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AIII-Natural Health Products > L11-MSK > Flashcards

L11-MSK Flashcards

1
Q

RA v OA.

List the 2 NHPs to reduce the Sx of RA.

A
  1. omega-3 fatty acid

2. gamma linolenic acid

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2
Q

RA v OA.

List the 5 NHPs to reduce the Sx of OA.

A
  1. glucosamine
  2. chondroitin
  3. turmeric
  4. MSM
  5. SAMe
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3
Q

RA v OA.
State the difference in:
1. Cause

A

RA: AI disease

OA: wear-n-tear

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4
Q

RA v OA.
State the difference in:
2. MOA

A

RA: IS attacks joint/tissues then over time cartilage/bone is damaged & muscles/ligaments/tendons are weakened

OA: age/overuse of joint causes the top layer of cartilage to break down/wear away. bones rub together.

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5
Q

RA v OA.
State the difference in:
3. Affected joints

A

RA: Fingers, wrists, usually symmetrical

OA: Hands, knees, hips, spine-not usually symmetrical

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6
Q

RA v OA.
State the difference in:
4. Sx.

A

RA: pain & inflammation

OA: pain, inflammation in severe cases

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7
Q

RA NHPs.

Which 3 are listed as effective?

A
  1. Borage (gamma-linolenic acid)
  2. Cat’s claw
  3. Fish oil
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8
Q

RA NHPs.

Which 6 are listed as INeffective?

A 
Bromelain
Collagen Type II
Evening Primrose oil (gamma linolenic acid)
Krill oil
New Zealand Green Lipped Mussel
Turmeric
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9
Q

RA NHPs.
Which 6 are indicated for RA & OA?
Does this make sense?

A 
Cat's claw
Krill oil
Turmeric
NZ Green Lipped Mussel
Collage Type II
Bromelain
-> nt really as RA is heavily inflammatory, but OA is not
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10
Q

RA NHPs.

T/F: Thunder god vine should not be used due to serious SE.

A

True!

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11
Q

RA NHPs - 1. Fish Oil.
Main source?
List other sources?

A 
=Omega 3 (PUFAs, EPA, DHA)
other sources:
•Krill oil
•Algae (blue-green)
•New Zealand green lipped-mussel
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12
Q

RA NHPs - 1. Fish Oil.

MOA.

A
  • Arachadonic acid through COX enzymes make a series of PGs that can cause inflammation
  • Omega 3’s make sense bc the same enzymes that make the inflam PGs can use EPA and make anti-inflam PGs instead
  • omega 3’s can also make resolvins in addition to the anti-inflam PGs
  • > these also help to resolve inflammation
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13
Q

RA NHPs - 1. Fish Oil.
Define resolvin.
How can fish oils help?

A

=resolution phase interaction product

-some ppl may have a hard time to naturally producing these resolvins fish oils can help.

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14
Q

RA NHPs - 1. Fish Oil.
RCT: Fish oil as add on Tx in recent OA of RA.
Methodology.

A
  • RA <12m
  • DMARD naive
  • Both groups received triple DMARD tx (MTX, sulfasalazine, and hydroxychloroquine)

-Treatment group received 5.5g/day of EPA+DHA
control received 400mg EPA+DHA
(so that they could at least smell and thought they may be getting it)

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15
Q

RA NHPs - 2. GLA.
Main source?
List other sources?

A 
GLA= Gamma linolenic acid
=omega 6 fa
-borage oil
-black currant
-evening primrose oil
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16
Q

RA NHPs - 2. GLA.

T/F: Addition of GLA supplementation is needed as we often do not get enough in our diet.

A

FALSE

-ppl tend to get more omega 6 in diet (to the point of too much)

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17
Q

RA NHPs - 2. GLA.

MOA - i.e.: Why would we want to take this? Wouldnt it just cause more regular PGs?

A

-possible reasoning:
>some enzymes along the way can get saturated, then the remainder can get sent off to the side and make different PGs that do have anti-inflam effect

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18
Q 
RA NHPs - 2. GLA.
Which one is the possibly effective?
1. Primrose
2. Borage
3. Black current
A

3! Only one that is possibly effective, has the highest concentration, still conflicting.

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19
Q

RA NHPs - 2. GLA.
Cochrane evidence of GLA itself?
Why did Cochrane NOT do a study on fish oil?

