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AIII-Natural Health Products > L11-MSK > Flashcards

L11-MSK Flashcards

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1
Q

RA v OA.

List the 2 NHPs to reduce the Sx of RA.

A
  1. omega-3 fatty acid

2. gamma linolenic acid

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2
Q

RA v OA.

List the 5 NHPs to reduce the Sx of OA.

A
  1. glucosamine
  2. chondroitin
  3. turmeric
  4. MSM
  5. SAMe
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3
Q

RA v OA.
State the difference in:
1. Cause

A

RA: AI disease

OA: wear-n-tear

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4
Q

RA v OA.
State the difference in:
2. MOA

A

RA: IS attacks joint/tissues then over time cartilage/bone is damaged & muscles/ligaments/tendons are weakened

OA: age/overuse of joint causes the top layer of cartilage to break down/wear away. bones rub together.

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5
Q

RA v OA.
State the difference in:
3. Affected joints

A

RA: Fingers, wrists, usually symmetrical

OA: Hands, knees, hips, spine-not usually symmetrical

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6
Q

RA v OA.
State the difference in:
4. Sx.

A

RA: pain & inflammation

OA: pain, inflammation in severe cases

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7
Q

RA NHPs.

Which 3 are listed as effective?

A
  1. Borage (gamma-linolenic acid)
  2. Cat’s claw
  3. Fish oil
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8
Q

RA NHPs.

Which 6 are listed as INeffective?

A 
Bromelain
Collagen Type II
Evening Primrose oil (gamma linolenic acid)
Krill oil
New Zealand Green Lipped Mussel
Turmeric
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9
Q

RA NHPs.
Which 6 are indicated for RA & OA?
Does this make sense?

A 
Cat's claw
Krill oil
Turmeric
NZ Green Lipped Mussel
Collage Type II
Bromelain
-> nt really as RA is heavily inflammatory, but OA is not
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10
Q

RA NHPs.

T/F: Thunder god vine should not be used due to serious SE.

A

True!

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11
Q

RA NHPs - 1. Fish Oil.
Main source?
List other sources?

A 
=Omega 3 (PUFAs, EPA, DHA)
other sources:
•Krill oil
•Algae (blue-green)
•New Zealand green lipped-mussel
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12
Q

RA NHPs - 1. Fish Oil.

MOA.

A
  • Arachadonic acid through COX enzymes make a series of PGs that can cause inflammation
  • Omega 3’s make sense bc the same enzymes that make the inflam PGs can use EPA and make anti-inflam PGs instead
  • omega 3’s can also make resolvins in addition to the anti-inflam PGs
  • > these also help to resolve inflammation
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13
Q

RA NHPs - 1. Fish Oil.
Define resolvin.
How can fish oils help?

A

=resolution phase interaction product

-some ppl may have a hard time to naturally producing these resolvins fish oils can help.

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14
Q

RA NHPs - 1. Fish Oil.
RCT: Fish oil as add on Tx in recent OA of RA.
Methodology.

A
  • RA <12m
  • DMARD naive
  • Both groups received triple DMARD tx (MTX, sulfasalazine, and hydroxychloroquine)

-Treatment group received 5.5g/day of EPA+DHA
control received 400mg EPA+DHA
(so that they could at least smell and thought they may be getting it)

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15
Q

RA NHPs - 2. GLA.
Main source?
List other sources?

A 
GLA= Gamma linolenic acid
=omega 6 fa
-borage oil
-black currant
-evening primrose oil
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16
Q

RA NHPs - 2. GLA.

T/F: Addition of GLA supplementation is needed as we often do not get enough in our diet.

A

FALSE

-ppl tend to get more omega 6 in diet (to the point of too much)

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17
Q

RA NHPs - 2. GLA.

MOA - i.e.: Why would we want to take this? Wouldnt it just cause more regular PGs?

A

-possible reasoning:
>some enzymes along the way can get saturated, then the remainder can get sent off to the side and make different PGs that do have anti-inflam effect

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18
Q 
RA NHPs - 2. GLA.
Which one is the possibly effective?
1. Primrose
2. Borage
3. Black current
A

3! Only one that is possibly effective, has the highest concentration, still conflicting.

