1
Q
What are the uses of peppermint?
A
- Good evidence: IBS
* Some evidence: ANTISPASMODIC, breastfeeding pain, dyspepsia, MIGRAINE & TENSION HEADACHES, NAUSEA
2
Q
What is the dosing of peppermint?
A
- 0.2 to 0.6 mL of peppermint oil TID
- 2 to 10 mg in lozenge form
- 10% peppermint oil in menthol applied topically for headache TID to QID
- 3 to 4 drops of oil added to 150mL of hot water TID for inhalation
3
Q
What are the side effects of peppermint?
A
- Topical: rash, hives, contact dermatitis
* Oral: dizziness, HEARTBURN, anal burning
4
Q
What are the counseling points for peppermint?
A
- avoid use during pregnancy and breastfeeding
- separate from antacids for 2 hours
- overall, considered safe for adults and children over 8
5
Q
What are the uses for aloe vera?
A
- Some evidence: CONSTIPATION, herpes, psoriasis
* Unclear evidence: SUNBURNS, WOUND HEALING
6
Q
What is the dose for aloe vera?
A
*topical use TID to QID (safe in children, but too much oral consumption by anyone is not recommended)
7
Q
What are the counseling points for aloe vera?
A
- reports of liver dysfunction
- MAY DECREASE GLUCOSE
- MAY CAUSE ALLERGIC REACTIONS (caution in patients allergic to the Liliaceae family–garlic, onions, tulips)
- TOPICAL USE MAY CAUSE DRY SKIN
- ORAL USE MAY CAUSE CRAMPING AND DIARRHEA
- SAFETY CONCERNS RELATED TO ORAL ALOE LATEX USE (avoid in children, pregnancy, and lactation)
- DO NOT TAKE WITH DIGOXIN
8
Q
What type of product is oscillococcinum? What is its other name?
A
- also called oscillo
- homeopathic product
- marketed for flu–nature’s #1 flu medicine
9
Q
What is Oscillo derived from?
A
From wild duck heart and liver (anas barbariae hepatitis et cordis extractum)
10
Q
What are the uses for Oscillo?
A
Insufficient evidence for the treatment and prevention of the flu.
11
Q
What is the dose of Oscillo?
A
1 gram or 1 tube up to TID
12
Q
What are the counseling points for Oscillo?
A
- the product is so dilute it likely does not contain any duck heart or liver
- NO KNOWN SIDE EFFECTS DUE TO LACK OF ACTIVE INGREDIENT
- NO PROVEN EFFICACY
13
Q
What is the definition of homeopathy?
A
System of medical practices that treat a disease by the administration of minute doses of a remedy that would in a healthy persons produce symptoms similar to those of the disease.
14
Q
What law do homeopathic medications follow?
A
The Law of Similars (like cures like)
15
Q
Who regulates homeopathics?
A
FDA–but the approval process is different than that of conventional medicines
16
Q
Who is the official compendium of homeopathics?
A
The Homeopathic Pharmacopoeia of the United States (HPUS)
- standards for homeopathic medicine
- must have data on safety and efficacy
- products must be made according to standards in the HPUS
17
Q
What is the efficacy of homeopathics dependent on?
A
On the strength and the mixing. The more you shake it, the better it works. The more diluted it is, the better it works.
18
Q
Describe how homeopathics are described with each dilution.
A
After each step, the substance is given a higher number with the letter designation dependent on the dilution factor. The number refers to how many times it has been diluted and successed. The letter refers to the size of each dilution (X is 1:10 and C is 1:100).
19
Q
Example: A substance claims 3X of a homeopathic. How was it made?
A
- 1 part med with 9 parts of solvent, success 10 times (1X)
- Take 1 part of 1X and add to 9 parts solvent (2X)
- Take 1 part of 2X and add to 9 parts solvent to get 3X
20
Q
What is the other name of echinacea?
A
Purple coneflower
21
Q
What part of echinacea is used?
A
*roots
*leaves
*flowers
(all used)
22
Q
What are the three species of echinacea? Which has the best evidence?
A
- E. angustifoia
- E. pallida
- E. purpurea (best evidence)
23
Q
What are the uses of echinacea?
A
- Some evidence: COMMON COLD, yeast infections
* Insufficient evidence: various viral infections
24
Q
What is the dose of echinacea?
A
- ranges from 300mg TID
* varies depending on indication and species of echinacea
25
What are the counseling points of echinacea?
* AVOID USE IN PATIENTS WITH ALLERGIES TO RAGWEE, CHRYSANTHEMUMS, MARIGOLDS, DAISIES
* INCREASE RISK OF RASH IN CHILDREN
* MAY CAUSE NAUSEA AND VOMITING, fever, heartburn, dizziness, dry mouth, and insomnia
* AVOID USE IN PATIENTS WITH AUTOIMMUNE DISEASES AND PATIENTS PRONE TO ALLERGIES
* POSSIBLE LIVER DYSFUNCTION
* may be safe in pregnancy, but evidence still lacking
* inhibits CYP1A2--watch for increase in CYP1A2 substrates
* caution with immune suppression
* can be use in animals
26
What is the latin name for milk thistle?
