Lec. 20 - Cures for Sale

Question 1

What are 3 questions always asked in evidence-based medicine

Answer 1

1. Does this drug work?
2. What are the side effects?
3. Is there anything better in comparison already

Question 2

Why is alternative medicine fundamentally flawed?

Answer 2

No such thing as alternative medicine. If there is evidence for it, it becomes conventional medicine.

Question 3

Name 4 tenets of conventional medicine

Answer 3

1. Evidence-based
2. Better than placebo
3. Benefits outweigh side-effects
4. Documented

Question 4

What are 3 principles necessary in drug testing?

Answer 4

1. Tested against a placebo
2. Double-blind:
   - Neither patient nor physician knows which is drug and which is placebo
3. Randomization:
   - Random distribution of placebo and drug (so as not to bias one group over the other)

Question 5

What are the rates of placebo effect?

And nocebo effect?

Answer 5

Placebo -> ~35%

Nocebo -> ~15%

Question 6

What is homeopathy?

Answer 6

Belief system that one can dilute a substance but somehow retain magical properties

Through “potentiation” (making potent by diluting)

Question 7

What is the process of potentiation?

Answer 7

Start with initial compound. Dilute it 1:100. Repeat 30 times (banging the vile in between dilutions)

Final concentration: 1/10^60

Question 8

What’s an example of contemporary snake oil?

Answer 8

Oregano oil. Sold as an antibiotic, but taking it while having infection can be dangerous.

Question 9

What are homeopathic nosodes?

Answer 9

Sugar pills that have been proclaimed to replace vaccines (influenza, whooping cough, diphtheria, polio, etc.)

Question 10

What is a common herbal remedy from year to year?

What main function is it said to have

Answer 10

Echinacea (pink flower) -> but no actual evidence for therapeutic use

Claim is that it is an anti-biotic

Question 11

What are prime targets for herbal remedies (5)?

Answer 11

• Conditions that resolve anyway
• Conditions with psychological component
• Chronic conditions that cycle
• Attempts to improve appearance
• Cure terminal illness

Question 12

What was sold as a remedy for cataracts recently?

Answer 12

Ginkgo biloba

Question 13

Name a common herbal remedy for baldness

Answer 13

Shen min

Question 14

What is Leritone?

What is it’s main ingredient

Answer 14

A ‘drug’ claimed to increase intelligence

Main ingredient -> cerebral phospholipid (ground up cow brain)

Question 15

What is Ephedra?

What does it claim to cure?

What can it actually cause?

What finally got it banned?

Answer 15

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

Question 16

What is one of the dangers with herbal remedies?

Answer 16

Herbal toxicity. Plants are full of chemicals, many of which are harmful to humans, so using them without prescription can be dangerous

Question 17

How does chinese traditional medicine operate and why is it dangerous?

Answer 17

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

Question 18

What is dangerous about using herbal remedies + conventional medicine

Answer 18

Drug-drug interactions! Herbal remedies have active compounds, so interactions can occur.

A salient danger is any effect on P450s

Question 19

What is St. John’s Worts?

Answer 19

So called treatment for depression

Question 20

Why does St. John’s Worts cause so many negative side effects with other drugs?

Answer 20

It increases CYP3A4 activity, thus decreasing levels of many other drugs

Question 21

Name some drugs affected by St. John’s Worts (6)

Answer 21

-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.

Question 22

What is dangerous about garlic supplements

Answer 22

Induction of P450s, which can affect things like anticoagulants (risk of bleeding to death)

Question 23

Name 2 main categories of over the counter (OTC) drugs

Answer 23

• Analgesics, NSAIDs

- Cough and cold-related drugs

Question 24

What do most OTCs have in common?

Answer 24

They are symptom relievers (don’t prevent or shorten actual illness)

Question 25

How do nasal decongestants work?

Answer 25

Constrict blood vessels in the nasal mucosa, making them less leaky

1. Stimulation of alpha 1 adrenoreceptors
2. Calcium released in smooth muscle cells
3. Smooth muscles contract, causing vasoconstriction

Question 26

How do anti-allergy drugs function?

Answer 26

Contain anti-histamines.

In an allergic reaction, histamine acts on H1 receptors in smooth muscle in the airways

Anti-histamines block this process

Question 27

How do antifungals function? Give an example using athletes foot

Answer 27

ex. Tolnaftate

“attacks” fungal cellular components (ex. cell wall)

Question 28

What are the 2 main approaches to treating heartburn

Answer 28

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.

Question 29

What is used for the treatment of constipation?

Answer 29

Fiber! Things like Metamucil, for example

Question 30

What is used to treat diarrhea?

Answer 30

Loperamide (Imodium) -> opioid!

Stimulates μ receptors of intestinal wall (myenteric plexus)

Does not cross BBB, no CNS effcts

Question 31

What over the counter drugs can be used to prevent osteoporosis

Answer 31

Calcium carbonate supplements (like TUMS) supplement calcium

Question 32

What is an OTC drug to treat warts?

Answer 32

Salicylic acid in a local application dissolves the wart