Pharmacotherapy 1 Exam 2
What are the uses of Lactobacillus?
Antibiotic associated diarrhea - possibly effective take probiotics > 2 hrs after antibiotics
What are the uses of Saccharomyces Boulardii?
Antibiotic associated diarrhea—likely effective Rotaviral Diarrhea: likely effective
What are the interactions with garlic?
Anticoagulants & antiplatelets: Increased INR Hypoglycemic agents Antihypertensive agents Oral contraceptives: decreased effectiveness
Case 4: A patient approaches the pharmacy window asking if you would recommend Echinacea, goldenseal, or high dose vitamin C to prevent catching colds this season. PMH: HTN, rheumatoid arthritis, lupus What do you suggest? A: Echinacea B: Goldenseal C: Vitamin C D: None
Anything that boosts immune system= NOT WITH LUPUS D: None of these options
What do corticosteroids do (OTC)?
-Works as a vasoconstrictor and antipruritic -Onset: 12 hours post application. -Clinical pearl: skin thinning -EX: hydrocortisone
For which medications is gas a side effect?
-Antibiotics -Certain Diabetes Medications: Metformin and Alpha-glucosidase inhibitors (acarbose and miglitol) -Laxatives: Lactulose -GI motility alterations: Anticholinergics, narcotics -Lipase Inhibitors: Orlistat -Psyllium fiber -Cholestyramine -Effervescent solutions: Alkaseltzer® Original -Calcium carbonate
How should you counsel a patient on DS?
-DS can interact with several medications -Always inform your HCP of all DS you are taking. -Purchase products with QA Seal or from large, reputable manufacturers. -Stay on the same brand and formulation. Those who don't have results with first brand may consider another. -Know which DS you are taking and report to HCP. -Report and ADRs. -Read labels carefully. -Never share DS with others. -Do not use products without lot number and expiration date; discard after 1 year is not present. -Do not use products without dosing recommendations or manufacturer information. -Seek advice from pediatrician before giving to your child. -Do not use DS when PG, trying to become PG, or breast feeding. -Consult your PCP if considering DS for life-threatening conditions (e.g. cancer, HIV). -Natural does not mean safe; report any ADRs to PCP immediately. -Do not take a DS for a condition already being treated with medication. -Do not take these products with alcohol.
What do Lactase supplements (Lactaid,® Lacteeze,® Dairy Ease®) do?
-Enzyme that aids in digesting lactose into absorbable sugars -Metabolizes lactose to glucose and galactose -Used to prevent flatulence -Clinical pearl: take with first bite of food or drink contains lactose -Dose: 3000-9000 units per meal (1-3 tablets)
What does Alpha-galactosidase (Beano®) do?
-Enzyme to help reduce amount of gas that beans and vegetables produce by metabolizing indigestible oligosaccharides to glucose, galactose and fructose -Caution in diabetics -Used to prevent flatulence -Clinical Pearl: take with first bite of food, not studied in infants and children -Dosing: 150 units per serving of problem food, 450 units max per serving (~ 2-3 chewable tablets or 1 Meltaway®)
What does effective mean?
-Evidence is consistent or equivalent to studies needed for FDA, Health Canada, or similar agency -Level A evidence: Evidence from multiple (2+) randomized clinical trials or meta-analysis including several hundred to several thousand patients -Quality rating A: Studies have low risk of bias & high level of validity -Evidence consistently shows POSTIVE outcomes for a given indication without valid evidence to the contrary.
What are some DS hazards?
-False advertising / quackery -Consumer induced: Over supplementation (intentional and accidental) Adverse effects Medication interactions Disease interactions
What supplements should be avoided in pregnancy and children?
-Fish Oil - mercury content -Red Rice Yeast - Statin-like compound case reports of fetal malformations (Statins are teratogenic formerly pregnancy category X or contraindicated) -Chamomile - may act as an abortifacient -Ginseng - teratogenic -Melatonin - may inhibit ovulation and prohibit contraception -Willow bark - contains aspirin Reye's syndrome due to salicylate (for children)
What is fish oil and what disease states is it effective in?
