Module 6 Pharm

• Complementary medicine


  Substance used in addition to or instead of conventional treatment
• Alternative medicine


  Substitute for more traditional or mainstream treatment
• Examples of alternative medicine


  • Herbal remedies
  • Naturopathic treatments
• Derived from 'nature' or 'natural source' does not mean it must be safe or that you can take as much as you want
• FDA requirements for prescription products

  • Adhere to strict variability standards (maximum of 5% deviation between batches)
• Supplements, herbals, and vitamins/minerals

  • Not FDA-regulated, variability could be + / - 100% (0% or 200% in the bottle)
• Adverse effects of supplements

  Difficult to predict, interactions are very common, variability in pharmacokinetics can affect incidence of side effects, prolonged use or excessive dosages can produce toxic effects
• Bee Venom


  • Common uses: Multiple sclerosis, Rheumatoid arthritis, autoimmune disorders
  • Evidence: Some positive outcomes
  • Side effects: Painful, allergic reaction
• Honey - MANUKA HONEY


  • Common uses: cough and colds, wounds, asthma, diabetes, cancer, infections, heart disease
  • Evidence: Strong for cough and cold, growing positive support for use in cancer, wounds, and diabetes
  • Side effects: Allergic reactions (ex. History of bee pollen allergy), not safe for children <12 months old (Clostridium botulism)
• St. John's Wort


  • Common uses: Mild-moderate depression
  • Evidence: Decent for mild-mod depression, limited for others
  • Side effects: photosensitivity, insomnia, anxiety, dry mouth, dizziness, GI symptoms, fatigue, headache, sexual dysfunction
  • Dangerous, life-threatening interactions with many medications (ex. Antidepressants, birth control, some heart medications, warfarin)
• Echinacea


  • Common uses: Stimulate or support immune function; colds and other mild respiratory tract infections; topical burns / wounds
  • Evidence: Support for reducing sx of common cold when taken quickly after symptoms appear; could help prevent colds if taken regularly
  • Side effects: GI upset, skin rash, allergic rxns
• Garlic


  • Common uses: CVD risk reduction; antineoplastic, antimicrobial, anti-inflammatory, antihyperglycemic, antioxidant
  • Evidence: Support is mixed, May reduce total cholesterol and LDL (small effect, >8 weeks), may help high BP
  • Side effects: Generally mild (garlic odor, GI upset); with other antiplatelet drugs can cause serious bleeding
• Ginkgo Biloba


  • Common uses: Allergies, anxiety, dementia, peripheral artery disease, vertigo
  • Evidence: No conclusive evidence to date FOR DEMENTIA
  • Side effects: headache, stomach upset, dizziness, constipation, palpitations, allergic skin reactions
• Linden Tree (Basswood)


  • Common uses: Sleep, anxiety, digestive issues (C/D, gas), cold and flu, rapid heart rate, ASCVD
  • Evidence: Mild positive evidence, small studies to date
  • Side effects: heart damage with frequent use, allergic reactions, reduced lithium elimination, mouth and stomach sores
• Melatonin


  • Common uses: Jet lag, falling asleep, sleep disorders in children, anxiety before and after surgery
  • Evidence: Better than placebo for sleep disorders and anxiety prior to surgery, but mixed for after surgery
  • Side effects (incl. kids): Drowsiness, increased urination in evening, headache, dizziness, agitation
  • Interacts with some anticoagulants and seizure medications
• Glucosamine and Chondroitin


  • Common uses: Osteoarthritis
  • Evidence: Inconsistent results and conflicting conclusions, esp. for knee, hip hand, and temporomandibular joint
  • Side effects: Increased blood glucose, increased bleed risk (w /warfarin)
  • Caution with anticoagulants / antiplatelets as may increase bleeding risk!
• Saw Palmetto


  • Common uses: Benign prostatic hyperplasia (BPH), chronic pelvic pain, migraine, hair loss
  • Evidence: Low quality for BPH
  • Side effects: mild GI upset, headache
• Red Yeast (Red Rice)