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19
Q

RA NHPs - 2. GLA.
Cochrane evidence of GLA itself?
Why did Cochrane NOT do a study on fish oil?

A
  • probably may improve pain; may improve function.

- b/c just looking at herbs, fish oil not a herb

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20
Q

RA NHPs.

Evidence of NHPs usage in RA.

A
  • no complementary medicines, oral or topcal have demonstrated efficacy
  • few have been sufficiently tested using RCTs

fish body oil given an effectiveness rating of 5 (safety green, w only possibility of anti-coag effects)
(borage oil, evening prim are 3); (cat’s claw and rose hip 2); (black current, flaxseed, green-lipped mussle 1)
*cat’s claw and flaxseed oil are ambers for safety

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21
Q

RA NHPs.

T/F: No complementary medicines, oral or topical, have demonstrated efficacy.

A

TRUE!

BUT few have been sufficiently tested using RCTs

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22
Q

RA NHPs.
Evidence of NHPs usage in RA.
____ is the only NHP has been given a 5 effectiveness rating & a green safety rating.

A

Fish body oil

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23
Q

RA NHPs.

List the effectiveness rating given a green in safety rating (5).

Study These Flashcards
A 
Fish body oil - 5
Borage oil - 3
Rose hop - 2
Black currant seed oil - 1
Green-lipped mussel - 1
24
Q

RA NHPs.

List the effectiveness rating given an amber in safety rating (2).