-Fish oil is a source of omega-3 fatty acids (EPA+DHA) -Safety: Likely safe up to 3g/day -Hypertriglyceridemia -- EFFECTIVE can reduce triglycerides (FDA approved) -Cardiovascular disease (primary/secondary)-- Insufficient reliable evidence -Primary prevention of heart failure - Possibly effective
What is Glucosamine/chondroitin/MSM and what is it used for?
-Glucosamine is an amino sugar that may promote formation and repair of cartilage. -Chondroitnin may promote elasticity in cartilage and prevent breakdown -MSM (Methylsulfonylmethane) is found in plants and humans Use: Reduce moderate severe knee pain from osteoarthritis when taken for several months
What are the adverse effects of Glucosamine/chondroitin/MSM?
-Glucosamine: gastrointestinal discomfort, drowsiness, skin reactions, and headache If derived from crab shells - watch for shell fish allergies -Chondroitin: stomach upset, Increased INR/risk of bleeding -MSM: aspirin like effect
What are some herbs and botanicals?
-Green tea -Garlic -Cranberry -Echinacea -Ginseng & Siberian ginseng (eleuthero)
What are the causes of hemorrhoids?
-Increased pressure on veins: Straining and Pregnancy -Chronic diarrhea or constipation -Laxatives (e.g. milk of magnesia, Mirlax, senna) -Opioids -Anal intercourse -Obesity -Low-fiber diet
What are the underlying root causes of disease according to functional medicine?
-Inflammatory imbalances -Structural imbalances -Immune imbalances -Digestive, absorptive, and microbiological imbalances -Toxic emotions -Hormonal imbalances -Detoxification imbalances -Mitochondrial dysfunction -Toxic chemical exposure
What can chronic gas symptoms be commonly caused by?
-Irritable Bowel Syndrome (IBS)-Needs Referral -Celiac Disease (Gluten Intolerance)-Needs Referral -Pancreatic insufficiency - Needs Referral -Diabetic gastroparesis - Needs Referral -Small bowel bacterial overgrowth -Lactase Deficiency - Can treat OTC -Indigestible Oligosaccharides - Can treat OTC
What does likely ineffective mean?
-Level A evidence -Quality A evidence -Evidence consistently negative without significant valid evidence to the contrary
What does ineffective mean?
-Level A evidence -Quality A evidence -Evidence consistently negative without valid evidence to the contrary
What does Likely effective mean?
-Level A evidence in several hundred patients -Quality rating A -Evidence consistently shows POSTIVE outcomes for a given indication without significant valid evidence to the contrary.
What are the components of the DS label?
-Name of product PLUS the word "supplement"; plant based DS scientific name or Latin binomial (genus and species) and specific part used -Manufacturer, packer's, or distributers name and place of business -Directions for use -Supplement facts panel listing dietary ingredients, amount per service size, and % daily value -Total weight of blend and components of blend, in order of predominance by weight -Fillers, artificial colors, sweeteners, flavors, or binders listed in descending order of predominance
What are the non-pharmacological treatments of hemorrhoids?
-No straining! < 10 minutes sit time -Avoid alcohol and perfumed wipes -Avoid dry toilet paper -Apply cold to relieve swelling -Diet: Avoid caffeine, citrus, spicy foods Seek dietary fiber and increase fluids -Keep anal area clean Wash with warm water daily Soap may aggravate -Soak regularly in warm water/sitz bath 10-15 minutes 2-3 times daily
What do vasoconstrictors do (OTC)?
-Non selective adrenergic agonist: stimulates alpha 1 & 2 and beta 1 & 2 receptors=> arteriole constriction=> reduced swelling -Reduces itching discomfort and inflammation -Avoid on open sores -Most agents can be used internally and externally -May decrease effectiveness of antihypertensives -SE: tremors, nervousness, nausea, anorexia -CI: diabetes, thyroid disease, hypertension, enlarged prostate EX: Phenylephrine
What are some specialty supplements?
-Omega-3/fatty acids/fish oils -Fiber -Pro-bioitics -Glucosamine/chrondrotin/MSM -CoQ10
What does possibly effective mean?
