Adams ch10 lecture

PHARMACOLOGY FOR NURSESPHARMACOLOGY FOR NURSES
A Pathophysiological ApproachA Pathophysiological Approach
FOURTH EDITIONFOURTH EDITION
Copyright © 2014, © 2011, © 2008 by Pearson Education, Inc.
All Rights Reserved
CHAPTER
Herbal and
Alternative
Therapies
10

Pharmacology for Nursing: A Pathophysiology Approach, Fourth Edition
Michael Patrick Adams | Leland N. Holland | Carol Urban
Complementary and AlternativeComplementary and Alternative
Medicine (CAM)Medicine (CAM)
• Considered outside mainstream health
care
• Very diverse set of therapies and
healing systems

Major Characteristics of CAMMajor Characteristics of CAM
• Treat each person as individual
• Consider health care of whole person
• Emphasize integration of mind and
body
• Promote disease prevention, self-care,
self-healing
• Recognize role of spirituality

ResearchResearch
• Rigorous research lacking, though
underway for many therapies
• Seeks effectiveness or lack of
effectiveness

Nurses and CAMNurses and CAM
• Have long known of healing benefits
• Can reduce reliance on some
medications, which reduces adverse
effects
• Can bring greater compliance
• Advantages and limitations should be
presented to patients.

CAM Healing MethodsCAM Healing Methods
• Ingested therapies
– Herbal therapies, nutritional
supplements, special diets

• Alternate health care systems
– Naturotherapy, homeopathy,
chiropractic
– Native American medicine (sweat
lodges, medicine wheels)
– Chinese traditional medicine
(acupuncture, Chinese herbals)

• Manual healing
– Massage, pressure-point therapies,
hand-medicated biofield therapies
• Mind-body interventions
– Yoga, meditation, hypnotherapy
– Guided imagery, biofeedback
– Movement-oriented therapies (music
and dance)

• Spiritual
– Shamans, faith, prayer
• Other therapies
• Bioelectromagnetics, detoxifying
therapies
• Animal-assisted therapy

Table 10.1 Complementary and Alternative Therapies
continued on next slide

Table 10.1 (continued) Complementary and
Alternative Therapies

HerbsHerbs
• Technically a botanical without any
woody tissue such as stems or bark
• Meaning has changed to refer to any
plant product with some useful
application either as a food enhancer or
a medicine.
• Documented use for thousands of years

Table 10.2 Top-Selling Herbal Supplements

Table 10.2 (continued) Top-Selling Herbal
Supplements

Dietary and Herbal SupplementsDietary and Herbal Supplements
• Use waned with rise of pharmacology.
• Marketing, increased awareness, and
availability brought resurgence in
1970s.
• Majority of adult Americans take or
have taken botanicals on a regular
basis.

Aging PopulationAging Population
• Pain
• Arthritis
• Hormone-replacement therapy
• Prostate difficulty

High Cost of PrescriptionHigh Cost of Prescription
MedicationsMedications
• Leads patients to seek CAM therapies

Examples of HerbalExamples of Herbal
SupplementsSupplements
• Garlic
• Soy
• St. John's wort
• Cranberry
• Ginseng
• Bilberry

Active Ingredient(s) in HerbsActive Ingredient(s) in Herbs
• Usually found only in specific part of
the plant
• May have multiple active ingredients,
unlike most modern drugs
• Potency can depend on where herb was
grown or how it was grown or
harvested.

Active Chemicals in HerbsActive Chemicals in Herbs
• Work synergistically
• May not have same activity if isolated

Herbal FormulationsHerbal Formulations
• Two basic formulations: solid and liquid

Solid Formulations of HerbsSolid Formulations of Herbs
• Pills
• Tablets
• Capsules
• Salves
• Ointments

Liquid Formulations of HerbsLiquid Formulations of Herbs
• Tea
• Infusion
• Decoction
• Tincture
• Extract

Figure 10.2 Three different ginkgo formulations: tablets, tea bags, and liquid extract

Table 10.4 Diseases for Which Medical Consensus
Exists That Herbal Therapies May Be Useful

Dietary Supplement Health andDietary Supplement Health and
Education Act of 1994 (DSHEA)Education Act of 1994 (DSHEA)
• Regulatory act for dietary supplements
• Less rigid than the Food, Drug, and
Cosmetic Act (FDA)
• Dietary supplements are exempted
from FDA standards.
• Gives FDA power to remove products
considered harmful.

