Herbals, Placebos & OTC Flashcards
Garlic
Purpose: dec lipids, BP, platelet aggregation, anti-microbial
Truth: modest reeducation, but statins and bile sequestrates are better
Gingko
Purpose: improve memory, free radical scavenger, inc BF
Truth: modest improvement only in Alzheimer’s
Donepezil is better
St John’s Wort
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
Ginseng
Purpose: adaptogen and general cure all, inc steroid
AE: CNS excitation, dysmenorrhea, hypoglycemia
Intxn: interferes with digoxin
Truth: doesn’t really
Black cohosh
Use: PMS and menopause relief
AE: liver tox (ab pain, jaundice)
Truth: small studies yes, big studies no
Alt: estrogen therapy
Glucosamine
Purpose: improve pain and swelling in OA
Truth: possibly effective but needs 2-4 weeks
Mech: GAG, connective tissue, anti-inflamm
Fish oil
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
Kratom
Use: relief of pain, anxiety, depression
AE: addiction, N/V, constipation, confusion
Banned in many states, death when mixed w opioids
Patients most likely to respond to placebo
High stress, mild disease, milder sx
Conditions that respond most to placebo
Pain, psych illness
Condition must be capable of variable intensity over time
Mechanisms of placebo effect
Psych: expectation, classical conditioning
Neuro: endogenous opioids, CCK, dopamine, serotonin
“Placebome” gene
Met-met COMT gene means less COMT activity and breakdown of DA
Top 3 OTC death causes
Aspirin
Cough/cold
Analgesics
3 requirements to become OTC
Standard for safety/efficacy
Good manufacturing practices
Labeling
Two pathways to OTC status
Citizen petition
Time/extent application initiated by manufacturer
Who controls OTC labeling and advertising?
FDA regulates labeling
FTC regulates advertising
Grading of OTC
I: GRASE (generally recognized as safe/effective)
II: not GRASE, misbranded (won’t get onto market)
III: insufficient data, will probably stay on market
5 characteristics of OTCs
Benefits > risks Low abuse potential Consumer can self dx the condition Can be adequately labeled Health practitioners not needed for use
Acetaminophen
Tylenol and excedrin
Not anti-inflamm or anti-platelet
Preferred in kids
Alcohol worsens hepatotoxicity
Ibuprofen
Advil, Motrin
Originally OTC for dysmenorrhea
Reversible inhibitor of COX, anti-phrenic, anti-inflamm and analgesic
Aspirin
Bayer, found in excedrin
Guaifenasin
Expectorant
Used in robitussin
Pseudoephedrine
Used in decongestants, cold preps
Alpha 1 agonist, little CNS stimulation
Can be used to make meth
Loperamide
Non-analgesic opioid used for diarrhea
Slows peristalsis, inc water absorption time
Does not cross BBB, causes less sedation