Silybum marianum
27
What is milk thistle made of?
Silymarin which has antioxidant, antifibrotic, and anti inflammatory activities
28
What part of the milk thistle has the most amount of silymarin?
The seeds
29
What are the uses of milk thistle?
* limited evidence: type 2 diabetes, dyspepsia
| * insufficient evidence: LIVER DISORDERS
30
What is the dose of milk thistle?
140mg TID (may vary depending on indication)
31
What are the counseling points for milk thistle?
* MAY CAUSE ALLERGIC REACTIONS IN PATIENTS WITH ALLERGIES TO ARTICHOKES, KIWIS, DAISY, RAGWEED, AND CHRYSANTHEMUMS
* SIDE EFFECTS ARE RARE and include: GI UPSET, headache, and itching
* some evidence that it may improve flow of breast milk, but not enough data to support safe use in pregnancy and lactation
* TYPICALLY USED TO TREAT LIVER SIDES, WHICH SHOULD NOT BE TREATED WITHOUT MEDICAL SUPERVISION
32
What are the uses of cranberry?
* some evidence: UTI PREVENTION
| * insufficient evidence: kidney stone prevention, BPH, H. pylori prevention, cancer prevention, URINE ODOR REDUCTION
33
What is the dosing of cranberry?
* 90 to 480 mL of cranberry cocktail
| * 15 to 30 mL of 100% unsweetened cranberry juice (TID dosing)
34
What is the mechanism of action for cranberry?
PREVENTS ADHESION OF E. COLI TO THE URINARY TRACT WALL AND POSSIBLY H PYLORI TO THE STOMACH WALL (DUE TO CONTENT OF PAC--PROANTHOCYANIDIN)
35
What are the counseling points for cranberry?
* avoid use if allergic to blueberries, ASA
* CAN CAUSE GI UPSET OR DIARRHEA
* quantities of 1 liter or more daily may cause kidney stones
* MAY INCREASE RISK OF BLEEDING IN PATIENTS ON WARFARIN
* safe in children
* caution in pregnancy and lactation
* use sugar free products
36
What is the brand name of black cohosh?
Remifemin
37
Are black cohosh and blue cohosh the same thing?
No, they are different.
38
What is the active constituent of black cohosh?
27-deoxyactein
39
What is the use of black cohosh?
* some evidence: MENOPAUSAL SYMPTOMS
| * insufficient evidence: arthritis, breast cancer, infertility, menstrual migraine
40
What is the dose for black cohosh?
RECOMMEND 20 TO 80MG BID
41
What is the mechanism of action of black cohosh?
ANTI-INFLAMMATORY, INDIRECT ESTROGEN EFFECT, AND POSSIBLE SEROTONIN EFFECT. COMPLETE MECHANISM IS UNCLEAR. DEBATE REGARDING INDIRECT ESTROGEN EFFECT.
42
What are the drug interactions with black cohosh?
* may inhibit CYP2D6
| * CAUTION WITH HEPATOTOXIC DRUGS
43
What are the counseling points for black cohosh?
* avoid use in patients allergic to buttercups
* USE CAUTIOUSLY IN PATIENTS WITH ASA ALLERGY
* DO NOT USE IN PREGNANCY OR WHEN BREASTFEEDING
* may cause GI discomfort, rash, headache, dizziness
* AVOID USE IN PATIENTS AT RISK FOR OR WITH A HISTORY OF BREAST CANCER
44
Where does saw palmetto come from?
American dwarf palm tree
45
What does saw palmetto contain?
* phytosterols
* free fatty acids
* ethyl esters
* glycerides
* beta-sitosterol
46
What are the uses for saw palmetto?
* some evidence: transurethral resection of the prostate (TURP)
* limited evidence: male pattern hair loss, prostate cancer, underactive bladder
* possibly ineffective: BPH (BENIGN PROSTATE)
47
What is the dose for saw palmetto?
160mg BID
48
What is the possible mechanism for saw palmetto?
* INHIBITS 5-ALPHA REDUCTASE ACTIVITY
* has not consistently lowered prostate size
* DHT receptor binding
* inhibits prostaglandin synthesis
* alpha-1 blockade
49
What are the counseling points for saw palmetto?
* TAKES 4 WEEKS TO SHOW EFFECTS
* DO NOT USE IN PREGNANT OR LACTATING WOMEN
* AVAILABLE MEDICATIONS LIKELY MORE EFFECTIVE
* may cause GI discomfort, ED, fatigue, and headache
* can increase risk of bleeding
50
What are the 2 types of glucosamine? Which is more effective?