Food, Drug, and Cosmetic ActFood, Drug, and Cosmetic Act
Definition of Dietary SupplementsDefinition of Dietary Supplements
• Products intended to enhance or
supplement the diet:
– Botanicals
– Vitamins
– Minerals
– Metabolites

DSHEA WeaknessesDSHEA Weaknesses
• Not necessary to demonstrate
effectiveness prior to marketing
• Manufacturer not required to prove
efficacy or safety
• Labels not monitored for accuracy in
product amounts or claims of benefits
of product

Figure 10.3a Labeling of black cohosh: front label with general health claim

Figure 10.3b Labeling of black cohosh: back label with more health claims and FDA disclaimer

Dietary Supplement and NonprescriptionDietary Supplement and Nonprescription
Drug Consumer Protection Act (2007)Drug Consumer Protection Act (2007)
• Companies must
– Include contact information on product
labels for reporting adverse events
– Notify the FDA of any serious adverse
event reports within 15 days of
receiving such reports
– Keep extensive records on reports

Further FDA RulesFurther FDA Rules
• Manufacturers of dietary supplements
required to evaluate the identity,
purity, potency, and composition of
their products and report on label

““Natural” Does Not AlwaysNatural” Does Not Always
Mean SaferMean Safer
• Some active chemicals are the same as
in prescription and OTC medications.
• Patient substituting alternative therapy
for established medical treatment may
prolong condition.

Nurse ResponsibilityNurse Responsibility
• Watch for herbal products with
ingredients that interact with
prescription drugs
• Ask questions and obtain medical
histories
• Pregnant/lactating women need
approval from health care provider.

Allergic ReactionsAllergic Reactions
• Natural products may contain several
chemicals or ingredients.
• Safer to begin with smaller doses

Seek Latest Medical InformationSeek Latest Medical Information
on CAMon CAM
• Keep current with updated information

Educate PatientsEducate Patients
• Strengths and weaknesses of CAM
• Encourage patients to seek information
from reputable sources
• Pregnant/lactating women should never
take supplements without approval
from health care provider.

Avoid False Hope of CureAvoid False Hope of Cure
• Ensure patients' understanding of uses
and limitations of CAM
• Encourage skepticism of claims on
manufacturer labels
• Never condemn a patient's desire to
use alternative therapies

Patient Health HistoryPatient Health History
• Aids in avoiding adverse reactions
• Aids in identifying drug interactions

Common Drug–Herb InteractionsCommon Drug–Herb Interactions
• Obtain patient's health history to
prevent drug–herb interactions

Table 10.5 Documented Herb–Drug Interactions

Table 10.5 (continued) Documented Herb–Drug
Interactions

Echinacea Traits (partial)Echinacea Traits (partial)
• Interacts with amiodarone and anabolic
steroids
• Results in possible increased
hepatotoxicity

Interactions with Feverfew,Interactions with Feverfew,
Ginger, and Ginkgo (partial)Ginger, and Ginkgo (partial)
• Aspirin
• Heparin
• NSAIDs
• Warfarin
• Results in possible increased bleeding
potential

Interactions with Garlic andInteractions with Garlic and
Ginseng (partial)Ginseng (partial)
• Insulin
• Oral hypoglycemic agents
• Results in increased hypoglycemic
effects

Interaction with Ginkgo (partial)Interaction with Ginkgo (partial)
• Anticonvulsants—decreased
effectiveness
• Tricyclic antidepressants—decreased
seizure threshold

Interactions with CNS DepressantsInteractions with CNS Depressants
• St. John's wort
• Ginseng
• Valerian
• Results in increased sedative effect

Specialty SupplementsSpecialty Supplements
• Nonherbal dietary products are used to
enhance a wide variety of body
functions.
• Occur naturally in the body
• Excessive amounts may have harmful
effects.
• Example—chondroitin and glucosamine
• Link with benefits is unclear.

Table 10.6 Selected Specialty Supplements

Standardizing Herbal ProductsStandardizing Herbal Products
• Attempts have been made to
standardize measurement of active
ingredient, but with no comprehensive
success yet.
• Uses marker substance such as percent
flavones in ginkgo
• Until science is better, it is best to
conceptualize the active ingredient of
an herb as being the entire herb itself.

Table 10.3 Standardization of Selected Herb Extracts

Figure 10.1a Two ginkgo biloba labels: note the lack of standardization in 60 mg of extract, 24% ginkgo
flavone glycosides and 6% terpenes

Figure 10.1b Two ginkgo biloba labels: note the lack of standardization in 50:1 ginkgo leaf extract, 24%
ginkgo flavone glycosides

Adams ch10 lecture

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