-One or more randomized trials or meta-analysis (level of evidence A or B) 1 or more population based studies (level of evidence B) -Quality rating B studies have moderate risk of bias & moderate level of validity -Valid positive evidence outweighs evidence to the contrary
What does possibly ineffective mean?
-One or more randomized trials or meta-analysis (level of evidence A or B) or 2 or more population based studies (level of evidence B) -Quality rating B studies have moderate risk of bias & moderate level of validity -Valid negative evidence outweighs evidence to the contrary.
What is the pathophysiology of hemorrhoids?
-Painful, inflamed, swollen veins, supporting tissues, and overlying mucus membranes in the lower portion of the rectum or anus. -May be located inside rectum (internal) or under skin around anus (external)
What is Simethicone (Gas-X,® Mylanta,® Mylicon®)?
-Prevents formation of mucus-surrounded gas pockets in GI tract and can absorb and disperse gas within the bowel lumen -Taken after symptoms occur; Relieves pressure and bloating -Not absorbed systemically, safe in children, nursing and pregnancy -CI: GI perforation or obstruction -Dosing: Adults: 40-125 mg PO QID PRN Children (2-12 years): 40-50 mg PO QID PRN Infants (< 2 years): 20 mg PO QID PRN
What do protectants do (OTC)?
-Reduces itching, dryness and discomfort by acting as a barrier -External or internal application -Glycerin is for external use only EX: cocoa butter, mineral oil, shark/cod liver oil, topical petrolatum
What is the pathophysiology of gas?
-Swallowing air -Carbonated beverages -Bacteria in the colon breaks down undigested carbohydrates in the small intestine= Flatulence and Belching
When are the exemptions to self-treatment?
-Symptoms persist more than several days in a row -Symptoms that occur > 3 times per month for several months AND are associated with diarrhea or constipation -Gas is severe/debilitating -Sudden increase in pain severity/location -Persistent diarrhea, constipation, GI bleeding or unintentional weight loss -Persistent even after OTC treatment
When should you refer to PCP?
-Symptoms related to foods other than causative agents (e.g. Lactose, oligosaccharides, ...) -OTC treatments provide no relief -Evaluate symptoms and time spend on OTC medications -Intestinal gas symptoms that persist for more than several days or occur more several times a month -Sudden change in the location of abdominal pain. -Significant increase in the severity or frequency of symptoms Or onset of symptoms > 40 years of age. -Sudden change in bowel function. -Presence of accompanying symptoms such as severe or persistent diarrhea/constipation; greasy or malodorous stools; GI bleeding (e.g., hematemesis, melena, or hematochezia); fatigue; unintentional loss; or frequent nocturnal symptoms
What are some DS preparation issues?
-Tinctures are fluid extracts of chopped herbs with alcohol. -Freshly pressed juice - may use an alcohol extract (e.g. Echinacea purpurea); alcohol increases the self-life. -Teas - root, bark, leaf, fruit (e.g. chamomile, ginger, peppermint, green tea, black tea) -Extracts - concentrates from soaking in alcohol, water, and/or oil. -Extraction ratio = parts of herb used to make 1 part of extract -Use of alcohol Concerns: sedation, disulfiram reactions, special populations
What are the seven principles of functional medicine?
1. Acknowledging the biochemical individuality of each human being, based on the concepts of genetic and environmental uniqueness 2. Incorporating a "patient-centered" rather than a disease-centered approach to treatment 3. Seeking a dynamic balance among the internal and external factors in a patient's body, mind, and spirit 4. Addressing the web-like interconnections of internal physiological factors 5. Identifying health as a positive vitality —not merely the absence of disease—and emphasizing those factors that encourage a vigorous physiology 6. Promoting organ reserve as a means of enhancing the health span, not just the life span, of each patient 7. Functional medicine is a science-using profession
What are the most commonly used dietary supplements?
1. Vitamins and Minerals 2. Specialty Supplements 3. Herbals & Botanicals 4. Sports Nutrition & Weight loss
What are the 3 beneficial probiotics studied?
1. Bifidobacteria 2. Lactobacillus 3. Saccharomyces Boulardii
What does St. John's Wort interact with?