Study These Flashcards
A

Cat’s claw - 2

Flaxseed oil - 1

25
OA NHPs. | List the 5 NHPs to reduce the Sx of OA.
1. glucosamine 2. chondroitin 2. 1. collagen 2. 2. Hyaluronic acid 3. turmeric 4. MSM 5. SAMe
26
OA NHPs - 1. Glucosamine. What is it? WHAT THREE FORMS IS IT AVAILABLE AS?
``` =2-amino-2-deoxy-D-glucose -available as: >glucosamine SO4 >glucosamine HCl >N-acetyl glucosamine ```
27
OA NHPs - 1. Glucosamine. | Which available form is thought to be effective?
Sulfate thought to be the "effective" one | -most studied on knee
28
OA NHPs - 1. Glucosamine. | MOA.
- Precursor to glycosaminoglycans & proteoglycans that make up articular cartilage - Theory: as you get older & you are getting OA, it may be from decreasing glucosamine over time
29
OA NHPs - 1. Glucosamine. | MOA - what is the problem w this theory?
-while this is good in theory there are lots of problems with this-> BA only 20% so likely not getting it where it needs to go
30
OA NHPs - 1. Glucosamine. | Evidence of glucosamine in OA of the knee.
-inconsistent, insuff evidence, many medical sources do not support it.
31
OA NHPs - 1. Glucosamine. | RCT: Effect of oral glucosamine on joint structure.
- 201 participants - Tx group: glucosamine HCl for 24wks, others had placebo -Primary outcome: decrease worsening of cartilage damage -Secondary outcomes: change in bone marrow lesions (BML), decrease in self reported pain >used MRI to evaluate cartilage damage
32
OA NHPs - 1. Glucosamine. RCT: Effect of oral glucosamine on joint structure. Results.
1. No evidence of structural benefits | 2. No reduction in pain
33
OA NHPs - 1. Glucosamine. | AE.
GI discomfort.
34
OA NHPs - 1. Glucosamine.
-shellfish allergy (?) >for NHP, made in lab but same compound in shells >though the allergy is from meat BUT not worth the risk -diabetes (??) >has sugar, may affect insulin sensitivity, not proven -Preg -Asthma (several case reports)
35
OA NHPs - 1. Glucosamine. | T/F: CI in patients w renal/hepatic impairment.
FALSE! | -not studied in pts w renal or hepatic impairment
36
OA NHPs - 1. Glucosamine. | DI.
-warfarin | >theoretical, only 20 case reports of glucosamine increasing INR
37
OA NHPs - 2. Chondroitin. | Describe.
- a polymer isolated from an animal sources - it is a glycosaminoglycan - poor oral BA
38
OA NHPs - 2. Chondroitin. | Reason of use.
-may prevent cartilage metabolism
39
OA NHPs - 2. Chondroitin. | T/F: Similar to heparin in structure.
TRUE! | -similar to heparin so may have anticoag effects (therefore theoretical interaction)
40
``` OA NHPs - 2. Chondroitin v GA. RCT: GAIT Glucosamine/chondroitin arthritis intervention trial. Peeps? Outcome measures? ```
- 5 diff possibilities: >Glucosamine or chondroitin on own OR as combo, celecoxib, or placebo - outcome measures: decreased pain, improved function
41
OA NHPs - 2. Chondroitin RCT: GAIT Glucosamine/chondroitin arthritis intervention trial. Results.
-compared to placebo: celecoxib group 10% glucosamine group 4% glucosamine plus chondroitin group 6.5% -not a gucci study, positive control was NOT good, rate of response was better for mod-sev pain group
42
OA NHPs - 2. Chondroitin RCT: LEGS LT Evaluation of GA Sulfate Trial.
-Studied chronic knee pain for 2yrs -either glucosamine sulfate, chondroitin sulfate, combo of bth or placebo -outcome measures: >disease progression (measured by radiograph), knee pain score
43
OA NHPs - 3. Collagen | T/F: Applies to both RA & OA.
False! - APPLIES TO RA NOT OA - Theory: inducing oral tolerance to reduce activity of T cells that release joint destroying factors - insuff evidence (both OA and RA) - similar to gelatin preps
44
OA NHPs - 3. Collagen | Define oral tolerance induction.
- described a state of immune hyporesponsiveness following the oral ingestion of a protein - method by which a periph immune tolerance to a particular Ag may be induced by presenting specific amounts of that antigen to the GI system
45
OA NHPs - 4. Hyaluronic acid (as an oral NHP).
- insuff evidence BUT is when given by intra-articular injections (not an NHP) - no studies for its action; likely not getting to where it needs to go as oral
46
OA NHPs - 5. Tumeric | WHAT IS IT?
=curucma longa | -used in herbal medicine to help relieve joint inflammation; possibly effective
47
OA NHPs - 5. Tumeric | MOA.
-may reduce inflammation by inhibiting COX-2 PGs, LTs, and other cytokines involved in proinflammatory signaling pathways
48
OA NHPs - 5. Tumeric | CI.
- diabetes? | - curcumin can reduce levels of blood glucose and glycosylated (HbA1C) hemoglobin
49
OA NHPs - 6. Celedrin/cetylated FAs.
=celedrin - possibly effective - may inhibit COX and 5-lipoyxygenase - may be a joint lubricant - it is hugely fat soluble; have been made into esters for better absorption
50
OA NHPs - 7. MSM | WHAT ERZ IT?
- pssibly effective | - is a simple, naturally occuring compound
51
OA NHPs - 7. MSM | MOA.
- inhibit degenerative changes in joints | - scavenge hydroxyl free radicals which trigger inflam
52
OA NHPs - 8. SAMe | What dis it?
-NHPD allows: helps alleviate OA pain
53
OA NHPs - 8. SAMe | DI
1. antidepressants, MAOIs, bipolar disorder, manic depression 2. hepatotoxic drugs 3.Hyperhomocysteinemia >do not take at night since may cause anxiety, restlessness and insomnia
54
OA NHPs - 9. Eggshell membrane
- promoted for "relieving joint pain in as little as 7-10d - natural source of collagent, glucosamine, chondroitin, and hyaluronic acid - msot studies had limited amount of evidence; you want the evidence to be clinically relevent
55
practical tips for pharmacists
* Med reviews should capture all NHPs being used * Always review for potential medication/NHP interactions * Recommend trying only one new NHP at a time to better assess benefit/ unexpected reactions * Review potential side effects with patient * Patients w renal or liver impairment, DM or HTN or are preg/BF should consult prior to initiating NHPs * A new NHP should be tried for 2 months before assessing benefit. After 2m, stopping for 7 days may help assess any benefit provided * Changing brands may affect benefit * Caution pts that no NHP is a "miracle cure" for OA; pain reduction goal

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