Transcript Slide 1

By: Fidel O. Garcia EMT-P
EMS Education Coordinator
EMS Outreach Office
St. Mary’s Hospital
[email protected]
Contemporary Alternative Medicine
What is it?
Aroma Therapy
Accupuncture
Vitamins and Minerals
Massage Therapy
Chiropractic Medicine
Herbal Therapy
Homeopathic Medicine
Dr. Samuel Hahnemann
What is it?
Stated to have minimal side effects
Stated to have fewer drug interactions
Current study for
asthma
rheumatoid arthritis
auto-immune diseases
Herbal remedies
herbs and supplements are drugs!
>30% of “conventional drugs”
Herbs and supplements have:
therapeutic effects
sub -therapeutic effects
side effects
toxic effects
How does it work?
Law of Similars
Law of Succussion
Law of Infintesimals
“No Medicine - Medicine” ?
6X , 30X
12C , 200C
LM
Why all the popularity?
Disappointment with modern medicine
Personal involvement with their own care
Easy to purchase and take
Perception that all herbal are healthier
Limited time with healthcare provider
***NOTE: Approx. 40% tell their healthcare
providers they are taking supplements!!!!!!!
Due to lack of control, it is possible that:
herbs may be sub-potent
they do not contain what is in the label
they misrepresent what it can be used for
Regulation
The DSHEA passed by congress in the 1994
“The Dietary Supplement Health Education
ACT”
- Categorized as dietary supplements
- No FDA approval as long as NO
“therapeutic claims” were made
-Manufacture can still make general
health claims
-This must be on all labels: “This
product is not intended to diagnose,
treat, cure, or prevent any disease”
-NO REQUIREMENTS FOR
QUALITY ASSURANCE, SAFETY,
OR EFFICACY
How big is this whole thing?
Billions of users (estimate by WHO)
Thousands of dealers
600 million visits annually
Thousands of “Homeopathic Experts”
Insurance companies assist or pay for
>$ 5.7 billion / yr industry
Approx. $20 billion / yr with all CAM
Top 10 selling products in the US(2002) in millions!
Garlic – 34.5
Ginkgo Biloba – 33.0
Echinacea – 32.4
Isoflavones – 28.2
Saw Palmetto – 23.0
St. John’s Wort – 15.0
Black Cohosh – 12.3
Valerian – 8.1
Milk Thistle – 7.8
Kava – 4.4
What is the responsibility of the patient?
What do they want to achieve !
Stop if not working !!
Document what and why they are taking
herbs !
What is the responsibility of the healthcare
provider?
Educate our patients
Be patient advocates
Class 1 – Can only be safely consumed when used
appropriately
Class 2 – Restrictions, unless directed by an expert
2a – external use only
2b – not to be used in pregnancy
2c – not to be used while nursing
2d – other specific restrictions as noted
Class 3 – Herbs for which significant data exists to
recommend the following label:
“To be used only under supervision of
an expert qualified in the appropriate
use of this substance”
Labeling must include:
dose; contraindications; adverse effects;
and drug interactions
Class 4 – Herbs for which insignificant data exists
to recommend
NIH
National Center for Complementary &
Alternative Therapy Clearinghouse
www.nccam.nih.gov
Office of Dietary Supplements
www.ods.od.nih.gov
U.S. Food & Drug Administration
www.cfsan.fda.gov
www.fda.gov/medwatch
Other
http://naturaldatabase.com
Name:
Class:
Possible uses:
Side effects:
Cautions:
Drug interactions:
Garlic
2c (bulb)
Digestive aid ; lowers
cholesterol and BP;
antiplatelet activity;
stimulation of the immune
system; protection from
cancer
GI distress; bleeding;
sweating; hypoglycemia;
hypotension
pts with active bleeds or
bleeding disorders;
diabetic patients
Anticoagulants;
antiplatelets;
antihypertensives;
hypoglycemics
Name:
Class:
Possible uses:
Gingko Biloba
1 (leaf)
Improves cerebral and
peripheral blood flow;
improved cognitive
function in alzheimers pts;
treatment of impotence;
depression; and asthma
Side effects:
GI distress; HA;
palpitations; bleeding
Cautions:
bleeding disorders
Drug interactions: ASA; antiplatelets;
anticoagulants
Name:
Class:
Possible uses:
Side effects:
Cautions:
Drug interactions:
Echinacea
1 (root / seed)
Stimulate immune system; prevent
colds – flu – allergies – upper
respiratory infections; topically
for eczema – mild burns – canker
sores – herpes and minor wounds
Immunosuppression with prolonged
use; allergic reactions
should not take for > 8 wks or >10
days with acute infection; NOT TO
be used by individuals with
autoimmune diseases:ie – HIV.