1. CYP 3A4 substrates (decreases drug levels) Alprazolam, amitriptyline, atorvastatin, finasteride, methadone, nifedipine, simvastatin, tacrolimus, verapamil warfarin, zolpidem 2. Cyclosporine - decreases drug levels May cause transplant rejection
What are some drug-supplement interactions that increase bleeding risk?
6 Gs interact with anti-platelets and/or anti-coagulants GINKO, GINSENG, GARLIC, GINGER, GREEN TEA GLUCOSAMINE Cranberry - increases INR Dong Quai - increases INR
What interaction does 5-HTP- SRRIs, tramadol have?
Additive serotonergic effects
What are the OTC meds for gas?
1. Immediate Simethicone Activated charcoal 2. Preventative Beano® Lactase supplements Probiotics
What are the degrees of hemorrhoids?
1st degree (Grade 1) - enlarged, no prolapse into anal canal 2nd degree (Grade 2) - prolapse, but return automatically on defecation 3rd degree (Grade 3) - prolapse and need to be retuned manually 4th degree (Grade 4) - permanently prolapsed
What is the definition of a dietary supplement
A product (other than tobacco) that is intended to supplement the diet that bears or contains one or more of the following dietary ingredients: *a vitamin, a mineral, an herb or other botanical, an amino acid (enzymes, organ tissue, or glandular extract), a dietary substance* for use by man to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, constituent, extract, or combinations of these ingredients."
Case 1:A patient heard the FDA has issued a warning letter regarding Zero Xtreme The tablets contain sibutraine Sibutraine is: -An appetite suppressant -The active ingredient in Meridia -an FDA-approved drug prescribed for obesity. Meridia was withdrawn from the U.S. market in 2010; it increases risk of heart attack and stroke Was this: A: Adulteration B: Misbranded C: Falsely advertised D: Nothing is wrong
A: Adulteration since Sibutraine is unsafe
Case 6: A patient approaches you and wants to know there are any natural techniques or medicines considered to be likely effective for high blood pressure. You respond: A: DASH diet and Potassium B: Chiropractic C: Blueberries D: Gingko, red yeast rice, and sunflower oil
A: DASH diet and Potassium
What does Activated charcoal do?
Absorbs drugs and chemicals and can decrease foul odors Off-label: 520 mg PO after meals or as needed Clinical pearl: tablets may stain inside of mouth and clothing Taken after symptoms occur;
What do probiotics do?
Activia yogurt, Align, Culturelle, Florastor etc. Contain single or multiple bacteria May help with IBS or lactose intolerance Stop probiotic if no benefit after 14 days
What are the adverse effects and interactions of ginseng?
Adverse Effects: Asian: Insomnia Interactions: additive hypoglycemic effects warfarin - Major... significant increase in INR Immunosuppressant - ginseng is an immune system stimulant
What are the adverse effects and interactions of CoQ10?
Adverse Effects: Insomnia if taken before bed Interactions: May reverse effects of warfarin
What are the adverse effects and interactions of Echinacea?
Adverse Effects: Well tolerated Interactions: Immunosuppressant - theoretically may interfere with immunosuppressant therapy because it is an immune system enhancer. Caffeine - increases caffeine levels
What are the adverse effects and interactions with cranberries?
Adverse Effects: Well tolerated at suggested dosages. Interactions: Atorvastatin - cranberry may inhibit CYP3A4 decreasing atorvastatin metabolism
What are the adverse effects and interactions of fish oil?
Adverse effects -Smelly burps, gas, bloating, diarrhea -3g of EPA+DHA have increased the risk of bleeding Interactions: -Anticoagulants and antiplatelet -May increase bleeding risk
What is the 1994 Dietary Supplement Health and Education Act (DSHEA)?
Allows FDA to regulate Dietary Supplements (DS) under the standards that apply to food preparation (Center for Food Safety and Applied Nutrition). Required establishment of Good manufacturing practices (GMP).
What is ginseng used for?
