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FINAL EXAM Flashcards

1
Q

Key features of a treatment strategy

A
  • Holistic
  • Patient-centred
  • Individualised
  • Rational
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2
Q

What are physiological enhancement objectives?

A

create or support robust health; optimise function of an organ or physiological system
eg. Improve digestive capability
• Normalise intestinal motility

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3
Q

What are physiological compensation objectives?

A

reduces symptoms; breaks vicious cycle of pathophysiology
Eg. Reduce colonic water secretion
• Reduce colonic spasm

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4
Q

What are perceived cause objectives?

A

addresses predisposing, excitatory, or sustaining causes
Eg. Reduce anxiety
• Eliminate irritating foods

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5
Q

What are multi-system disorders?

A

conditions with a core fundamental pathophysiological process, but the result of that process affects multiple body systems
Eg systemic lupus erythematosus (SLE)

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6
Q

What are comorbidities?

A

Two or more conditions occurring at the same time in one patient that may or may not be directly related to each other, but do contribute to the total disease burden in that individual

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7
Q

What are cognitive errors?

A 
mistakes which affect the accuracy & effectiveness of clinical decision making
Types 
- Availability error
- Representation error
- Premature closure error
-  Anchoring error
- Confirmation bias
- Attribution error
- Affective error
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8
Q

Explain Availability error?

A
  • Choosing the first thing that comes to mind, often due to past clinical experience
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9
Q

Explain Representation error?

A

Focusing on symptoms and signs only, and not taking into consideration prevalence of the condition

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10
Q

Explain premature closure error?

A

The clinician assumes shortness of breath and vague chest pain in a patient with existing lupus to be lung inflammation, and doesn’t ask any further questions or examine other possibilities

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11
Q

Explain anchoring error?

A

clinging to an impression or decision despite contradictory or conflicting information

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12
Q

Explain confirmation bias?

A

seeking and selectively accepting information which supports a decision; often compounds an anchoring error

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13
Q

Explain attribution error?

A

decisions based on (often negative) stereotypes

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14
Q

Explain affective error?

A

personal feelings towards the patient affecting decisions

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15
Q

Constituent exhibiting Anti-inflammatory action of Salix alba?

A

Salicylate glycosides - COX-inhibiting activity

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16
Q

Constituent exhibiting Anti-inflammatory action of Zingiber officinale?

A

oleoresin - COX and LOX inhibiting activity, and circulatory stimulant activity

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17
Q

Constituent exhibiting cholagogue & Bitter action of Berberis vulgaris?

A

Isoquinoline alkaloids - berberine

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18
Q

Constituent exhibiting Bulk laxative action of Plantago lanceolata?

A

Polysaccharides

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19
Q

Constituent exhibiting Bitter action of Gentiana lutea?

A

Bitter iridoid glycosides

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20
Q

What other action to prescribe when dosing with anthraquinone glycosides?

A

Anthraquinone glycosides are laxative - prescribe with carminative to reduce griping pains associated

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21
Q

Patient factors affecting dosage?

A 
Age
Body weight
Physiological state (strong/debilitated etc)
Acute or chronic presentation
Interaction with other treatments
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22
Q

Drug factors affecting dosage?

A

Raw material quality
Extraction method
Preparation form
Pysiochemical interactions between drugs

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23
Q

Fried’s Rule for modifying dose for an infant?

