Lec. 20 - Cures for Sale Flashcards
What are 3 questions always asked in evidence-based medicine
- Does this drug work?
- What are the side effects?
- Is there anything better in comparison already
Why is alternative medicine fundamentally flawed?
No such thing as alternative medicine. If there is evidence for it, it becomes conventional medicine.
Name 4 tenets of conventional medicine
- Evidence-based
- Better than placebo
- Benefits outweigh side-effects
- Documented
What are 3 principles necessary in drug testing?
- Tested against a placebo
- Double-blind:
- Neither patient nor physician knows which is drug and which is placebo - Randomization:
- Random distribution of placebo and drug (so as not to bias one group over the other)
What are the rates of placebo effect?
And nocebo effect?
Placebo -> ~35%
Nocebo -> ~15%
What is homeopathy?
Belief system that one can dilute a substance but somehow retain magical properties
Through “potentiation” (making potent by diluting)
What is the process of potentiation?
Start with initial compound. Dilute it 1:100. Repeat 30 times (banging the vile in between dilutions)
Final concentration: 1/10^60
What’s an example of contemporary snake oil?
Oregano oil. Sold as an antibiotic, but taking it while having infection can be dangerous.
What are homeopathic nosodes?
Sugar pills that have been proclaimed to replace vaccines (influenza, whooping cough, diphtheria, polio, etc.)
What is a common herbal remedy from year to year?
What main function is it said to have
Echinacea (pink flower) -> but no actual evidence for therapeutic use
Claim is that it is an anti-biotic
What are prime targets for herbal remedies (5)?
- Conditions that resolve anyway
- Conditions with psychological component
- Chronic conditions that cycle
- Attempts to improve appearance
- Cure terminal illness
What was sold as a remedy for cataracts recently?
Ginkgo biloba
Name a common herbal remedy for baldness
Shen min
What is Leritone?
What is it’s main ingredient
A ‘drug’ claimed to increase intelligence
Main ingredient -> cerebral phospholipid (ground up cow brain)
What is Ephedra?
What does it claim to cure?
What can it actually cause?
What finally got it banned?
Stimulant in amphetamine family
Claims to cure obesity, asthma, increase athletic ability
Can cause stroke and myocardial infarct
Famous baseball player died in locker room taking it before a game
What is one of the dangers with herbal remedies?
Herbal toxicity. Plants are full of chemicals, many of which are harmful to humans, so using them without prescription can be dangerous
How does chinese traditional medicine operate and why is it dangerous?
Mix of a bunch of ingredients (plants, animals, etc.), sometimes potpourri of 30 substances
Never know what you’re going to consume, and could lead to drug-drug interactions
What is dangerous about using herbal remedies + conventional medicine
Drug-drug interactions! Herbal remedies have active compounds, so interactions can occur.
A salient danger is any effect on P450s
What is St. John’s Worts?
So called treatment for depression
Why does St. John’s Worts cause so many negative side effects with other drugs?
It increases CYP3A4 activity, thus decreasing levels of many other drugs
Name some drugs affected by St. John’s Worts (6)
-Statins decreased (risk of heart attack)
-Antiepileptics (risk of seizures)
-Oral contraceptives (risk of pregnancy)
-HIV protease inhibitor (go out of HIV remission)
-Chemotherapy drug
-Immunosuppressants
etc.
What is dangerous about garlic supplements
Induction of P450s, which can affect things like anticoagulants (risk of bleeding to death)
Name 2 main categories of over the counter (OTC) drugs
- Analgesics, NSAIDs
- Cough and cold-related drugs
What do most OTCs have in common?
They are symptom relievers (don’t prevent or shorten actual illness)
How do nasal decongestants work?
Constrict blood vessels in the nasal mucosa, making them less leaky
- Stimulation of alpha 1 adrenoreceptors
- Calcium released in smooth muscle cells
- Smooth muscles contract, causing vasoconstriction
How do anti-allergy drugs function?
Contain anti-histamines.
In an allergic reaction, histamine acts on H1 receptors in smooth muscle in the airways
Anti-histamines block this process
How do antifungals function? Give an example using athletes foot
ex. Tolnaftate
“attacks” fungal cellular components (ex. cell wall)
What are the 2 main approaches to treating heartburn
H2 blockers:
HCL producing cells (parietal cells) are stimulated by histamine, acetylcholine, and gastrin. By blocking H2 receptors, decreases gastric output
Proton pump inhibitors:
Parietal cells have proton pumps to pump out gastric acid. These drugs (generally ending in -ole; ex. Omeprazole,) block this process. Prodrugs that are activated in stomach.
What is used for the treatment of constipation?
Fiber! Things like Metamucil, for example
What is used to treat diarrhea?
Loperamide (Imodium) -> opioid!
Stimulates μ receptors of intestinal wall (myenteric plexus)
Does not cross BBB, no CNS effcts
What over the counter drugs can be used to prevent osteoporosis
Calcium carbonate supplements (like TUMS) supplement calcium
What is an OTC drug to treat warts?
Salicylic acid in a local application dissolves the wart