American: Diabetes & respiratory tract infections -- Possibly Effective Asian: Alzheimer's, COPD, cognitive function, erectile dysfunction, influenza, multiple sclerosis fatigue-- Possibly Effective Bipolar, common cold, diabetes, herpes simplex virus 2-- Possibly Effective
Case 4: A patient who has just finished in-patient treatment for alcoholism and is feeling a little stressed and wants to know if tribulus would interact with any of her new medications Antabuse (disulfiram). Lopressor (metoprolol) A: Yes it interacts, but you can still take it B: Yes it interacts and do NOT take it C: No it does not interact
B: Yes it interacts with Metoprolol and Disulfiram since it contains alcohol and disulfiram is an alcoholism med, and do NOT take it
What are the symptoms of gas?
Bloating: Tightness or discomfort in abdomen Belching Flatulence Gas pains: Sharp jabbing pains/cramps
Case 3: A patient would like to take the recommended amount ginseng for her memory She shows you this supplement Based on the label, how much should she take? Serving size: 2 veg capsules of 500mg each A: 1 capsule once daily B: 1 capsule twice daily C: 2 capsules once daily D: 2 capsules twice daily
C or D is correct Ginseng should not be taken with warfarin Gingko should not be taken with hypertensive meds
Case 5: A 35 y.o. pregnant female asks if you think if it would be okay if she took valerian extract to help with her insomnia. You respond: A: It is possibly effective, take 400-900mg before bedtime B: It is likely effective, but only take 400mg before bedtime C: It should not be taken during pregnancy
C: It should not be taken during pregnancy It hasn't been studied, some concerns about increasing zinc which is harmful to fetus Talk to your OBGYN
Case 2: A 66 y.o. male taking atorvastatin 40 mg once daily says he needs his LDL cholesterol to drop another 15 points to achieve ≥50% reduction in LDL-C from his baseline. PMH: MI, angina He cannot afford ezetimibe; his insurance has the lowest copay for atorvastatin. He doesn't want to change statins. He tried 80 mg once before but complained of muscle pain. His doctor wrote him a Rx for 80 mg again. He doesn't want to fill it. He takes fish oil 1 gram once daily Other medications: Lisinopril, metoprolol, aspirin, clopidogrel, nitroglycerin He approaches the pharmacy counter with red yeast rice, fish oil and green tea and wants to know if any of these will help? In addition to your meds, you should take: A: Red yeast rice B: Garlic C: Green tea D: Fix Rx for atorvastatin 80 mg; start CoQ10
CoQ and statin= myopathy Red yeast= "natural statin" don't put them together Garlic= bad with anticoagulant C: Green tea (decaf better)
What are the uses of Bifidobacteria?
Constipation: possibly effective
Case 7: A patient taking the following medications would like to know if there are any supplements that should be replaced. Carbamazepine Metformin Sitagliptin Carvidelol Torsemide Potassium Prednisone Hydrochlorothiazide A: Calcium +Vitamin D B: B 12 C: Potassium and magnesium D: All of the options are depleted
D: All of the options are depleted Well known depletions: Carbamazepine: Calcium + Vitamin D Metformin: B12 Torsemide: Potassium, Magnesium Prednisone: Calcium + Vitamin D Hydrochlorothiazide: Potassium and magnesium
Case 2: A patient struggling with opioid addiction wants to know what you think about Kratom. The patient read the following on their website. "The Red Vein type of Kratom is more desirable to use to quit opiates because it can relieve the withdrawal symptoms well. It is a healthy and natural way to overcome opiate drug addiction. Whether you are a victim of heroin addiction or addicted to oxycodone, hydrocodone, suboxone, or methadone, Kratom can successfully eliminate opiate withdrawal symptoms for you. "It helps in reduction of insomnia and pain associated with withdrawal. Also, it uplifts mood and acts like an anxiolytic. With the right dose, it also helps in relieving symptoms like nausea and vomiting." There is no label with directions for use; no study data can be found Was this: A: Adulteration B: Misbranded C: Falsely advertised D: Misbranded and falsely advertised
D: Misbranded and falsely advertised Misbranding- promoting it for opioid withdrawal (the use of the product) Falsely advertised- no evidence to support claims
What foods can cause gas?
Dietary sugars (artificial additives) like LACTOSE Complex Carbohydrates like Gluten Indigestible oligosaccharides like Beans
What are the Natural Medicines effectiveness ratings?