A

(Age in months x adult dose) / 150

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24
Q

Actions for treatment of pain

A 
Anti-inflammatory
Analgesic
Antispasmodic (skeletal or visceral)
Adaptogen
Nervines
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25
What is components of Bone & Mills therapeutic strategy?
``` Prime Movers (Base and/or specific) - focus on main objective - high reliability. Prescribe in upper end of range Adjuvants (Synergist) - Assist prime mover or work on lower objectives - prescribe in lower end of range ```
26
What is socratic questioning?
- Qs for clarification - Qs that probe assumptions - Qs that probe reason & evidence - Qs about viewpoints & perspectives - Qs that probe implications & consequences - Qs about the question
27
Define Evidence based practice
Evidence-based medicine (EBM) requires integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances
28
Red flags in GIT issues?
``` Anorexia Anaemia Blood in stool Fever Dysphagia Pain that awakens the patient Persistent N&V ```
29
Primary classes of GIT medicines
- Bitters - Carminatives - Aromatic digestives - Antispasmodics - Anthelmintics - Antimicrobials - Demulcents - GIT anti-inflamms - Astringents - Antacids - MM Trophorestoratives - Antiemetics - Laxatives
30
Aromatic digestive herbs?
Angelica archangelica Cinnamomum verum Citrus reticulata Zingiber officinale
31
Nausea herbs?
``` Zingiber Cinnamomum Mentha x piperita Matricaria chamomilla Filipendula ulmaria ```
32
Common contributing factors to GIT bloating?
- Dysmotility - secondary to stress - Overeating - Hepatobiliary dysfunction - Dysbiosis - Food allergies/intolerances
33
What is dyspepsia?
sensation of pain or discomfort in the upper abdomen; it often is recurrent. It may be described as indigestion, gassiness, early satiety, postprandial fullness, gnawing, or burning
34
Principles for atonic dyspepsia?
Herbs that are warming, stimulating & tonifying | Eg Ginger
35
Principles for hypertonic dyspepsia?
Herbs that are cooling, calming & dispersing Eg. peppermint Avoid strong bitters
36
T or F? Mentha x piperita is indicated in GORD?
F. Is contraindicated - in vol oil isolation/high dose. | Can reduce lower oesophageal sphincter tone, increasing GORD risk
37
Key medicine classes in hypotonic constipation?
Stimulant laxatives (anthraquinone) Bitters Bulk laxatives
38
Key medicine classes in hypertonic bowel states?
Carminatives Intestinal antispasmodics Nervine sedatives Low dose bulk laxatives
39
Key medicine classes in decreased biliary flow?
Choleretics Cholagogues Bitters Bulk Laxatives
40
What herbs are in Iberogast?
``` Iberis amara Angelica archangelica Matricaria chamomilla Carum carvi dry fruit Silybum marianum Melissa officinalis Mentha x piperita Chelidonium majus Glycyrrhiza glabra ```
41
Key hepatobiliary activities?
Xenobiotic metabolism eg. endogenous, exogenous Routine biochemistry eg. glycogenolysis Digestion & assimilation eg. bile production Immune defense eg. kupffer cells
42
Primary classes of hepatobilary medicines?
``` Cholagogues Choleretics Bitters Immunomodulators Hepatic anti-inflames Antioxidants Hepatoprotectives Antispasmodics Antivirals ```
43
Which herb is highly indicated in biliary dyskinesia and/or billiary colic secondary to choleliathliasis?
Chelidonium majus - cholagogue & choleretic, mild analgesic and antispasmodic
44
Why is mentha x piperita indicated in choleliathialisis?
Carminative and mild cholagogue action. Terpenes in vol oil may assist in dissolving cholesterol stones
45
What herb used in simplex in acute biliary dyskinesia attacks?
Artemisia absinthium - Sesquiterpene lactones (absinthin, artabsin, santoinin)
46
What does innate immunity involve?
Surface Barriers Mucosal immunity Normal flora Phagocytes
47
Whats involved in acquired/adaptive immunity?
Cell mediated immunity | Humoral immunity
48
Is Andrographis a cold or warm herb?
Cold. Take in combination with warming herbs
49
Do you use the P0As chemotype of Uncaria tomentosa or the T0A chemotype?
important to use only the immune-enhancing pentacyclic oxindole alkaloids (P0As). TOAs can have an immune suppressing activity.
50
What is Uncaria tomentosa's MOA?
may involve suppression of the transcription factor TNF-kappaB
51
When is Astragalus membranaceus advised not to be used?
In acute infections - can exacerbate the infection & potentially cause crisis
52
What kind of viruses can Thuja assist in?
enveloped and non- | enveloped viruses with DNA and RNA nucleic acids.
53
Tx considerations for Candida?
Eliminate refined sugar, yeast containing foods o Search and eliminate food intolerances o Support stomach acid production o Support Immunity o Liver Detoxification o Support Gut repair o Anti-fungals o Support lifestyle-psychological stress, exercise
