforce GMPs that are specific for dietary supplements?

A

FDA

98
Q

What do GMPs govern?

A

Preparation
Packaging
Labeling
Storing

99
Q

What is GBE indicated for?

A

Cerebrovascular disease

Preventing Cognitive decline

100
Q

What is the MOA of GBE in cerebrovascular disease?

A

Blocks platelet activation and inactivates free radicals

101
Q

ADRs of GBE

A

GI symptoms
HA
N/V

102
Q

What is GBE CI with?

A

Bleeding disorders

103
Q

What are DDIs of GBE?

A

Anticoags
ASA
NSAIDs

104
Q

What are the active ingredients of GBE/

A

Flavone glycosides

Terpenoids

105
Q

What is the aim of standardization?

A

To ensure high quality, safety and effectiveness of botanical dietary supplements

106
Q

Do all manufacturers standardize their products?

A

No

107
Q

What is a standardized product?

A

Produced using a standard protocol
Ingredients are identical, both qualitatively and quantitatively, from one batch to the next
Should perform the same way each time

108
Q

When is a marker compound used?

A

When the active ingredient is not known

109
Q

What is the standardization protocol currently used?

A

Acquisition of high quality herbal/botanical material
Perform quality and quantity control procedures
Extraction and sterilization
Preparation of extract followed by quality controls
Standardization of the extract
Addition of auxiliary agents
Performing quality control procedures in the finished product

110
Q

What complications are there with standardization?

A

Activity of most botanicals is not d/t a single chemical
Components in a botanical extract may enhance/detract from the therapeutic utility of the active principles
Most botanical products are standardized based on one marker
Assumption that if the single marker is in the right quantity, the other components will be too

111
Q

What is phytoequivalency?

A

The only practical way to ensure uniformity of therapeutic action

112
Q

When is phytoequivalency particularly important?

A

When we do now know the exact MOA and/or the identity of all of its active ingredients

113
Q

Why do manufacturers not use phytoequivalency?

A

Expensive

114
Q

Who do the manufacturers/packers/distributors report serious AEs or toxicities to?

A

FDA

115
Q

How do botanial dietary supplements affect surgery patients?

A

Prolong clotting time and increase risk of bleeding
OR
Adversely affect BP/HR

116
Q

What are two was to report AEs?

A

MedWatch

Department of Health and Human Services’ Safety Reporting Portal

117
Q

Who does MedWatch belong to?

A

FDA

118
Q

When an AE or product problem is reported, what can the FDA do?

A

Label changing
Boxed warnings
Product recalls and Withdrawals
Medical and safety alerts

119
Q

What should a pharmacist report?

A 
Product contamination
Defective components
Poor packaging or product mix up
Questionable stability
Labeling concerns
AEs
Interactions
120
Q

What are the common botanicals that are known to be toxic?

A 
Comfrey
Sassafras
Colts foot
Pennyroyal oil
Germander
Chaparral
Bayberry
Ephedra
Licorice
Wormwood
121
Q

What is the toxic ingredient and toxicity of comfrey?

A

Pyrrolizidine alkaloids

Hepatotoxicity & carcinogenicity

122
Q

What is the toxic ingredient and toxicity of sassafras

A

Safrole

Carcinogenic

123
Q

What is the toxic ingredient and toxicity of coltsfoot

A

Pyrrolidizine alkaloids

Hepatotoxicity & carcinogenic

124
Q

What is the toxic ingredient and toxicity of Pennyroyal oil?

A

Pulegone

Hepatotoxicity

125
Q

What is the toxic ingredient and toxicity of germander?

A

Furanoditerpenes

Hepatotoxicity

126
Q

What is the toxic ingredient and toxicity of bayberry

A

Tannins

Carcinogenic

127
Q

What is the toxic ingredient and toxicity of ephedra

A

Ephedrine

CV

128
Q

What is the toxic ingredient and toxicity of chaparral

A

Nordihydro-guaiaretic acid

Hepatotoxicity & nephrotoxocity

129
Q

What is the toxic ingredient and toxicity of licorice?

A

Glycyrrhizic acid
HTN
Na and water retention
HF

130
Q

What is the toxic ingredient and toxicity of wormwood

A

Thujone
Convulsions
Psychotic effects

CAM (2 decks)

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