A
  • probably may improve pain; may improve function.

- b/c just looking at herbs, fish oil not a herb

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20
Q

RA NHPs.

Evidence of NHPs usage in RA.

A
  • no complementary medicines, oral or topcal have demonstrated efficacy
  • few have been sufficiently tested using RCTs

fish body oil given an effectiveness rating of 5 (safety green, w only possibility of anti-coag effects)
(borage oil, evening prim are 3); (cat’s claw and rose hip 2); (black current, flaxseed, green-lipped mussle 1)
*cat’s claw and flaxseed oil are ambers for safety

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21
Q

RA NHPs.

T/F: No complementary medicines, oral or topical, have demonstrated efficacy.

A

TRUE!

BUT few have been sufficiently tested using RCTs

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22
Q

RA NHPs.
Evidence of NHPs usage in RA.
____ is the only NHP has been given a 5 effectiveness rating & a green safety rating.

A

Fish body oil

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23
Q

RA NHPs.

List the effectiveness rating given a green in safety rating (5).

A 
Fish body oil - 5
Borage oil - 3
Rose hop - 2
Black currant seed oil - 1
Green-lipped mussel - 1
24
Q

RA NHPs.

List the effectiveness rating given an amber in safety rating (2).

A

Cat’s claw - 2

Flaxseed oil - 1

25
Q

OA NHPs.

List the 5 NHPs to reduce the Sx of OA.

A
  1. glucosamine
  2. chondroitin
    1. collagen
    1. Hyaluronic acid
  5. turmeric
  6. MSM
  7. SAMe
26
Q

OA NHPs - 1. Glucosamine.
What is it?
WHAT THREE FORMS IS IT AVAILABLE AS?

A 
=2-amino-2-deoxy-D-glucose
-available as:
>glucosamine SO4
>glucosamine HCl
>N-acetyl glucosamine
27
Q

OA NHPs - 1. Glucosamine.

Which available form is thought to be effective?

A

Sulfate thought to be the “effective” one

-most studied on knee

28
Q

OA NHPs - 1. Glucosamine.

MOA.

A
  • Precursor to glycosaminoglycans & proteoglycans that make up articular cartilage
  • Theory: as you get older & you are getting OA, it may be from decreasing glucosamine over time
29
Q

OA NHPs - 1. Glucosamine.

MOA - what is the problem w this theory?

A

-while this is good in theory there are lots of problems with this-> BA only 20% so likely not getting it where it needs to go

30
Q

OA NHPs - 1. Glucosamine.

Evidence of glucosamine in OA of the knee.

A

-inconsistent, insuff evidence, many medical sources do not support it.

31
Q

OA NHPs - 1. Glucosamine.

RCT: Effect of oral glucosamine on joint structure.

A
  • 201 participants
  • Tx group: glucosamine HCl for 24wks, others had placebo

-Primary outcome: decrease worsening of cartilage damage
-Secondary outcomes: change in bone marrow lesions (BML),
decrease in self reported pain
>used MRI to evaluate cartilage damage

32
Q

OA NHPs - 1. Glucosamine.
RCT: Effect of oral glucosamine on joint structure.
Results.

A
  1. No evidence of structural benefits

2. No reduction in pain

33
Q

OA NHPs - 1. Glucosamine.

AE.

A

GI discomfort.

34
Q

OA NHPs - 1. Glucosamine.

A

-shellfish allergy (?)
>for NHP, made in lab but same compound in shells
>though the allergy is from meat BUT not worth the risk
-diabetes (??)
>has sugar, may affect insulin sensitivity, not proven
-Preg
-Asthma (several case reports)

35
Q

OA NHPs - 1. Glucosamine.

T/F: CI in patients w renal/hepatic impairment.

A

FALSE!

-not studied in pts w renal or hepatic impairment

36
Q

OA NHPs - 1. Glucosamine.

DI.

A

-warfarin

>theoretical, only 20 case reports of glucosamine increasing INR

37
Q

OA NHPs - 2. Chondroitin.

Describe.

A
  • a polymer isolated from an animal sources
  • it is a glycosaminoglycan
  • poor oral BA
38
Q

OA NHPs - 2. Chondroitin.

Reason of use.

A

-may prevent cartilage metabolism

39
Q

OA NHPs - 2. Chondroitin.

T/F: Similar to heparin in structure.

A

TRUE!

