Week 3
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| Herbal remedies | Use of plant-derived products to promote health and relieve symptoms of disease
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| What's the most common form of alternative medicine? | Herbal medicines
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| Why are herbal meds being used more and more? | Available without prescription
Frequently cheaper
Perception that herbs are safer and healthier than conventional drugs
Some people like the sense of empowerment that comes from self-diagnoses
Frustrated with conventional meds
Aggressive marketing
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| Dietary Supplement Health and Education Act of 1994 | Exempts herbs, vitamins, minerals, and botanical products from FDA regulation
-Dietary supplements can be made and sold without giving the FDA any proof they are safe or effective
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| How must herbal products be labeled? | As dietary supplements, not regulated by FDA, cannot claim to diagnose, prevent, or treat disease, allowed to make claims about products ability to favorably increase body structure, but cannot say it diagnoses, treats, or cures
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| Accuracy of herbal labels? | FDA doesn't require accuracy, therefore there is no assurance that a product actually contains the ingredients listed or contains them in stated amounts
-Leading to impurities and lack of uniformity among similarly labeled products
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| What concentration of herbal formulas are preferred most? | Solid extracts (tablet or capsule)
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| Nurses responsibility with herbal products? | Teach patient to use lowest dose
Is it the right drug for them?
What are they using it for?
Is it safe to continue?
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| Aloe uses | Primarily for skin ailments (scalds, burns, acne, eczema)
Oral aloe is used to relieve constipation
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| Aloe preparations | Aloe gel (aloe vera) is extracted from inner portion of aloe leaf - for topical therapy only
Aloe latex is derived from layer just beneath the outer skin of leaf - taken only as oral laxative
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| Aloe actions | Contains salicylic acid, bradykinin, and superoxide dismutase
Gel promotes healing of burns by inhibiting thromboxane (product of arachidonic acid metabolism)
Aloe gel also works as mild antimicrobial product and moisturizer
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| Aloe adverse effects | When applied to skin, rarely any ADRs
Hypersensitivity reactions may occur
Oral aloe latex can cause severe diarrhea
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| Black Cohosh uses | Treats acute symptoms of menopause (hot flashes, vaginal dryness, palpitations, depression, irritability, and sleep disturbances)
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| Black Cohash actions | Black Cohash suppresses the release of LH from pituitary (unregulated LH release causes menopause symptoms)
2 ingredients - 1 mimics action of estrogen at receptors in pituitary, 1 acts through an estrogen-independent mechanism
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| Black Cohash ADR | Safe for routine use (no more than 6 months)
Rarely, user may get upset stomach
Should not be taken during pregnancy (due to estrogenic effects)
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| Black Cohash interactions with conventional drugs | Increases hypotensive effects of antihypertensive drugs as well as the hypoglycemic effects of insulin and oral hypoglycemics
May increase the effects of estrogens used for hormone replacement therapy or contraception
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| Black Cohash vs. Blue Cohash | Blue cohash promotes menstruation and labor (causes uterine contractions) and can elevate BP, increase intestinal motility, and accelerate respiration
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| Echinacea uses | Oral - taken to stimulate immune function, suppress inflammation, and treat viral infections (including influenza and common cold)
Topical - treats wounds, burns, eczema, psoriasis, and herpex simplex infection
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| Echinacea preparations | Dried roots, freeze-dried plants, dry-powder extracts, teas, and tinctures
Preparations from roots and leaves are most active
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| Echinacea actions | Contains cichoric acid, polysaccharides, flavenoids, and essential oils
Produce antiviral, anti-inflammatory, and immunostimulant effects through:
-mobilization of phagocytes, stimulation of T-lymphocyte proliferation, stimulation of interferon
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| Echinacea effectiveness | Taken widely to prevent and treat colds, efficacy is questionable
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| Echinacea ADR | Few have been reported
Unpleasant taste
Allergies
It stimulates immune system, so it should be avoided in patients with autoimmune disease
Oppose effects of conventional immunosuppressant drugs
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| Feverfew uses | Prophylaxis and treatment of migraines
Applied topically to treat infection and relieve toothache
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| Feverfew actions | Active ingredient - parthenolid
-works by blocking formation of a gene transcription factor required for activation and proliferation of certain inflammatory cells that may be critical to pathogenesis of migraine
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| Feverfew effectiveness | Evidence suggests it benefits patients with migraines, and can reduce frequency and severity of attacks
Less effective when taken to abort an ongoing attack
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| Feverfew ADR | Well tolerated
People allergic to ragweed may also be allergic to feverfew
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| Feverfew interactions with conventional drugs | Suppresses platelet aggregation (thereby increase the risk of bleeding in patients taking antiplatelet or anticoagulant therapy)
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| Garlic uses | Effects cardiovascular system
Taken to reduce triglyceride and LDL cholesterol, and increase HDL
Reduce BP, suppress platelet aggregation, and decrease formation of atherosclerotic plaque
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| Garlic actions | Allicin is active ingredient and gives it bad smell (when crushed)
MORE????
