Herbal Remedies and Homeopathy

Question 1

Dilutions–BONUS

Answer 1

15X= remedy that has been diluted 1015 times

12C= remedy that has been diluted 10012 times
50 MC: and

Homeopathic potencies are designated by the roman numerals “X” or “C” according to whether each dilution is 10-fold or 100-fold, and by a coefficient that represents the number of steps
X= 1:10
C= 1:100

Question 2

Homeopathy

Answer 2

Homeopathy is the practice of stimulating the body’s ability to heal itself by giving small doses of highly diluted substances (called remedies) derived from a plant, mineral, or animal substance

Homeopaths believe in threating the individual vs. treating the disease
Homeopathy

Homoios (similar)
Pathos (suffering or disease

Question 3

Red Yeast Rice: Monacolin K

Answer 3

Naturally occurring analogue of lovastatin inhibits cholesterol synthesis

Question 4

Red Yeast Rice: Adverse Effects

Answer 4

Increased liver function enzymes

Rhabdomyolysis

Question 5

Red Yeast Rice:

Monitoring

Answer 5

Monitor LFTs

Should NOT drink more than 2 drinks/ day due to increased risk of hepatotoxicity

Pregnancy Category X

Question 6

Melatonin : MOA

Answer 6

Regulates sleep and circadian rhythms

Light inhibits melatonin secretion and darkness stimulates secretion

Question 7

Melatonin: Proposed benefits

Answer 7

Insomnia

Prevention of “jet lag”

Question 8

Kava: Proposed benefits

Answer 8

Mild anxiety

Sleep disturbances

Question 9

Kava: MOA

Answer 9

Dopamine, monoamine oxidase-B, and GABAB receptors.

May have antithrombotic activity.

Question 10

Kava: Drug Interactions

Answer 10

Levodopa- Reduced efficacy of levodopa

Concomitant use is not recommended with medications that cause hepatotoxicity

Question 11

Evening Primrose Oil:

Proposed benefits

Answer 11

Menopause

PMS (studies inconclusive)

Question 12

Evening Primrose Oil:

Caution

Answer 12

Thought to possess antiplatelet effects and patients taking warfarin and platelet active medications or herbs should use with caution.

Should avoid use in patients with seizures (lowers seizure threshold).

Question 13

Ginseng: Proposed benefits

Answer 13

Immunomodulatory/ Antiviral- reduce severity of cold and upper respiratory infection symptoms

Antineoplastic/ Anti-tumor

Question 14

Ginseng: Asian

Answer 14

Panax ginseng (Asian ginseng

Question 15

Ginseng: American

Answer 15

Panax quinquefolius

(American ginseng-better);

Question 16

Ginkgo biloba:

Proposed Benefits

Answer 16

Peripheral Vascular Disease

Dementia

Memory impairment

Question 17

Ginkgo biloba:

Adverse Effects

Answer 17

Allergic skin reaction
-Ginkgo pollen can be allergenic; contact with fleshy fruit pulp can cause contact dermatitis

Spontaneous bleeding (rare)

Seizures (seed consumption) –ONLY GET LEAF or you will have a seizure.

Question 18

Ginkgo biloba: Drug interactions

Answer 18

Increased bleeding (3G’s) risk with anticoagulants (i.e. warfarin), anti-platelets.

Advise patients using anticoagulants to be cautious and talk to healthcare provider prior to starting

Only leaves should be used- seeds and pulp are toxic

Question 19

Garlic: Active ingredients

Answer 19

Allicin

Question 20

Garlic: Proposed benefits

Answer 20

Hyperlipidemia

Hypertension –increases 20mgHH

Inhibition of platelet aggregation

Question 21

What are the herbals Anti-platelet effects?

Answer 21

AVOID 3G’s Ginger/Garlic/Gingo

Question 22

Garlic: Adverse Effects

Answer 22

Potential increased risk in bleeding

Question 23

Black Cohosh:

Proposed benefits

Answer 23

Menopause

Premenstrual Syndrome (PMS)

Question 24

Black Cohosh:

Adverse Effects

Answer 24

*GI upset – Occurs in 50% patients

Acute hepatitis (increase case reports of acute hepatitis)

Question 25

Black Cohosh: Drug Interactions

Answer 25

Possible additive estrogenic activity with estrogen therapy or oral contraceptives

Question 26

Black Cohosh: Dietary Supplement Information Expert Committee

Answer 26

cautionary statement regarding potential hepatotoxicity Consider getting LFTs periodically*****

Question 27

Extraction Ratio

Answer 27

5:1 ratio 5 parts of herb were used to prepare 1 part of the extract Ginkgo biloba is prepared as a dried extract in tablet form and is typically standardized to a 50: 1 extract ratio - 50 parts of the ginkgo leaf were used to prepare 1 part of the extract

Question 28

Plant Based Dietary Supplements

Answer 28

Plant based DS should indicated the scientific name of the plant containing the Latin binomial, as well as the specific plant part ``` The common name Latin binomial (genus and species) ```

Question 29

The only Echinacea that works?

Answer 29

Echinacea purpurea

Question 30

Counseling Points

Answer 30

Purchase products with a seal of quality on the label: United States Pharmacopeia’s Dietary Supplement Verification Program or NSF International’s Certification Program Continue to use the same brand and formulation for a continued use product -Variability between batches; Consistent product and dose

Question 31

Act passed with only test Dietary supplements for SAFETY, not efficacy?

Answer 31

Dietary Supplement Health and Education Act (DSHEA) of 1994 Efficacy claims cannot be made, only claims of effects on body structure or function

Question 32

USP Verified Mark: Mandatory disclaimer?

Answer 32

allowed on label only if manufacturer meets certain standards This product is not intended to diagnose, treat, cure or prevent any disease”

Question 33

Dietary Supplement (DS) Synonyms –Synonymously

Answer 33

``` Nutraceuticals Natural products Supplements Herbs Botanicals Phytochemicals ```

Question 34

meaning Nutritional Supplement?

Answer 34

Substance added to diet to improve health. Usually contains dietary ingredients such as vitamins

Question 35

Meaning Herbal Medication?

Answer 35

Plants or plant extracts used to improve health

Question 36

Meaning Complimentary Therapy?

Answer 36

Used in ADDITION to conventional treatment

Question 37

Meaning Alternative Medicine?

Answer 37

Treatments that are NOT generally recognized by the medical community as standard and are used instead of conventional treatments

Question 38

What is DSHEA identified GMPs for dietary supplements in 2007?

Answer 38

To ensure supplements “are produced in a quality manner, do not contain contaminants or impurities, and are accurately labeled” Covers manufacturing, packaging, labeling, storing of supplements, quality control, testing of ingredients, and record keeping

Question 39

Medications vs. Dietary Supplements

Answer 39

Medication: Active ingredient identified Safety and efficacy proven by manufacturer Purity and contents regulated Claims to treat/cure/ prevent disease Dietary Supplement May not identify active ingredient No proof of efficacy required; FDA must provide proof if unsafe Standards for quality and purity not as strictly regulated No claims to treat/cure/prevent disease