54
Herbs useful in Candida?
Origanum vulgare | Pimpinella anisum
55
Risk factors of autoimmunity?
``` altered immune function chemical exposure diet & lifestyle hormones Stress ```
56
Autoimmune diseases
``` Ankylosing spondylitis Graves SLE Insulin dependent DM RA ```
57
Environmental factors of autoimmunity?
``` Viral/bacterial infections Certain chemicals/drugs Molecular mimicry - unable to differentiate between self & foreign antigens Bystander activation Dietary antigens (coeliac) ```
58
What are Sustaining factors implicated in autoimmunity?
o A self antigen presents which is identified as still a component of the body. o The body lacks the ability to eradicate this antigen so the disease persists. o Dependent on the antigen involved and the mechanism of action determines the clinical expression of the disease . o The immune reaction may be local or systemic.
59
Herbs in autoimmune diseases?
``` Boswellia serrata Harpagophytum procumbent Curcuma longa Urtica dioca Tylophora indica Hemidesmus indicus Foeniculum vulgare ```
60
What herb is CI in Chrohns & ulcerative colitis? why?
Harpagophytum procumbens. Harpagosides increase gastric acid secretion
61
Egs of eicosanoid synthesis modifiers?
Curcuma longa Scutellaria baicalensis Fish oil
62
Objectives when treating HIV?
1. Reduce viral load 2. Strengthen immune function 3. Reduce oxidative stress 4. Reduce inflammation 5. Promote naturopathic diet & lifestyle 6. Support vitality 7. Manage opportunistic infections 8. Reduce wasting/[promote anabolism 9. Manage mood & promote stress adaptation
63
Aetiological factors of skin issues?
``` Allergy - local, systemic Irritation - local, toxic encumbrance Infection - Local, invasive, systemic Stress - acute, chronic Metabolic - hormonal, autoimmune, nut. deficiencies ```
64
What is a depurative?
AKA alterative Aids in detoxification & elimination Aids in xenobiotic metabolism
65
Examples of urinary depuratives?
USE LEAVES OF Galium aparine Urtica urens Taraxacum officinale folia
66
Examples of biliary depuratives?
USE ROOT/RHIZOME Berberis aquifolium Taraxacum officinale radix Iris versicolor
67
Examples of Bowel depuratives?
``` ROOT/RHIZOME Iris versicolor Smilax ornata Rumex crispus Frangula purshiana ```
68
What is atopic dermatitis?
chronic inflammatory and pruritic skin condition. Immunoglobulin E, eosinophils, T- helper cells and their cytokines, all play a significant role in the pathogenesis of this condition. Hyperreactivity to environmental triggers, genetic predisposition, and defective skin barrier function are involved
69
What is involved in hypersensitivity contact dermatitis?
T – lymphocytes are sensitized to the antigen some time after the first contact. Langerhans cells in the dermis of the skin present the Ag to T – lymphocytes. Sensitivity to the antigen lasts for life
70
Herbs (topical) useful in eczema & dermatitis?
Matricaria chamomilla | Glycyrrhiza glabra - glycyrrhetinic acid
71
What is Psoriasis?
chronic, recurrent disease characterized by dry, well-circumscribed, silvery, scaling papules and plaques of various sizes.
72
Tx Aims in acne?
* Increase detoxification through all channels of elimination * Reduce oxidative load and improve anti-oxidant status * Regulate blood sugar levels * Reduce production of inflammatory compounds * Regulate sympathetic and parasympathetic nervous system activity * Reduce serum androgen levels * Reduce sebum production and sebocyte proliferation
73
What is rosacea?
``` Chronic eruption in the central region where the blood vessels enlarge of the face, typically beginning in middle age and older Implicating factors – Alcoholism – Hypochlorhydria – Vitamin B deficiency – Seborrhoeic tendency ```
74
What are Recurrent or chronic skin infections often indicative of?
– impaired immunological function – sustained physical or chemical local irritation – an attempt by the body to remove toxic encumbrance – nutritional deficiencies in some cases
75
Key medicines in alopecia areata?
Rosmarinus officinalis Urtica dioca Ginkgo biloba Avena sativum & Scutellaria lateriflora - if nervines needed
76
Primary classes of ENT medicines?
``` Anticatarrhals Astringents Demulcents Anti-inflammatories Decongestants Mucolytics Lymphatics Antimicrobials MM trophorestoratives Immunomodulators Antiallergics Circ stimulants Diaphoretics ```
77
What is catarrh?
build up of mucous in the airways (upper or lower) or any cavity of the body (e.g. the GIT)
78
What is an important DDX in chronic pharyngitis?
Severe GORD - can cause cough and sore throat
79
Key medicines in pharyngitis?
Althaea officinalis radix - water extract Olea europaea folia Salvia officinalis - fresh leaves as gargle
80
Key medicines in the common cold?