* glucosamine ccl
| * glucosame sulfate (more effective)
51
How is glucosamine produced?
Produced naturally in the body, but is concentrated in cartilage and other connective tissue
52
What is glucosamine used for?
* good evidence: OSTEOARTHRITIS
| * insufficient evidence: interstitial cystitis, knee pain due to injury, MS, temporomandibular joint (TMJ) arthritis
53
What is the dosing of glucosamine? How long does it take for the effect to show?
* 500 MG TID OR 1500 MG DAILY
| * MAY TAKE UP TO 1 MONTH TO SHOW FULL EFFECT
54
What is the mechanism of action for glucosamine?
* STARTING SUBSTANCE IN THE SYNTHESIS OF GLYCOSAMINOGLYCANS AND PROTEOGLYCANS (COMPONENTS OF CARTILAGE) AND HAVE A SHOCK ABSORBING EFFECT
* MAY STIMULATE SYNTHESIS OF CARTILAGE
* MAY INHIBIT CARTILAGE BREAKDOWN
55
What are the counseling points for glucosamine?
* AVOID USE IN PATIENTS WITH A SHELLFISH ALLERGY
* CAUTION IN PATIENTS ON WARFARIN
* IMPACTS GLUCOSE
* may cause GI discomfort
* avoid in pregnancy and lactation (limited evidence)
56
What are the uses for chondroitin?
* GOOD EVIDENCE: OSTEOARTHRITIS, CATARACT SURGERY, UTIs
| * unclear evidence: bladder control, dry eye, GERD
57
What is chondroitin derived from?
Shark and bovine cartilage
58
What is the dosing of chondroitin? How long does it take to notice effect?
400 MG TID OR 1200 MG DAILY
| MAY TAKE UP TO 1 MONTH TO SHOW FULL EFFECT
59
What is the mechanism of action of chondroitin?
* STIMULATES CHONDROCYTE SYNTHESIS OF COLLAGEN, PROTEOGLYCANS, AND OTHER CARTILAGE COMPONENTS
* IMPROVES ARTICULAR WATER RETENTION, ELASTICITY, AND INHIBITS ENZYMATIC DEGRADATION OF CARTILAGE
60
What are the counseling points of chondroitin?
* may increase risk of bleeding
* avoid use in pregnancy and lactation (not enough evidence)
* MAY EXACERBATE ASTHMA (USE CAUTION)
* AVOID USE IN PATIENTS WITH PROSTATE CANCER OR THOSE AT INCREASED RISK FOR PROSTATE CANCER
* CAUTION IN PATIENTS ON WARFARIN
61
What is SAMe?
S-Adenosyl-L-Methionine
62
How is SAMe made?
It is synthesized in all living cells from essential amino acid methionine
* can't be supplemented by diet
* SAMe is necessary in many reactions for synthesis of variety of neurotransmitters
63
What is SAMe indicated for?
* Good evidence: OSTEOARTHRITIS, DEPRESSION, BETTER TOLERATED AND AS EFFECTIVE AS NSAIDS, AS EFFECTIVE AS TCAS FOR DEPRESSION
* Some evidence: AIDS related myelopathy, fibromyalgia, intrahepatic cholestasis, sexual dysfunction
64
What is the dose for SAMe?
800 to 1600mg per day
| *varies depending on indication and dosage form
65
What are the side effects of SAMe?
* mild GI effects
* SWEATING
* skin rash
66
What are the safety precautions for SAMe?
* possibly safe in children and 3rd trimester of pregnancy
| * unknown safety in early pregnancy and lactation
67
What are the counseling points for SAMe?
* SLOWER ONSET OF ACTION THAN NSAIDS FOR OSTEOARTHRITIS
* may need to continue NSAIDs, but may be able to use smaller dose
* may lower blood sugar levels
68
What are the drug interactions with SAMe?
* antidepressants or other herbals that increase serotonin (SEROTONIN SYNDROME)
* levodopa: may worsen existing Parkinson's disease
69
What is the other name for turmeric?
CURCUMIN
70
What are the uses for turmeric?
* some evidence: OSTEOARTHRITIS
| * insufficient evidence: GI CONDITIONS, ALZHEIMER'S DISEASE, diabetes, rheumatoid arthritis, cancer
71
What is the dose of turmeric?
Varies significantly depending on indication
72
What are the counseling points of turmeric?
* generally well tolerated at recommended dosages
* caution with supplements in pregnancy and lactation
* MAY CAUSE GI COMPLAINTS SUCH AS HEARTBURN AND NAUSEA
* use caution in patients at risk for bleeding
* use caution in women with hormone sensitive disorders and men trying to conceive
* may decrease blood glucose
* use caution in patients at risk for hepatoxicity
* allergic reactions = contact dermatitis
Pharmacist Provided Care I
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