Herbals Flashcards
Many herbals are…..
placebo
need to ask….
What has been tried so far?
Frustration level of patient?
Standard therapies tried?
The risk this will delay MD input
Stuff to consider
- Does this seem reasonable
- If not better in ____ seek help
- Under MD care
Warfarin. We should…
look up every agents
Glucosamine
- Prevent cartilage deterioration
- Disease modifying agent
- Makes synovial cavity more smooth
OA vs. Rheumatoid arthritis
Patients with inflammatory arthritis, typically, are very stiff and this lasts longer than 1 hour after waking. The pain and stiffness in these patients gets better with mobilisation and as the day progresses.
In contrast, osteoarthritis patients tend to be transiently stiff for seconds to minutes after waking and problems are worse through the day and on activity. Post rest stiffness called gelling is typical lasting seconds to minutes in osteoarthritis patients.
Glucosamine/Chondroitin Uses
Osteoarthritis
Describe the process of OA
Wear/tear - oss of cartilage - friction bn bones - pain swelling, less rom
where does oa impact?
knee, hip, spine
Oa risk factors
age, obesity, genetics
MOA of glucosamine/chondrotin
normal component of cartilage matrix and synovial fluid
may prevent joint-space narrowing
What is glucosamine/chondrotoin? What is normal in the joints?
GlycosAminoGlycans
normal component of cartilage / connective tissue
water sticks to GAGs (cushioning action)
glucosamine is a precursor cpd / chondroitin is a GAG
Is glucosamine worth a try?
YES
How long to try glucosamine? When it will work?
try for 3-6 months
Takes 4-8 weeks to work
Should one stop their other meds when taking glucosamine?
NO
glucosmaine Sulfate Dose
500 mg TID
Chondrotin Sulfate DOse
400 mg TID
S/e of glucosamine
ellent safety record – GI, derm
Drug Interactions of Glucosamine
minimal
warfarin interference
blood glucose impact unlikely
Is MSM useful/needed?
NO
Is tumeric/curcurin worth a try?
YES
Dose of curcurin for arthritis
1-2g of curcurin
What is curcurin used for?
Arthritis
Is topical arnica good for arthritis?
NO
In regards to Omegas, which are essential? can it occur in the body?
Omega-3 –> EPA and DHA are essential
Alpha-linolenic acid can be converted by humans to EPA/DHA, but only minimally 5%, so ingesting a marine source is key to attaining any benefit here
Do we need anymore omega-6’s?
NO –> Have more omega-6’s than 3’s which promotes inflammation
How are omega-9’s made?
Made by the body
Omega-3’s are useful for….
Cell membranes
Hormones
Anti-inflamm
Less platlet adheison
Omega-6’s cause….
Energy production
Undesirable PG’s
Inflammation
In CV, what is primary and secondary prevention?
1 - Prevent first MI
2- Prevent a second MI
Are omega-3’s useful for CV health? What are they more hopeful for?
Not likely
Modest or NO benefit from supps
More hope for 2o prevention than 1o
Likely less helpful if taking full MI medicine regimen
What is the best source of omega-3’s?
Dietary fish
When are omega-3’s clinically helpful?
High elevated TG’s
S/e of Omega-3’s
Unlikley risk of bleeding
Fishy Taste (main one)
Drug Inetractions of Omega-3’s
NOT an ISSUE
What is the delivery system of omega-3’s?
Fish Oil
What is the starting dose recommendation of omega-3’s?
Go natural first
500 mg a week
Can fish in sask give omega-3’s?
NO
primary prevention omega-3 Dose
2 servings/wk of specific fish
or ~500 mg supp (EPA/DHA) daily
secondary omega-3 dose
1000 mg fish oil (to deliver 180/120 mg EPA/DHA) TID
Fish oil to omega-3 ration
1000 mg - 300 mg EPA/DHA
High TG Omega-3 Dose
2-4 grams of EPA/DHA
In regards to flax seed, it must be….
Ground up to be absorbed
Omega-3 useful for….
rhemaotoid arthritis
depression (maybe)
dry eyes
ADHD
Should omega-3’s be used to lower cholesterol?
2-4 g EPA/DHA to lower TGs only –> Should be physician care extra calories
Metamucil Cholesterol lowering
10g/day (= 3 level tsp TID) ~5% in cholesterol
Plant sterols/stanols to decrease cholesterol
2 g ~10%
Soy to decrease cholesterol
25 g soy protein (~4 cups soy milk) / day ~5%
What can ubiquinone be used for?
Heart Failure
HTN
Heart attack
Migraine
What should be the mindset for insomnia?
attempt to curb OTC product use and shift their focus to getting medical care
What is thr first thing to try for insomnia?
CBT
Does turkey make you sleepy?
No - Tryptophan gets credit but just feeling full
Chamomile
- Just tea for insomnia
- Relaxing
Does lavender work?
No just TLC
Is valerian good for insomnia?
NO
Should diphendydramine be given to seniors?
NO
Diphenhydramine Sleep?
Sedating
What should we try to do in pharmacy in regards to OTC sleep agents?
Shift from diphenhydramine to melatonin
What is melatonin?
a hormone (produced from tryptophan)
ties into our circadian rhythms (seasonal/daily)
increased levels at night –> levels drop as we age
What can melatonin be used for?
Insomnia, depression, jet lag, CV, GERD, anti-oxidant, cancer
Is melatonin useful?
Not overly - give it a try
Does one develop dependance to melatonin?
No
Melatonin dose?
1-2 mg HS x 2 weeks then 5 mg HS x 2 weeks reasses
Melatonin s/e
mild GI
additive drowsiness to any other sedating agent
headache
Should melatonin be used in a kid?
Safe but referral for sure
What is flax seed used for?
CV (not likely)
Constipation (dietary fiber)
Menopause (maybe)
Is eichana good for a cold?
NO
Is St. John’s Wort effective? What for?
yes
mild-moderate depression not major depression
St. John’s Wort compared to other anti-depressants
better than TCAs
good as (or better) than SSRIs
S/e St. John’s Wort
GI, rash, photosens, sedation, anxiety,
dizziness, headache, dry mouth
Drug Interactions of St. Johns Wort
Induces Cyp P450
Decreases Birth control pills
Decrease warfarin
Other anti-depressants (serotonin syndrome)
What is serotonin syndrome?
when you have too much serotonin (a normal chemical) in your body
agitation or restlessness.
Insomnia.
Confusion.
Rapid heart rate
Ranges from Mild to Severe
Adding specific drugs to SSRIs
1 day after increasing dose
most cases 2 drugs
Is carnberry useful for UTI?
NO
- Used for prevention (1-2 months for effect)
- Recurrent UTI’s
Statins and Ubiquinone
vitamin-likepresent in all cellsantioxidantexpensive
some in meats / seafood
reduced by statins –> worth a try to supplement