``` Echinacea Andrographis paniculata Allium sativum Achillea millefolium Sambucus nigra Zingiber officinale ```
81
Causes of chronic recurrent sinusitis?
Allergies Low grade chronic or intermittent infections Environmental irritant exposure
82
Predisposing factors for otitis externa?
– injury to ear canal from using cotton buds or other objects – allergies – psoriasis or eczema (can cause a chronic otitis externa) – irritants such as hair dyes or sprays
83
Classes of medicines in pulmonary therapeutics?
``` Expectorants Antitussives antimicrobials Immunomodulators Demulcents Anti-inflammatories Bronchodilators Trophorestoratives ```
84
Definition of expectorant?
Promoting or facilitating the secretion or expulsion of phlegm, mucus, or other matter from the respiratory tract
85
Indications for stimulating expectorants?
Thick congested conditions of the lungs with unproductive cough or no cough
86
Phytochemistry of stimulating expectorants?
Mostly saponins, sometimes alkaloids
87
Action of stimulating expectorants?
– slight gastric irritation leading to reflexive bronchial irritation – result is thinner bronchial secretions, and more activity in the mucociliary escalator – increase in productive coughing
88
Examples of stimulating expectorants?
Inula helenium Euphorbia hirta Viola odorata Lobelia inflata
89
Action of relaxing expectorants?
– reduce airway irritation and relax bronchial smooth muscle – grey line between demulcents, respiratory antispasmodics, bronchodilators – tend to be gentle, with wide application
90
Phytochemistry of relaxing expectorants?
mucilage | vol. oil
91
Indications for relaxing expectorants?
irritating cough productive or non-productive cough wet & dry conditions
92
Examples of relaxing expectorants
``` Glycyrrhiza glabra Hedera helix Verbascum thapsus Thymus vulgaris Plantago lanceolata Pimpinella anisum allium cepa ```
93
Action of warming expectorants/mucolytics?
– thins and breaks down mucous, especially when thick and tenacious – increase blood flow to respiratory mucosa – often considered to be anticatarrhals
94
Phytochemistry of warming expectorants/mucolytics?
Glucosinolates Organosulfur compounds resins, vol. oil
95
Indications of warming expectorants/mucolytics?
Acute or chronic congestion with thick, tenacious mucous
96
Examples of warming expectorants/mucolytics?
``` Glucosinolates - Armoracia rusticana - Brassica alba Organosulfur compounds - Allium sativum - Allium cepa Vol oils, resins, oleoresins - Zingiber officinale - Angelica archangelica - Inula helenium ```
97
Key medicines in treating inflammation assc with asthma?
Boswellia serrata - inhibits 5-lipoxygenase, key cytokine in asthmatic inflamm Curcuma longa Glycyrrhiza glabra - lowers cytokines Zingiber officinale - inhibits prostaglandin release Astragalus membranaceus - reduce lung inflammation
98
What herbs are PAF inhibiting?
Ginkgo biloba - PAF antagonist Glycyrrhizin - PAF inhibition Allium cepa - anti-PAF activity
99
What herb has shown to reverse asthma?
Cordyceps sinensis
100
Immunosuppressive herbs?
Tylophora indica | Hemidesmus indicus
101
What other disorders are assc with Asthma?
Increased digestive permeability Oesophageal reflux Dysbiosis
102
What herb may potentiate effects of corticosteroids?
Glycyrrhiza glabra
103
What herb is effective in treating opiod & tobacco withdrawal?
Avena sativa
104
What herbs can increase 5-HT levels?
Rhodiola rosea Hypericum perforatum Scutellaria baicalensis
105
Which herbs can modify the HPA axis?
Eleutherococcus senticosus Schisandra chinensis Rhodiola rosea Panax ginseng
106
Primary classes of neurological medicines
``` Analgesics Nervine sedatives Nervine trophorestoratives Neuroprotective Nervine stimulants ```
107
Which herb may be CI in epilepsy?
Ginkgo biloba
108
What constituent and which plant is known to trigger seizures?
Camphor. | Present in Rosmarinus officinalis, Juniper, Achillea millefolium, Salvia officinalis
109
What nutrient elevates dopamine? What herb contains this?
Theanine elevates dopamine. Found in Camellia sinensis
110
What herb is CI in Parkinson due to interaction with Levodopa?
Piper methysticum - Kava | May potentiate Parkinson reactions
111
Types of. dementia?
``` Vascular dementia Alzheimer disease Lewy body dementia Frontotemporal dementia HIV-associated dementia ```
112
What is reversible dementia?
General cognitive decline as a secondary consequence - seen in hypothyroidism, B12 deficiency, alcohol abuse & some infections. Generally improve once underlining condition is addressed
113
Aetiology of general cognitive decline?
``` Suboptimal nutrition - B vits & EFAs Toxicity. - pesticides, heavy metals Physical & mental fatigue Mental stress Lack of personal and social stimulation Depression Oxidative change in NS ```