Leukemia, MS, TB, Lupous,
Rheumatiod arthritis
immunosuppressants
Name:
Class:
Possible uses:
Side effects:
Cautions:
Drug interactions:
Saw Palmetto
No class noted
benign prostatic
hypertrophy; mild diuretic;
cystitis
HA and nausea – rarely;
abd. Pain; dysuria
prostatic cancer should be
ruled out
May INCREASE
anticoagulants; alpha
adrenergic blockers; aspirin
Name:
Class:
Possible uses:
Side effects:
Cautions:
Drug interactions:
Isoflavones
No class noted
Replenish estrogen; relieve
menopausal symptoms;
decrease risk of heart disease
and osteoporosis
Unsure of safety or efficacy
since most trials have been
done on animals or in test
tubes
Need to use soy products not
capsules or pills; may alter
thyroid function
Name:
Class:
Possible uses:
Side effects:
Cautions:
Drug interactions:
St. John’s Wart
2d (flowering tops)
depression and anxiety; topically for
burns and infections; contusions;
sprains
drowsiness; GI distress; fatigue;
restlessness; hypertension
Do not use in pregnancy;
hypertension; suicidal; psychotic or
severely depressed
May INCREASE MAOI’s & paxil;
ADDITIVE effects with tricyclic
antidepressants; amphetamines:
“Serotonin Syndrome” – autonomic
NS instability, muscle rigidity,
hyperreflexia, vital sign instability,
COMA & DEATH; may DECREASE
effectiveness of HIV drugs
Name:
Class:
Possible uses:
Side effects:
Cautions:
Drug interactions:
Black Cohosh
2b / 2c
Smooth muscle relaxant;
antispasmodic; diuretic;
dysmenorrhea; antidiarrheal
Bradycardia; hypotension; N/V;
anorexia; possible
spontaneous abortion
Should not be used in pregnancy or
during lactation, although it may be
used in first trimester to decrease
uterine spasms
Antihypertensives; oral
contraceptives; sedatives /
hypnotics
Name:
Class:
Possible uses:
Valerian
1 (root)
anxiety; restlessness;
insomnia
Side effects:
HA; restlessness;
insomnia; hepatotoxic
(OD); poss. Palpitations;
Cautions:
Pregnancy; lactation
Drug interactions: CNS depressants, MAOI’s;
phenytoin; warfarin
Name:
Class:
Possible uses:
Side effects:
Cautions:
Drug interactions:
Milk Thistle
1 (seed)
Hepatotoxicity caused by
poisonous mushrooms;
cirrhosis; HCV; exposure to
toxic chemicals
Diarrhea; menstrual
irregularities; rash; N/V;
anorexia
Should not use in
pregnancy; lactation; or for
children
those metabolized by P-450
enzyme
Name:
Class:
Possible uses:
Possible side effects:
Cautions:
Drug interactions:
Kava Kava
2b/2c/2d (root / rhizome)
Anxiety; insomnia; skeletal muscle
relaxation; ADD/ADHD;
antidepressant; antiepileptic
rash; drowsiness; hallucinations;
increased reflexes; blurred visions;
anorexia; N/V; decreased platelets;
hematuria; pulmonary hypertension;
liver damage
pregnancy; lactation; use while
driving or operating machinery
May INCREASE digoxin;
barbiturates; benzodiazepines
(tends to increase depression); CNS
depressants
Name:
Class:
Possible uses:
Poss side effects:
Cautions:
Drug interactions:
Bilberry
4
Treatment of eye disorders;
myopia; night blindness;
diabetic retinopathy; cataracts;
varicose veins; phlebitis
bleeding; impaired
glucose controlling diabetics
pregnancy and lactation;
diabetics; DC 14 days prior to
surgical procedures
Insulin; oral hypoglycemics
Name:
Cranberry
Class:
No class noted
Possible uses:
Prevention of kidney stones,
treatment of UTI
Poss side effects:
May develop GI symptoms with
large doses
Cautions:
None noted
Drug interactions:
Drugs that increase uric acid
levels
Name:
Class:
Possible uses:
Poss side effects:
Cautions:
Drug interactions:
Arnica
No class noted
Anti – inflammatory; analgesic;
cholesterol lowering (under
supervision only), shock;
jet lag; bleeding
Considered poisonous if
taken internally; BP; anxiety;
liver failure; bleeding;
dyspnea; muscle weakness;
COMA, CARDIAC ARREST and
DEATH
should not take for > 8 wks or
>10 days with acute infection
May decrease effectiveness of
antihypertensives if taken orally
Name:
Class:
Possible uses:
Evening primrose oil
No class noted
Digestive aid with irritable
bowel; eczema; dermatitis;
PMS; menopausal
symptoms; diabetic
neuropathy; rheumatoid
arthritis; MS
Poss side effects: Seizures; bleeding
Cautions:
do not use with seizure
pts;
Name:
Class:
Possible uses:
Possible side effects:
Cautions:
Drug interactions:
Ginseng
2d (root)
enhances mental and physical
performance; decreases stress;
improves immune function
nervousness; depression;
tachycardia and hypotension at high
doses; bleeding; diarrhea
do not use in renal failure – acute
infection – pregnancy – lactation
and active bleeding; use cautiously
in pts with hypertension or high risk
for hypotension
anticoagulants; antiplatelets; Asa;
antihypertensives; CNS stimulants;
may INCREASE effects of insulin
and hyperglycemic agents
Name:
Class:
Possible uses:
Possible side effects:
Cautions:
Drug interactions:
Goldenseal
2b (rhizome / root)
Gastritis; PUD, bladder infections;
anti-hemorrhagic; antihemorrhoidal; anti-infective; anticancer
Hallucinations; seizures; N/V/D;
abdominal cramps; rashes;
bradycardia, heart blocks; COMA;
ASYSTOLE; DEATH
NO DATA to support for most uses
unless the pure form of berberine
was used
May INCREASE ETOH; antiarrhythmics; beta blockers and CNS
depressants; May DECREASE anticoagulants; calcium channel
blockers and cardiac glycosides