- Does this seem reasonable - If not better in ____ seek help - Under MD care

- Prevent cartilage deterioration - Disease modifying agent - Makes synovial cavity more smooth

Herbals Flashcards by Tony Ward

Many herbals are…..

placebo

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need to ask….

What has been tried so far?
Frustration level of patient?
Standard therapies tried?

The risk this will delay MD input

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Stuff to consider

Does this seem reasonable
If not better in ____ seek help
Under MD care

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Warfarin. We should…

look up every agents

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Glucosamine

Prevent cartilage deterioration
Disease modifying agent
Makes synovial cavity more smooth

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OA vs. Rheumatoid arthritis

Patients with inflammatory arthritis, typically, are very stiff and this lasts longer than 1 hour after waking. The pain and stiffness in these patients gets better with mobilisation and as the day progresses.

In contrast, osteoarthritis patients tend to be transiently stiff for seconds to minutes after waking and problems are worse through the day and on activity. Post rest stiffness called gelling is typical lasting seconds to minutes in osteoarthritis patients.

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Glucosamine/Chondroitin Uses

Osteoarthritis

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Describe the process of OA

Wear/tear - oss of cartilage - friction bn bones - pain swelling, less rom

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where does oa impact?

knee, hip, spine

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Oa risk factors

age, obesity, genetics

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MOA of glucosamine/chondrotin

normal component of cartilage matrix and synovial fluid

may prevent joint-space narrowing

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What is glucosamine/chondrotoin? What is normal in the joints?

GlycosAminoGlycans
normal component of cartilage / connective tissue

water sticks to GAGs (cushioning action)

glucosamine is a precursor cpd / chondroitin is a GAG

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Is glucosamine worth a try?

YES

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How long to try glucosamine? When it will work?

try for 3-6 months

Takes 4-8 weeks to work

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Should one stop their other meds when taking glucosamine?

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glucosmaine Sulfate Dose

500 mg TID

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Chondrotin Sulfate DOse

400 mg TID

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S/e of glucosamine

ellent safety record – GI, derm

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Drug Interactions of Glucosamine

minimal

warfarin interference

blood glucose impact unlikely

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Is MSM useful/needed?

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Is tumeric/curcurin worth a try?

YES

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Dose of curcurin for arthritis

1-2g of curcurin

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What is curcurin used for?

Arthritis

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Is topical arnica good for arthritis?

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In regards to Omegas, which are essential? can it occur in the body?

Omega-3 --> EPA and DHA are essential Alpha-linolenic acid can be converted by humans to EPA/DHA, but only minimally 5%, so ingesting a marine source is key to attaining any benefit here

Do we need anymore omega-6's?

NO --> Have more omega-6's than 3's which promotes inflammation

How are omega-9's made?

Made by the body

Omega-3's are useful for....

Cell membranes Hormones Anti-inflamm Less platlet adheison

Omega-6's cause....

Energy production Undesirable PG's Inflammation

In CV, what is primary and secondary prevention?

1 - Prevent first MI 2- Prevent a second MI

Are omega-3's useful for CV health? What are they more hopeful for?

Not likely Modest or NO benefit from supps More hope for 2o prevention than 1o Likely less helpful if taking full MI medicine regimen

What is the best source of omega-3's?

Dietary fish

When are omega-3's clinically helpful?

High elevated TG's

S/e of Omega-3's

Unlikley risk of bleeding Fishy Taste (main one)

Drug Inetractions of Omega-3's

NOT an ISSUE

What is the delivery system of omega-3's?

Fish Oil

What is the starting dose recommendation of omega-3's?

Go natural first 500 mg a week

Can fish in sask give omega-3's?

primary prevention omega-3 Dose

2 servings/wk of specific fish or ~500 mg supp (EPA/DHA) daily

secondary omega-3 dose

1000 mg fish oil (to deliver 180/120 mg EPA/DHA) TID

Fish oil to omega-3 ration

1000 mg - 300 mg EPA/DHA

High TG Omega-3 Dose

2-4 grams of EPA/DHA

In regards to flax seed, it must be....

Ground up to be absorbed

Omega-3 useful for....

rhemaotoid arthritis depression (maybe) dry eyes ADHD

Should omega-3's be used to lower cholesterol?

2-4 g EPA/DHA to lower TGs only --> Should be physician care  extra calories

Metamucil Cholesterol lowering

10g/day (= 3 level tsp TID) ~5% in cholesterol

Plant sterols/stanols to decrease cholesterol

2 g ~10%

Soy to decrease cholesterol

25 g soy protein (~4 cups soy milk) / day ~5%

What can ubiquinone be used for?

Heart Failure HTN Heart attack Migraine

What should be the mindset for insomnia?

attempt to curb OTC product use and shift their focus to getting medical care

What is thr first thing to try for insomnia?

CBT

Does turkey make you sleepy?

No - Tryptophan gets credit but just feeling full

Chamomile

- Just tea for insomnia - Relaxing

Does lavender work?

No just TLC

Is valerian good for insomnia?

Should diphendydramine be given to seniors?

Diphenhydramine Sleep?

Sedating

What should we try to do in pharmacy in regards to OTC sleep agents?

Shift from diphenhydramine to melatonin

What is melatonin?

a hormone (produced from tryptophan) ties into our circadian rhythms (seasonal/daily) increased levels at night --> levels drop as we age

What can melatonin be used for?

Insomnia, depression, jet lag, CV, GERD, anti-oxidant, cancer

Is melatonin useful?

Not overly - give it a try

Does one develop dependance to melatonin?

Melatonin dose?

1-2 mg HS x 2 weeks then 5 mg HS x 2 weeks reasses

Melatonin s/e

mild GI additive drowsiness to any other sedating agent headache

Should melatonin be used in a kid?

Safe but referral for sure

What is flax seed used for?

CV (not likely) Constipation (dietary fiber) Menopause (maybe)

Is eichana good for a cold?

Is St. John's Wort effective? What for?

yes mild-moderate depression not major depression

St. John's Wort compared to other anti-depressants

better than TCAs good as (or better) than SSRIs

S/e St. John's Wort

GI, rash, photosens, sedation, anxiety, dizziness, headache, dry mouth

Drug Interactions of St. Johns Wort

Induces Cyp P450 Decreases Birth control pills Decrease warfarin Other anti-depressants (serotonin syndrome)

What is serotonin syndrome?

when you have too much serotonin (a normal chemical) in your body agitation or restlessness. Insomnia. Confusion. Rapid heart rate Ranges from Mild to Severe Adding specific drugs to SSRIs 1 day after increasing dose most cases 2 drugs

Is carnberry useful for UTI?

NO - Used for prevention (1-2 months for effect) - Recurrent UTI's

Statins and Ubiquinone

vitamin-likepresent in all cellsantioxidantexpensive some in meats / seafood reduced by statins --> worth a try to supplement

Herbals Flashcards

(74 cards)