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| Garlic effectiveness | Favorably effects BP and plasma lipids
Depends on quality and preparation
When high quality prep is used - it decreases cholesterol, LDL cholesterol, and TG (but not as much as conventional drugs)
Can decrease BP
Need 1-2 whole cloves twice daily
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| Garlic ADR | Generally well tolerated
Unpleasant taste and bad breath
Can cause heartburn, flatulence, nausea, vomiting, diarrhea, and a burning sensation in mouth
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| Garlic interactions with conventional drugs | Significant antiplatelet effects (increase risk of bleeding on ppl taking antiplatelet/anticoagulant drugs)
Can increase insulin levels (can increase hypoglycemic effects of drugs)
Can reduce levels of saquinavir, which is used to treat HIV
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| Ginger root uses | Suppress nausea and vomiting caused by motion sickness, morning sickkness, and chemotherapy
Anti-inflammatory and analgesic properties that may help people with arthritis and other inflammatory conditions
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| Ginger root actions | May be through blocking serotonin receptors in chemoreceptor trigger zone of brain or neurons in GI tract (activation of these receptors trigger emesis)
Anti-inflammatory actions have been attributed to stopping synthesis of inflammatory mediators
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| Ginger root effectiveness | Benefits prevention and treatment of motion sickness, morning sickness, seasickness, and postoperative nausea and vomiting
Needs 9x higher dose than using Dramamine
Reduces pain, improve joint mobility, and decrease swelling and morning stiffness
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| Ginger root ADR | Very well tolerated
Severe toxicity never reported, but could cause CNS depression and cardiac dysrrhythmias
Used in caution during pregnancy
High doses can stimulate uterus, and might cause spontaneous abortions
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| Ginger root interactions with conventional drugs | Inhibit production of thromboxane by platelets and thereby suppress platelet aggregation (increases risk of bleeding in patients receiving antiplatelet or anticoagulant therapy)
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| Best sources of ginger root? | Produce section of grocery store, peel skin and chew medium slice
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| Ginkgo uses | -Improve memory, sharpen concentration, and promote clear thinking
-Being looked at to help pts with Alzheimers disease
-Counteract erectile dysfuncttion induced by antidepressants (especially fluoxetine)
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| Ginkgo preparation | Acetone extraction of leaves from Ginkgo biloba tree
-Has flavenoids (24%) and terpenoids (6%)
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| Ginkgo actions | Multiple biological effects
Most benefit from improved blood flow secondary to ginkgo-induced vasodilation
In brain, it appears to increase blood flow by stimulating synthesis of prostaglandins
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| Ginkgo effectiveness | Supports benefits of ginkgo for patients with cognitive impairment secondary to low cerebral blood flow
Improves short term memory in adults
Improved erection due to increased blood flow
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| Ginkgo ADR | Can cause upset stomach, dizziness, or vertigo
Suppresses coagulation and should be used in caution in pts taking antiplatelet or anticoagulant drugs
May promote seizures
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| Goldenseal uses | Treats bacterial, fungal, and protozoal infections of mucous membranes
Skin and eye irritations, still in some sterile eye washes
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| Goldenseal actions | Alkaloids - suppresses inflammation of mucous membranes, stimulate peristalsis, altering BP, promote homeostasis, induces secretion of bile, and possess astringent and antiseptic properties
Berberine - inhibits attachment of bacterial cells to epithelial
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| Goldenseal ADR | High doses can cause nausea, vomiting, diarrhea, and stimulation of CNS
Toxic doses can cause hypertension, convulsions, and death from respiratory failure
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| Kava uses | Relieves anxiety, promotes sleep, and relaxes muscles
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| Kava actions | Active ingredients - alpha-pyrones or kava-lactones
Mechanism of action is unknown
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| Kava effectiveness | Does relax skeletal muscles and relieves tension and anxiety
Must be taken for weeks before effects develop
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| Kava ADR | Can cause CNS depression, skin problems, liver damage, impaired vision, muscle incoordination, dry flaking skin, reddened eyes, yellow color of skin, hepatitis, cirrhosis, and liver failure
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| Kava interactions with conventional drugs | Can intensify effects of other CNS depressants
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| Ephedra uses | Reduce appetite, increase energy, overcome tiredness, treat narcolepsy, relieve bronchospasm, and ehance athletic performance
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| Ephedra actions | Alpha 1 - constriction of aterioles in skin and mucous membranes
Beta 1 - increases HR and force of contraction
Beta 2 - promotes bronchodilation
Activation of receptors in brain cause appetite suppression and CNS stimulation
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| Ephedra ADR | Death
Banned in US
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| St. Johns Wort uses | Treats depression
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| St. Johns Wort action | Hypericin - decreases uptake of serotonin, NE, and dopamine, binds GABA receptors, and mildly inhibits MAO (same as traditional anti-depressants)