Effective, Likely effective, Possibly effective, Ineffective, Likely ineffective, Possibly ineffective, insufficient evidence
Who is responsible for the advertising claims made on labels?
FTC (Federal Trade Commission) claims of safety and efficacy be supported by "competent and reliable scientific evidence"
Case 1: A 67 y.o. male and retired primary care doctor who has recently been diagnosed with NYHA Class III heart failure, understands that there is mixed evidence regarding the use of fish oil in heart failure. He would like to know if there are any large scale studies in people with his degree of heart failure that have had positive results? If so, what is the benefit of taking it, and how would he know if it is working? If so, how much should he take? How would you counsel him on product selection, administration, and side effects? Fish oil has been shown to A: Reduce mortality and hospitalizations in patients with heart failure B: Reduce mortality, coronary heart disease, or stroke C: Increase triglyceride levels D: is unsafe as it causes blood clots
Fish oil possibly effective A: Reduce mortality and hospitalizations in patients with heart failure 1 g daily for 4 years significantly reduces risk of all-cause mortality, CV mortality, and hospitalizations associated with heart failure
What is Echinacea and what is it used for?
Flower-like a daisy Common Cold -- Possibly Effective
What are the adverse effects of garlic?
Garlic breath and body order Increased risk of bleeding
What are the interactions of Glucosamine/chondroitin/MSM?
Glucosamine may increase bleeding risk Chondroitin may increase bleeding risk MSM may increase bleeding risk
What is the effectiveness of Glucosamine/chondroitin/MSM when treating osteoarthritis?
Glucosamine sulfate - Likely effective ... particularly with pharmaceutical grade glucosamine Glucosamine Hydrochloride -- Insufficient evidence to rate Chondroitin sulfate - Possibly effective Evidence for MSM --- Possibly effective
What is fiber and its adverse effects?
Indigestible part of plants USED FOR CONSTIPATION 1. Soluble fiber: oat bran, apples, citrus, pears, peas, beans, potatoes, seeds, oranges, grapefruit, *psyllium* 2. Insoluble fiber: Wheat bran, corn bran, nuts, cabbage, and root vegetables Adverse effects: flatulence, bloating or diarrhea
What are the New DS Ingredients and Good Manufacturing practices (GMP)?
Premarket notification (75 days in advance) is required for "new dietary ingredients" which have not been previously marketed. -Must also provide FDA with evidence the DS is safe in humans when used as directed.
What are the interactions with Green tea?
Interactions: Antiplatelet effect - may increase the risk of bleeding Warfarin - green teak contains a minute amount vitamin K1... need to monitor INR carefully Additive effects with other stimulants: amphetamines, albuterol, decongestants,ephedrine, theophylline
What does insufficient evidence mean?
Lacking enough reliable evidence to provide a rating.
What are the adverse effects and interactions of Green tea?
Large doses of caffeine can cause: Tachycardia, headache, anxiety, chest pain, premature heart beats, and other arrhythmias. Insomnia
What are some self-treatment goals of hemorrhoids?
Maintain soft-stools without straining Alleviate FDA approved indications: Itching Discomfort Irritation Burning Soreness Inflammation Pain Dry anal tissue Swelling in perianal area
What is Natural Medicines B?
Natural Medicines has reviewed over 89,000 clinical trials and other studies -Evaluate: Relevance Reliability Validity Consistency Overall rigor of the study -Establish safety and effectives ratings
Do Structure-function claims require FDA approval? Example: calcium builds strong bones, support a healthy immune system
No, may have disclaimer: This statement has not evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent disease
Case 3: A 23 y.o. female college student reports increased urgency to void small amounts of urine. She has burning with urinary. She comes to the pharmacy window with cranberry capsules, Ocean Spray Cranberry Juice, and D-mannose. She wants to know which of these would be best to mange her symptoms. A: Ocean spray juice 300mL 4x daily until symptoms subside B: Cranberry capsules 500mg qd until symptoms subside C: Refer to PCP D: take no action, symptoms will resolve on their one
Not as effective in premenstrual women as antibiotics also only for prevention C: Refer to PCP
What does "pharmaceutical grade" mean?