  • Common uses: Cholesterol
  • Evidence: Monacolin K (large amounts) may reduce blood cholesterol, blood glucose, and blood pressure (considered unapproved drugs by FDA and are illegal in US!)
  • Side effects: Myopathy, kidney and liver damage, diarrhea, cramping
• Wide variability in monacolin K content in red yeast (red rice) supplements
• Signs and symptoms of CAM excess

  • Muscle weakness
  • Incoordination/Balance problems
  • Excessive fatigue
  • Skin rashes or bruising
  • Neuropathic changes
  • Cardiovascular impairments (increased blood pressure, arrhythmias, etc.)
• Cannabis


  Refers to all products derived from plant Cannabis sativa, containing 540 chemical substances, some with very little THC and called "industrial hemp" under US law
• Marijuana


  Refers to parts of or products from Cannabis sativa that contain substantial amounts of tetrahydrocannabinol (THC), the substance primarily responsible for mental effects
• Only 3 drugs are FDA-approved cannabinoids: Epidiolex, Marinol, Syndros, and Cesamet
• THC or CBD-containing products cannot be legally sold as dietary supplements or in interstate commerce
• Evidence for use of cannabis and cannabinoids

  • May be helpful for rare epileptic disorders, nausea and vomiting from chemotherapy, loss of appetite and weight loss caused by HIV
  • Modest benefits possible for chronic pain and multiple sclerosis
  • Unhelpful for glaucoma, little evidence for reduced anxiety
  • Passing medical marijuana laws has NOT been associated with less nonmedical prescription opioid use
  • Higher death rates in states with medical marijuana laws from opioid overdoses
• Risks of cannabis and cannabinoids

  • Increased risk of psychosis or schizophrenia, motor vehicle crashes, orthostatic hypotension, recurrent severe vomiting (long-term high dose), contaminated/laced product
  • Cannabis use disorder: withdrawal/cravings, lack of control, negative effects on personal and professional responsibilities
  • Adolescent use -> 4-7x more likely to develop cannabis use disorder
• Adverse reactions to CBD

  • Decreased alertness, mood changes, decreased appetite, GI (ex. Diarrhea), liver injury, male reproductive harm, sleepiness, frequent drug interactions
• Look for third-party random testing, good manufacturing practices, and less ingredients on supplement packages
• Brands commonly recommended by pharmacists

  • Centrum
  • Nature Made
  • Nature's Bounty
  • Vitafusion
• Energy drinks


  Contain 70 to 240 mg of caffeine per 16 oz bottle or 113 to 200 mg per "energy shot" of concentrated liquid, used to increase energy and enhance mental alertness and physical performance
• Evidence and side effects of energy drinks

  • Works as caffeine is known to work, ER visits common with 1 in 10 leading to hospitalization
  • Serious heart arrhythmias, inc heart rate and BP, anxiety, sleep disturbances, digestive issues, and dehydration
• Protein powder


  Used for muscle building, wound healing, weight gain, nutritional boost
• Evidence and side effects of protein powder

  • Some support
  • High calorie content (weight gain), extra sugar/processed ingredients, contamination is common, constipation
• Creatine


  May somewhat enhance effects of exercise on strength, muscle mass, and endurance, but long-term effects not well studied
• Essential oils


  Used for mood, sleep, anxiety, pain, inflammation, nausea, most common types include lavender, tea tree, peppermint, eucalyptus, lemon, lemongrass, orange, rosemary, bergamot, cedarwood
• Evidence and side effects of essential oils

  • Some mixed results, only small amounts for short durations
  • Relatively safe when inhaled, diffused, or applied in small amounts topically
• Vitamins


  Organic chemicals needed by the body to facilitate metabolic and biosynthetic processes, relatively balanced diet provides adequate vitamins needed
• Fat soluble vitamins


  A, D, E, and K
• Excessive dosages of fat soluble vitamins can accumulate and cause harm in tissues and organs
• Minerals


  Chemical substances involved in physiological processes, often essential for life, trace minerals are not abundant in the body but needed to promote functions of specific cells and tissues