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| St. Johns Wort effectiveness | Superior to placebo, and equal to standard antidepressants
Mild antidepressant effects
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| St. Johns Wort ADR | May increase photosensitivity and risk for cataracts
Induces cytoP450 enzymes (decreases effectiveness of various drugs, including oral contraceptives, cyclosporine, indivavir (HIV protease inhibitor))
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| Saw Palmetto uses | Relieves urinary symtpoms associated with prostatic hypertrophy
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| Saw Palmetto actions | Inhibits the enzyme that converts testosterone to DHT (the active form of testosterone in prostate)which would reduce the urinary tract obstruction - same as conventional drug
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| Saw Palmetto effectiveness | Relieves urinary problems associated with BPH although prostate size remains unchanged
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| Saw Plametto ADR | Upset stomach or headache rarely
Reduces levels of prostate specific antigen, a marker for prostate cancer (causing a false-negative on test)
Pregnant women should avoid touching or using
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| Valerian uses | Promotes sleep
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| Valerian actions | Increases availability of GABA at synapses in the CNS
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| Valerian effectiveness | Helped people fall asleep, but didn't prevent waking during night
Takes days-weeks to work
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| Valerian ADR | May cause headache, nervousness, or cardiac abnormalities
Reduces alertness so should exercise caution while driving or operating heavy machinery
Does not seem to potentiate CNS depression effects of alcohol
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| Coenzyme Q10 uses | Treats heart failure, muscle injuries caused by statins, and mitochrondrial encephalopathies (muscle and nervous system injury caused by deranged mitochrondial metabolism)
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| Coenzyme Q10 actions | Found in every cell in body
Potent antioxidant and participates in many metabolic pathways, most notably, the production of ATP
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| Coenyme Q10 effectiveness | In patients with Q10 deficiency, replacement therapy helped
Improves quality of life but doesn't improve objective measures in heart failure
One form is effective to treat mitochrondrial encephalopathies
Not enough evidence to treat statins
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| Coenzyme Q10 ADR | Well tolerated
High doses may produce GI disturbances (gastritis, reduced appetite, nausea, and diarrhea)
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| Coenzyme Q10 interactions with conventional drugs | Structurally similar to vit. K so may antagonize the effects of warfarin
Shares pathway with cholesterol
Drugs like statins (which inhibit production of cholesterol) can also inhibit synthesis of Q10
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| Soy uses | Prevention of breast cancer, and in postmenopausal women, treats vasomotor symptoms (hot flashes), and prevents osteoporosis
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| Soy actions | Structurally similar to estradiol (endogenous estrogen) and can bind with estrogen receptors
In women with normal estrogen levels, soy appears to antagonize the endogenous estrogen
In postmenopausal women, soy acts as estrogen agonists
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| Soy effectiveness | Studies have show it reduces hot flashes
Trials have shown that soy may reduce the risk of developing breast cancer
It does increase mineral density or slows the progression of osteoporosis in women
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| Soy ADR | GI effects are most common, but usually well tolerated
Can cause migraine, because of estrogenic effects
May increase risk of kidney stones
Goider and hypothyroidism in infants who drank soy-based formula
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| Soy interactions with conventional drugs | Should not be combined with tamoxifen and other drugs that can block estrogen receptors
Antibiotics may decrease the effectiveness of soy
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| Probiotics uses | Composed of potentially beneficial bacteria or yeasts
Treats IBS, ulcerative colitis, antibiotic-associated diarrhea, and rotavirus diarrhea
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| Probiotic actions | Help metabolize food and some drugs
Promote nutrient absorption
Reduce colonization of gut by pathogenic bacteria
Control bacterial overgrowth by producing hydrogen peroxide
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| Probiotic effectiveness | Reduces duration of diarrhea, improves stool consistency, and decreases stool frequency
May reduce bloating and abdominal pain
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| Probiotic ADR | Generally well tolerated
Most common - bloating and flatulence
Infection of the blood with bacteria reported only with patients who were severely immunocompromised
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| Probiotic interactions with conventional drugs | May be altered by antibiotics and antifungals
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| Ginseng uses | Immune stimulant
Slows aging
Lowers blood glucose
Energy/stress
Lowers BP
Sexualitty- erectile dysfunction
Means "all healing"
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| Ginseng concerns | Genseng abuse syndrome
Nephrotoxic contaminant germanium (damages cells)
Warfarin
Hormones/pregnancy
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| Verbal order rules | Enter the order while on phone, and read it back to them!
SBAR
-Situation
-Background
-Assessment
-Recommendations
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