Herbals, Placebos & OTC

Question 1

Garlic

Answer 1

Purpose: dec lipids, BP, platelet aggregation, anti-microbial
Truth: modest reeducation, but statins and bile sequestrates are better

Question 2

Gingko

Answer 2

Purpose: improve memory, free radical scavenger, inc BF
Truth: modest improvement only in Alzheimer’s
Donepezil is better

Question 3

St John’s Wort

Answer 3

Use: anti-depressant
Mech: GABA and 5HT binding
AE: photosensitivity
Intxns: SSRIs (sedation), MAOI (inc BP/HR), dec levels of HIV PIs, OTCs, and anti leukemia drugs
Truth: no more effective than placebo

Question 4

Ginseng

Answer 4

Purpose: adaptogen and general cure all, inc steroid
AE: CNS excitation, dysmenorrhea, hypoglycemia
Intxn: interferes with digoxin
Truth: doesn’t really

Question 5

Black cohosh

Answer 5

Use: PMS and menopause relief
AE: liver tox (ab pain, jaundice)
Truth: small studies yes, big studies no
Alt: estrogen therapy

Question 6

Glucosamine

Answer 6

Purpose: improve pain and swelling in OA
Truth: possibly effective but needs 2-4 weeks
Mech: GAG, connective tissue, anti-inflamm

Question 7

Fish oil

Answer 7

Purpose: hyperlipidemia, high BP, CV dz, macular degeneration, ADD, RA
Truth: dec in TG, BP, equal to statins in CV dz
AE: inc LDL, inc risk of bleeding
Use with statin if LDL is high

Question 8

Kratom

Answer 8

Use: relief of pain, anxiety, depression
AE: addiction, N/V, constipation, confusion
Banned in many states, death when mixed w opioids

Question 9

Patients most likely to respond to placebo

Answer 9

High stress, mild disease, milder sx

Question 10

Conditions that respond most to placebo

Answer 10

Pain, psych illness

Condition must be capable of variable intensity over time

Question 11

Mechanisms of placebo effect

Answer 11

Psych: expectation, classical conditioning
Neuro: endogenous opioids, CCK, dopamine, serotonin

Question 12

“Placebome” gene

Answer 12

Met-met COMT gene means less COMT activity and breakdown of DA

Question 13

Top 3 OTC death causes

Answer 13

Aspirin
Cough/cold
Analgesics

Question 14

3 requirements to become OTC

Answer 14

Standard for safety/efficacy
Good manufacturing practices
Labeling

Question 15

Two pathways to OTC status

Answer 15

Citizen petition

Time/extent application initiated by manufacturer

Question 16

Who controls OTC labeling and advertising?

Answer 16

FDA regulates labeling

FTC regulates advertising

Question 17

Grading of OTC

Answer 17

I: GRASE (generally recognized as safe/effective)
II: not GRASE, misbranded (won’t get onto market)
III: insufficient data, will probably stay on market

Question 18

5 characteristics of OTCs

Answer 18

Benefits > risks
Low abuse potential
Consumer can self dx the condition
Can be adequately labeled
Health practitioners not needed for use

Question 19

Acetaminophen

Answer 19

Tylenol and excedrin
Not anti-inflamm or anti-platelet
Preferred in kids
Alcohol worsens hepatotoxicity

Question 20

Ibuprofen

Answer 20

Advil, Motrin
Originally OTC for dysmenorrhea
Reversible inhibitor of COX, anti-phrenic, anti-inflamm and analgesic

Question 21

Aspirin

Answer 21

Bayer, found in excedrin

Question 22

Guaifenasin

Answer 22

Expectorant

Used in robitussin

Question 23

Pseudoephedrine

Answer 23

Used in decongestants, cold preps
Alpha 1 agonist, little CNS stimulation
Can be used to make meth

Question 24

Loperamide

Answer 24

Non-analgesic opioid used for diarrhea
Slows peristalsis, inc water absorption time
Does not cross BBB, causes less sedation