114
What herbs are glucocorticomimetics?
Rehmannia glutinosa | Glycyrrhiza glabra
115
Which herbs support erythropoiesis?
Withania somnifera Urtica dioca Codonopsis pilosula
116
What is Bradydysrhythmias?
resting HR less than 60bpm
117
What is. Tachydysrhythmias
resting HR more than 100bpm
118
What is acute atrial fibrillation?
new onset, lasting < 48 hours
119
What is Paroxysmal atrial fibrillation?
Recurrent episodes, last < 48 hours, convert spontaneously to sinus rhythm without treatment
120
What is Persistent atrial fibrillation?
episodes last > 1 week or require treatment to convert to sinus rhythm
121
What is Long-standing persistent atrial fibrillation?
Episodes last > 1 year, with possibility of restoring sinus rhythm with treatment (usually electrical cardioversion)
122
What is permanent atrial fibrillation?
spontaneous or treatment-induced conversion to sinus rhythm not possible
123
What pharmaceutical drug is Salvia miltiorrhiza CI with?
Anticoagulants
124
Comorbidities of MSK disorders?
Entrapment of nervous tissue Lack of sleep due to pain Mood disorders due to lack of sleep & chronic pain
125
What is the aim of the process of inflammation?
- Protect injuried area from further damage - Mobilise and direct defensive resources to injury site - Encourage removal of debris - Encourage healing and resolution
126
Outcomes of acute inflammation
- Resolution - Abscess formation - Healing by fibrosis - Chronic inflammation
127
Role of Nuclear factor kappa B?
Found in most cell types, involved in cellular responses to many stimuli such as stress, free radicals, UV irradiation, oxidised LDL, bacterial or viral antigens, cytokines – Key role in regulating immune function and the inflammatory response – Rapid “first responder” activity – May even play a role in cerebral function (eg. memory, psychiatric disorders, addiction)
128
Comorbidities of chronic Inflammation?
``` Lethargy Depression Memory & mood disorders Addiction Insulin resistance & diabetes Migraine Alzheimer's disease Cancer ```
129
3 aspects to choosing right combination of anti-inflamm & antioxidants herbs in MSK issues?
Mediator specificity Tissue specificity Secondary actions
130
Topical herbs for soft tissue damage?
Arnica montana | Symphytum officinale
131
What is gout?
Inflammatory disease resulting from imbalance between waste production and elimination, resulting in accumulation and crystalisation of waste materials in joints and other connective tissue
132
Dosage in geriatric patient?
``` Clarks rule (weight in kg/67) x adult dose ```
133
Anti-prostatic herbs?
Serenoa repens Urtica dioca/urens Epilobium parviflorum
134
Herbs for hyperprolactinaemia?
``` Vitex agnus-castus Caulophyllum thalictroides (Blue Cohosh) ```
135
Herbs that. help with thick viscous cervical mucus?
Promote oestrogen with - • Chamaelirium luteum (False Unicorn) • Asparagus racemosus (Shatavari) • Dioscorea villosa (Wild Yam)
136
What emotion can trigger prolactin release?
Stress & other emotional stimuli - can affect repro function
137
What are category A herbs?
Drugs that have been taken by many pregnant women and women without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus having been observed. Eg. Rubus ideaus, Zingiber officinale, Echinacea, Chamomle
138
What are category B1 herbs?
• Drugs that have been taken by only a limited number of pregnant women without an increase in the frequency of malformation or other direct or indirect harmful effects on the human foetus having been observed. • Studies in animals have not shown evidence of an increased occurrence of foetal damage. Eg. Astragalus, Valerian, Gingko
139
What are category D herbs?
• Drugs that have caused, are suspected to have caused, or may be expected to cause an increased incidence of human foetal malformations or irreversible damage. Eg. Ruta graveolens, Phytolacca spp.
140
What are category x herbs?
Drugs that have such a high risk of causing permanent damage to the foetus that they should not be used in pregnancy or when there is a possibility of pregnancy. Eg. Aristolochia spp., Senecia spp., Peumus boldus
141
Eg of a category b2 herb?
Agathosma betuline
142
Eg of a category C herb?
Andrographis paniculata
143
When is Vitex not to be used?
Pts with oestrogen sensitive cancers Pts with pituitary disorders Pts taking dopamine agonists, antagonists, synthetic oestrogen & anti-oestrogen
144
Uterine spasmolytic herbs?
Verbena officinalis Angelica sinesis Rubus ideaus Virburnum opulus
145
Diuretic herbs
``` Urtica dioca Equisetum arvense (depurative) Eupatorium purpurea Elymus repens Zea mays ```
146
Herb for chronic UTIs?
Crataeva nurvala - urinary antiseptic

CLINIC HERBAL (1 decks)

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