Final

Question 1

What can the Acetylcholine protocol help treat? Why?

Answer 1

Treating tachycardias (sinus, atrial, PSVT).
Lowers heart rate (inhibits contraction of cardiac muscle fibers) while inducting contraction of skeletal muscles.
The only neurotransmitter used in the motor division of the somatic nervous system.

Question 2

What are some other conditions treated by the Acetylcholine protocol?

Answer 2

Reducing PVCs, PACs. Controlling ventricular response to A. Fib.

Question 3

How to do the Acetylcholine protocol?

Answer 3

1000mg of Pantethenic Acid or Pantethine, mixed with 2 Tbsp powdered lecithin or choline bitartrate into water or juice and drank throughout the day.

Question 4

How might elevated homocysteine influence blood pressure?

Answer 4

Elevated homocysteine may be resultant from methylation defects. NorEpi may not methylated to Epi very well. NorEpi is a more potent vasoconstrictor.

Question 5

How to lower homocysteine?

Answer 5

Folate, B6, B12 can lower by 50%.

Question 6

What is an effective natural treatment for hypercholesterolemia?

Answer 6

Niacin. Work up from 500mg qd to 1500-2000mg qd. Begin with 500mg QD week 1, then 500mg BID week 2.
Monitor with labs beginning at 1000mg QD.

Question 7

What is a potent fibrinolytic enzyme and how is it monitored?

Answer 7

Nattokinase.
“Fibrinolysis is a process that prevents blood clots from growing and becoming problematic.”
Dose: 2000 FU, 1-4 BID
Monitor:
Fibrinogen (250-300 mg/dl optimal) and Bleeding time (6-8 min optimal)

Question 8

What is the arginine protocol used for? Dosing?

Answer 8

First line ND treatment for HTN. (Also good for ED)
MOA: Releases into nitric oxide, potent vasodilator.
Sig: 3-10g BID, taken with Gamma Tocopherol 200mg BID– quenches nitric oxide.
May increase cough (ACEi, asthma, COPD)

Question 9

When is valve replacement essential in Aortic Stenosis?

Answer 9

0.5cm2 to

Question 10

What are the top ND treatments for HTN (besides diet, exercise, weight management, stress reduction)?

Answer 10

Arginine protocol
Garlic, Celery, Capsicum
Magnesium: 400-1200mg qd
CoQ10: 100-600mg qd
EFAs: 1-3grams DHA (6g total)
Fish peptides (pre-HTN or stage 1) aka Vasotensin

Question 11

Botanicals for HTN?

Answer 11

Tons of Crataegus
Rauwolfia
Linden or Hellbrun Formulas

(Linden= linden, crataegus, mistletoe, valeria)
(Hellbrun= cactus, crataegus, avena, viscum, gelsemium)

Question 12

Stressed out hypertensive?

Answer 12

B-complex
Nervines
Magnesium

Question 13

Loop diuretic pts?

Answer 13

HTN with CHF, atrial fib. failure.
Avoid with DM.
Potassium and magnesium depleting.

Question 14

Spironolactone pts?

Answer 14

HTN with PCOS.
Potassium-sparing, watch for hyperkalemia.
Best diuretic for diabetics.

Question 15

ACE (Lisinopril)/ARB (Losartan) patients?

Answer 15

HTN and CHF (ACE first, ARB second for CHF).
Cardiomyopathy, post-MI, for preload and
afterload reduction, vasodilation.
DM nephropathy protection– ARBs first line for DM.

Question 16

What is the are the major effects of Calcium Channel Blockers?

Answer 16

Vasodilation (HTN).
Slows/controls heart rate (tachyarrhythmias- sinus tach., PVCs, PAT/PSVT. Use diltiazem).

Dihydropyridines (amlodipine) more potent and a better choice than non-dihydropyridines (verapamil).

Question 17

Are Beta-blockers a first line treatment for HTN?

Answer 17

No. No longer considered reduced morbidity/mortality and possible increase in stroke risk.
HTN with migraines, PVC, or MI. Avoid with DM.

Question 18

Monitor fibrinogen and bleeding time?

Answer 18

Monitor monthly.
Fibrinogen: 250-300
Bleeding time: 6-8 min optimal in anti-coagulation patients (normal 8-12 min).

Question 19

Dilated cardiomyopathy: systolic or diastolic dysfunction?

Answer 19

Systolic.
Impaired contractility = cannot pump well.
Compensatory mechanisms can lead to left ventricular hypertrophy and CHF.

Question 20

Hypertrophic cardiomyopathy: systolic or diastolic dysfunction?

Answer 20

Diastolic.
Normal contractility.
Abnormal filling of left ventricle due to reduced compliance or distensibility.

Question 21

ACEi MOA for CHF?

Answer 21

Venous dilation: reduces preload.
Arterial dilation: reduces afterload.
Favorable effects on ventricular remodeling.

Question 22

Thiazide diuretic pts?

Answer 22

Most common diuretic for HTN pts.

Loop more common with CHF

Question 23

Are Beta-blockers used in CHF?

Answer 23

Only if STABILIZED. First line when stable.
Contraindicated in unstable CHF.
Avoid with DM.

Question 24

Beta-blocker MOA for HTN and CHF?

Answer 24

HTN: Reduce cardiac output.
(Actually block vasodilation)
CHF: Block effects of NorEpi, which increases cardiac work.

Question 25

Are Calcium Channel Blockers indicated for CHF?

Answer 25

Not usually, because they decrease contractility and can exacerbate CHF. Indicated in DIASTOLIC HF.

Question 26

3Cs for valve disease?

Answer 26

Crataegus, Cactus, Convallaria

Question 27

Indication for digitalis?

What does it do?

Answer 27

CHF, spec. systolic with LOW BLOOD PRESSURE.
Only indicated for diastolic failure if a. fib present.
Arrythmias: PAT, supraventricular tachycardias, A. fib, A. flutter

Reduces heart rate.
Increases CO.
Does not lower BP.
Reduces edema, dyspnea, orthopnea.

CONTRAINDICATION: V. FIB

Question 28

Most important tx for acute pulmonary edema?

Answer 28

IV Lasix push
Oxygen

(LMNOP)

Question 29

Naturopathic pulmonary HTN tx?

Answer 29

Licorice
Pregnenalone 25-50mg QD or more
Nattokinase 100mg/2000 FU 1-5 BID
Gingko 125mg TID

Question 30

Pulmonary HTN tx if alveoli involvement?

Answer 30

Vitamin A
CoQ10
Nebulized reduced glutathione
Reduce preload: diuretics, coleus root, hydrotherapy, bed rest

Question 31

What mineral can interact with digitalis?

Answer 31

Calcium– can cause serious arrhythmias in pts taking cardiac glycosides.

Question 32

Digoxin dosing?

Answer 32

Gradual:
0.125mg or 0.25mg (70kg person) QD

Rapid:
0.5mg to 0.75mg (body weight dependent) plus 0.125 to 0.375 may be given cautiously at 6-8 hour intervals until clinical evidence of effectiveness.