Nothing. Not FDA defined
What are the goals of self-treatment with gas?
OLDCART Reduce: Frequency, intensity and duration of intestinal gas Consequences on lifestyle
What is functional medicine?
Object of therapy: Determine how and why illness occurs and restore health by addressing the root cause of the disease -an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness -Views traditional western medicine as using quick acting resources good for short term management, but is poor at long-term and chronic relief of illness
What populations should you be cautious with DS?
Older Adults Children Pregnancy and Lactation Kidney Disease Liver Disease Surgery
What are Quality Assurance Programs?
Participation is "voluntary." Certify contents only from testing of one batch. Consumer Lab is the exception; must pass random testing annually. QA programs do not ensure safety and efficacy Ex: USP, NSF
What do local anesthetics do (OTC)?
Relieves itching, irritation, burning, discomfort, pain Only for topical use Avoid on open sores Ask about allergy status Clinical pearl: try to avoid cream formulations -Benzocaine, Dibucaine, Lidocaine, Pramoxine
What is cranberry and what is it used for?
Shrub found in bogs or wetlands in northeastern and northcentraal parts of USA Urinary tract infection (UTI) Prevention -- Possibly Effective Cranberry 500 mg daily for 6 months was as effective as trimethoprim 100 mg daily in elderly women Cranberry 500 mg daily for 12 months was less effective as trimethoprim-sulfamethoxazole single strength once daily in premenopausal women
Is functional medicine scientifically valid?
Studies did NOT find sufficient evidence to support the use of functional medicine
What causes stinky gas?
Sulfate containing foods: broccoli, macadamia nuts S2O=>Hydrogen Sulfide H2S via sulfate reducing bacteria
Do health and nutrient claims require FDA approval? Health claim example: "Diet low in saturated fat and cholesterol that includes 25g of soy protein may reduce the risk of heart disease"
Yes
What is misbranding?
To brand or label incorrectly, falsely, or in a misleading way. (e.g. making false claims, omitting required information, inaccurate information on the label) Note: package inserts and medication information sheets are considered part of the label
What are the non-pharmaceutical therapies for gas?
To help reduce/relieve gas Identify and avoid problematic foods/portion control Example: fatty foods can delay stomach emptying and cause bloating *Eat slowly* *Don't smoke* *Don't chew gum*
What is an ARR?
absolute risk reduction= absolute risk in control group - absolute risk in treatment group
What is adulteration?
containing impurities, metals, enhancing substances (simvastatin), hazardous substances (i.e. poisons), poor quality (i.e. inferior ingredients), unsafe, represents significant and unreasonable risk of illness or injury when used in accordance with suggested labeling.
What is garlic and what is it used for?
culinary herb Atherosclerosis -- Possibly Effective Diabetes -- Possibly Effective Hyperlipidemia -- Possibly Effective Hypertension -- Possibly Effective Prostate cancer prevention -- Possibly Effective Tinea corporis, pedis, or cruris -- Possibly Effective
What is Coenzyme Q10 (Ubiquinone & ubiquinol) and its uses?
fat soluble compound, likely safe Coenzyme Q10 deficiency- Likely effective Mitochondrial encephalomyopathies- likely effective Diabetic Neuropathy -- Possibly Effective Fibromyalgia -- Possibly Effective Migraine Headaches -- Possibly Effective Multiple sclerosis -- Possibly Effective Muscular dystrophy -- Possibly Effective *Statin Induced myopathy --- Insufficient reliable evidence* First try a different statin or lower dose Cardiovascular morality -- possibly effective CHF - possibly effective (in addition to treatment) Migraines - possibly effective Fibromyalgia in women - possibly effective
What can severe gas pains be mistaken for?
gallstones, heart disease, appendicitis
What should you not give someone with an auto-immune disorder?
immune system stimulants Common examples: Echinacea & Elderberry
What is Green tea (Camellis sinesis) and what are its uses?
leaves and leaf buds, safe Genital warts - Likely Effective Hyperlipidemia - Likely Effective Mental alertness - Insufficient reliable evidence
What is an NNT?
number of patients needed to treat for the study period to prevent 1 event
