Chapter 108: Complementary and Alternative Therapy

Adverse effects of flaxseed

GI related issues like bloating, cramping, or flatulence

Cranberry juice adverse effects

GI upset, can increase bleeding in those taking warfarin, increases risk of kidney stones

Saw palmetto

treatment of benign prostatic hyperplasia (BPH) and may have some anti-platelet effects

Long term use of ginger root can

suppress the cNS and cause cardiac dysrhythmias

Contraindications for ginkgo biloba use

suppresses coagulation and should be used with caution in pts taking antiplatelet drugs like aspirin and anticoagulants like warfarin and heparin

Garlic

used primarily for cardio system effects like reducing levels of triglycerides and raises HDL (hypertension, decreases plaque formation)

Kava

used to relieve anxiety, promote sleep, and relax muscles. it can cause severe liver injury

Flaxseed

used to treat dyslipidemia and constipation (doesn't effect HDL or triglycerides)

Adverse effects of feverfew

usually well tolerated and no serious effects; just causes mild GI reactions

Echinacea adverse effects

usually well tolerated; allergic reactions, angioedema, and anaphylaxis

St. John's Wort

widely used to treat depression; not severe (there is no prescription needed)

A patient asks the nurse for a supplement that can be used to prevent motion sickness during a vacation cruise. The nurse suggests which supplement? A. Ginger root (Zingiber officinale) B. Garlic (Allium sativum) C. Coenzyme Q-10 (CoQ-10) D. Feverfew (Tanacetum parthenium)

A. Rationale: Ginger root is used to suppress nausea and vomiting caused by motion sickness and morning sickness and also for postoperative nausea and vomiting. It may be involved in the blockade of serotonin receptors located in the chemoreceptor trigger zone of the brain. Garlic, coenzyme Q-10, and feverfew are not used to suppress nausea and vomiting.

Which product did the U.S. Food and Drug Administration (FDA) ban in the United States because of the serious adverse effects of myocardial infarction, stroke, and death? A. Ma huang (Ephedra) B. Valerian (Valeriana officinalis) C. St. John's wort (Hypericum perforatum) D. Saw palmetto (Serenoa repens)

A. Rationale: Sales of ma huang have been banned in the United States since 2004, making it the first time that a dietary supplement has been ordered off the market. It has been associated with stroke, myocardial infarction, and death. The ban was challenged in 2007, but a rehearing petition was denied. Valerian, St. John's wort, and saw palmetto are currently available for sale in the United States.

The patient is prescribed warfarin [Coumadin] to treat deep vein thrombosis. The nurse is teaching the patient about dietary supplements that have the potential to interfere with coumadin therapy. What herbs should the nurse include in the teaching? (Select all that apply.) A. Echinacea B. Garlic C. Ginger root D. Gingko biloba E. Valerian

B, C, and D Rationale: Garlic, ginger root, and gingko biloba can increase the risk of bleeding in patients receiving anticoagulants or antiplatelet drugs.

A patient is taking black cohosh (Cimicifuga racemosa) for relief of menopausal symptoms. The nurse should caution her about adverse interactive effects with which conventional medication? A. Docusate sodium [Colace] B. Insulin C. Furosemide [Lasix] D. Aspirin

B. Rationale: Black cohosh may potentiate the hypoglycemic effect of insulin and oral hypoglycemics. In addition, adverse hypotensive effects have been associated with antihypertensive medications. No interactive effects have been reported with docusate sodium, aspirin, or furosemide.

It is most important for the nurse to inform which pt NOT to use ginkgo biloba? A. a pt with Alzheimer's disease and hypertension B. a pt with A-fib taking warfarin (Coumadin) C. a pt taking sildenafil (Viagra) for ED D. a pt prescribed fluoxetine (Prozac) for depression

B. Rationale: Gingko biloba suppresses coagulation and should be used with caution in pts taking anti-platelet drugs and anticoagulants.

The nurse is completing an admission assessment for a patient who requires treatment of an anxiety disorder. The patient states "I take the dietary supplement kava every day to help my anxiety and stress." The nurse understands the patient is at risk for which serious adverse effect? A. Stroke B. Hepatoxicity C. Suicidal behavior D. Acute renal failure

B. Rationale: In the United States, kava is promoted as a natural alternative to benodiazepines to treat anxiety and stress. However, kava has the risk for the serious adverse effect of hepatoxicity, which lead the FDA to issue a public warning in March 2002. Also, in 2002, the Centers for Disease Control and Prevention issued a report on kava-related hepatoxicity.

A pt plans to take saw palmetto. Which statement should the nurse include when teaching the pt about this supplement? A. saw palmetto has numerous serious adverse effects B. saw palmetto should be used with caution in pts taking antiplatelet drugs C. saw palmetto is used to treat hot flashes associated with menopause D. beneficial effects of saw palmetto usually occur within 1 week

B. Rationale: This drug should be used in caution with pts taking antiplatelet drugs or anticoagulants. It is very well tolerated and significant adverse effects have not been reported. Benefits take 1-2 months to develop.