-similar to heparin so may have anticoag effects (therefore theoretical interaction)

40
Q 
OA NHPs - 2. Chondroitin v GA.
RCT: GAIT 
Glucosamine/chondroitin arthritis intervention trial.
Peeps?
Outcome measures?
A
  • 5 diff possibilities: >Glucosamine or chondroitin on own OR as combo, celecoxib, or placebo
  • outcome measures: decreased pain, improved function
41
Q

OA NHPs - 2. Chondroitin
RCT: GAIT
Glucosamine/chondroitin arthritis intervention trial.
Results.

A

-compared to placebo:
celecoxib group 10%
glucosamine group 4%
glucosamine plus chondroitin group 6.5%

-not a gucci study, positive control was NOT good, rate of response was better for mod-sev pain group

42
Q

OA NHPs - 2. Chondroitin
RCT: LEGS
LT Evaluation of GA Sulfate Trial.

A

-Studied chronic knee pain for 2yrs
-either glucosamine sulfate, chondroitin sulfate, combo of bth or placebo
-outcome measures:
>disease progression (measured by radiograph), knee pain score

43
Q

OA NHPs - 3. Collagen

T/F: Applies to both RA & OA.

A

False!

  • APPLIES TO RA NOT OA
  • Theory: inducing oral tolerance to reduce activity of T cells that release joint destroying factors
  • insuff evidence (both OA and RA)
  • similar to gelatin preps
44
Q

OA NHPs - 3. Collagen

Define oral tolerance induction.

A
  • described a state of immune hyporesponsiveness following the oral ingestion of a protein
  • method by which a periph immune tolerance to a particular Ag may be induced by presenting specific amounts of that antigen to the GI system
45
Q

OA NHPs - 4. Hyaluronic acid (as an oral NHP).

A
  • insuff evidence BUT is when given by intra-articular injections (not an NHP)
  • no studies for its action; likely not getting to where it needs to go as oral
46
Q

OA NHPs - 5. Tumeric

WHAT IS IT?

A

=curucma longa

-used in herbal medicine to help relieve joint inflammation; possibly effective

47
Q

OA NHPs - 5. Tumeric

MOA.

A

-may reduce inflammation by inhibiting COX-2 PGs, LTs, and other cytokines involved in proinflammatory signaling pathways

48
Q

OA NHPs - 5. Tumeric

CI.

A
  • diabetes?

- curcumin can reduce levels of blood glucose and glycosylated (HbA1C) hemoglobin

49
Q

OA NHPs - 6. Celedrin/cetylated FAs.

A

=celedrin

  • possibly effective
  • may inhibit COX and 5-lipoyxygenase
  • may be a joint lubricant
  • it is hugely fat soluble; have been made into esters for better absorption
50
Q

OA NHPs - 7. MSM

WHAT ERZ IT?

A
  • pssibly effective

- is a simple, naturally occuring compound

51
Q

OA NHPs - 7. MSM

MOA.

A
  • inhibit degenerative changes in joints

- scavenge hydroxyl free radicals which trigger inflam

52
Q

OA NHPs - 8. SAMe

What dis it?

A

-NHPD allows: helps alleviate OA pain

53
Q

OA NHPs - 8. SAMe

DI

A
  1. antidepressants, MAOIs, bipolar disorder, manic depression
  2. hepatotoxic drugs
    3.Hyperhomocysteinemia
    >do not take at night since may cause anxiety, restlessness and insomnia
54
Q

OA NHPs - 9. Eggshell membrane

A
  • promoted for “relieving joint pain in as little as 7-10d
  • natural source of collagent, glucosamine, chondroitin, and hyaluronic acid
  • msot studies had limited amount of evidence; you want the evidence to be clinically relevent
55
Q

practical tips for pharmacists

A
  • Med reviews should capture all NHPs being used
  • Always review for potential medication/NHP interactions
  • Recommend trying only one new NHP at a time to better assess benefit/ unexpected reactions
  • Review potential side effects with patient
  • Patients w renal or liver impairment, DM or HTN or are preg/BF should consult prior to initiating NHPs
  • A new NHP should be tried for 2 months before assessing benefit. After 2m, stopping for 7 days may help assess any benefit provided
  • Changing brands may affect benefit
  • Caution pts that no NHP is a “miracle cure” for OA; pain reduction goal

AIII-Natural Health Products (19 decks)

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