TCM

Question 1

What is the difference between complementary Versus Alternative medicine?

Answer 1

If a non mainstream practice is used together with conventional medicine –> complimentary
If a non mainstream practice is used in place of conventional medicine –> alternative

Question 2

What are 3 main problems associated with the use of health supplements or herbal products?

Answer 2

Contamination of a herbal remedy with poisonous chemicals (e.g. residual herbicide, and toxic minerals like copper, arsenic, lead, mercury)

Adulteration of the herbal remedy with potentially harmful western drug(s) (e.g. fenfluramine, steroid, aspirin, sibutramine glibenclamide)

Misidentification of a plant species used in the herbal remedy, causing a toxic variety to be used instead

Question 3

What are the 4 CAM that you should know?

Answer 3

Garlic, St john’s wort, ginkgolides, ginseng

Question 4

What are the pharmacological effects of Garlic?

Answer 4

1. Anti-thrombosis
2. block cholesterol synthesis by inhibiting HMG-CoA reductase
   activity –> atherosclerosis
3. lower blood pressure –> use for High blood pressure

Question 5

WHat are the ADRs of Garlic?

Answer 5

1. GIT-related symptoms (nausea, vomiting, diarrhea)
2. burning sensation in the mouth

Question 6

WHat are some potential DDI and contraindications of Garlic?

Answer 6

1. Increase breakdown of anti-HIV drugs
2. Increase risk of bleeding, especially in patients taking aspirin, warfarin, clopidogrel and ginkgo biloba

Question 7

What are the pharmacological effects of St john’s wort?

Answer 7

Inhibits monoamine-oxidase, increasing brain levels of monoamine neurotransmitters that affect mood

Question 7

DDI of st john wart?

Answer 7

CYP450 enzyme inducer
- reduced effectiveness of other drugs like warfarin (thrombosis), cyclosporines (transplant rejection), oral contraceptives (unexpected pregnancy), anti-HIV drugs/anti-convulsants
2. Enhanced effects of serotonin (“serotonin syndrome”) with conventional drugs which also increase serotoninergic transmission
- SSRIs, Tricyclic anti-depressants, MAO inhibitors

Question 7

Clinical uses of St john worts?

Answer 7

improve symptoms in patients with mild to moderate depression

Question 8

What are the pharmacological effects of Ginkgolides?

Answer 8

1. dilate blood vessels
2. reduce blood viscosity
3. scavenge free radicals
4. inhibits platelet aggregation
5. Ginkgolides may potentially be beneficial in asthma
6. Help with memory disorders

Question 9

DDi of ginkgolides

Answer 9

Ginkgo leaf extract interferes with platelet aggregation, and thus should not be taken with anti platelet or anti coagulant medications (like aspirin, warfarin) to avoid occurrence of erratic bleeding and bruising

Question 10

Clinical effects of ginseng

Answer 10

1. blood thinning
2. lower blood sugar
3. immunomodulatory
4. memory enhancing
5. Heart nad blood vessels

Question 11

Adverse effects of ginseng

Answer 11

1. weak oestrogenic properties –> breast pain and menstrual irregularities
2. insomnia and nervousness due to excessive brain stimulation
3. hypertension from high dose

Question 12

Contraindication of Ginseng

Answer 12

1. diabetes
2. patients on warfarin
3. Immunocompromised individuals