A pt with type 2 diabetes mellitus is taking an oral hypoglycemic agent. The pt tells the nurse that he wants to start taking garlic supplements. It is most important for the nurse to do what? A. inform the pt that garlic may interfere with absorption of the oral hypoglycemic agent B. caution the pt against taking any herbal supplement C. warn the pt that garlic can potentiate the effects of oral hypoglycemic agents D. teach the pt that ingestion garlic with oral hypoglycemic agents can cause hyperglycemia

C. Rationale: Garlic can increase insulin levels and potentiate the hypoglycemic effects of drugs for diabetes.

The nurse is preparing the discharge teaching plan for a patient who had a mechanical valve replacement and has been prescribed Coumadin. The nurse reviews the patient's medication history and notes the patient is taking the herbal supplement glucosamine to treat osteoarthritis. Which instructions should the nurse give to this patient? A. Increase in consumption of foods high in vitamin K. B. Do not take any dietary or herbal supplements. C. Notify the healthcare provider immediately if you experience any signs of bleeding. D. Research studies have shown there is no benefit in using herbs to treat medical conditions.

C. Rationale: Glucosamine may increase the risk of bleeding in patients taking anticoagulants such as coumadin. The nurse should educate the patient about the signs of bleeding. Glucosamine is widely used to treat osteoarthritis of the knee, hip, and wrist. Increasing vitamin K intake may decrease the effect of Coumadin.

Which information on the product label of an herbal supplement would comply with the regulations established by the Dietary Supplement Health and Education Act (DSHEA)? A. Lowers cholesterol B. Relieves menopausal hot flashes C. Supports the immune system D. Reduces pain of arthritis

C. Rationale: The DSHEA restricts the wording of labels on product packaging. A label cannot claim to diagnose, treat, cure, or prevent disease. However, the label is allowed to state the product's ability to favorably influence body function or structure. Statements on a label such as "reduces the pain of arthritis," "lowers cholesterol," and "relieves menopausal hot flashes" would not be in compliance with DSHEA regulations.

The nurse recognizes that the supplement echinacea (Echinacea angustifolia) should not be taken as prolonged therapy for patients with which condition? A. Peptic ulcer disease B. Diabetes C. Glaucoma D. Tuberculosis

D. TB Rationale: When taken on a short-term basis to suppress inflammation and stimulate the immune system, echinacea has few adverse effects. However, if taken as long-term therapy, it can suppress immune function. It should be avoided in patients with chronic infections, such as tuberculosis, that require optimal immune function. Patients with diabetes, peptic ulcer disease, or glaucoma need not avoid taking echinacea.

Adverse effects of glucosamine/chondroitin

GI disturbances like nausea and heartburn (may increase bleeding with conventional drugs)

Coenzyme Q-10 (CoQ-10)

antioxidant in the body that participates in the production of ATP; can be used for congestive heart failure, and myopathy caused by statins

Resveratrol

antioxidant promoted for aging effects and protection against chronic diseases

Adverse effects of garlic

bad breath and body odor; rarely causes heartburn, flatulence, nausea, vomiting, and diarrhea

Black cohosh

can be used to treat symptoms of menopause (MOA is unknown)

Feverfew interactions

can increase risk of bleeding in those taking anti-platelet drugs like aspirin and anticoagulants like warfarin and heparin

Echinacea interactions

can oppose immunosuppressant drugs and can interfere with HIV and cancer treatment

What complementary medication can antagonize warfarin because it is like vitamin K?

coenzyme Q-10 (if they are taking warfarin they will need a higher dose to keep the coagulation levels good)

Ma Huang (Ephedra)

contains ephedrine that can elevate BP and stimulates the heart and CNS (high doses can cause stroke, MI, and death)

Most common side effects of probiotics

flatulence and bloating

Garlic and those with diabetes

garlic can increase insulin levels and potentiate hypoglycemic effects of the drugs used for diabetes

Probiotics

generally well tolerated with GI effects; helps metabolize food and other nutrient absorption

Ginger root

good for nausea related to morning sickness, pain related to arthritis (can suppress platelet aggregation)

Echinacea

has antiviral, anti-inflammatory, and immunostimulant effects (can be used to treat viral infections, influenza, and the common cold)

Peppermint oil

helps with the management of irritable bowel syndrome

Comfrey

herbal supplement that can increase the HR and BP and can counteract an antihypertensive medication

Adverse effects of Q-10 (CoQ-10)

high doses produce GI disturbances like gastritis, reduced appetite, nausea, and diarrhea.

Gingko biloba

increases pain-free walking distance in pts with peripheral arterial disease (reduces claudication and is usually well tolerated)

Adverse effects of black cohosh

liver inflammation and liver failure (rare), rash, headache, dizziness, and abdominal discomfort

Glucosamine/Chondroitin

osteoarthritis of the knee, hip, and wrist (use in caution with those with a shellfish allergy)

Soy

prevention of breast cancer and treatment of hot flashes in postmenopausal women

Cranberry juice therapeutic uses

prevents UTI, and interferes with bacterial adhesion to the urinary tract

Feverfew

primarily used prophylactically for migraines

Valerian

primarily used to promote sleep (generally well tolerated)