Herbal and Dietary Supplement Therapy Chapter 48 Herbal and Dietary Supplement Therapy Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 48 Lesson 48.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives Describe the possible impact of the use of herbal and dietary supplement products on cultural/ethnic beliefs Summarize the primary actions, uses, and interactions of the herbal and dietary supplement products cited Self-care and alternative therapies are very popular. There are more than 250 herbal medicines. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Herbal and Dietary Supplements “All natural” is NOT synonymous with “better” Some herbal medicines/supplements are harmful Adverse effects Drug interactions Most have been used for centuries. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Dietary Supplement Health and Education Act of 1994 Almost all herbal medicines, vitamins, minerals, amino acids for health reclassified as “dietary supplements,” a food category Allows manufacturers to include information about products’ effects on the body on labels and in advertisements Must state that product is not evaluated by FDA Does not stop others from making claims Intent of DSHEA was to ensure that safe and appropriately labeled products remain available to consumers who want to use them. Anyone can make claims of therapeutic value; most claims are unproven. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Dietary Supplements Herbal medications, vitamins, minerals, amino acids, other chemicals used for health reclassified No safety, effectiveness requirements Vast majority of claims unproven No standardized manufacturing requirements Several organizations test for labeled potency, good manufacturing practices, and contamination—not safety or effectiveness National Sanitation Foundation (NSF) International began testing dietary supplements in 2003. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Label Certification A, From ConsumerLab.com; B, from NSF International; C, from U.S. Pharmacopeia. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Role of Health Care Professional Moral, ethical responsibility to recommend only medicines proven safe and effective Factors to consider Most supplements not scientifically tested Consumers may be misinformed Supplements cannot cure serious conditions Quality control is deficient Exercise caution for pregnant or pediatric patients Watch for adverse effects Examine label carefully Be aware of a medicine’s legal versus popular use. Reliable resources specific to dietary supplements are widely available, as are peer-reviewed journal articles. Knowledge should be based on current scientific information. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Assessment Discuss patient’s reasons for interest and/or use Obtain list of patient symptoms and information about changes in symptoms since supplement use Find out source of recommendation Obtain complete list of all medications Determine cultural/ethical beliefs contributing to supplement use decision Discuss cultural and ethnic beliefs with patient Dietary supplements are affected by religious beliefs also (e.g., many Muslims prefer alcohol-free products). Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Patient Education Expectations of therapy Discuss medication information Ensure understanding of proper use Promote the development and maintenance of a written record of monitoring parameters Complete the Premedication Data column of the patient self-assessment form to track response to drug therapy Enhanced compliance is based on belief in the prescribed regimen. Disclosure of taking dietary supplements before surgical procedures is extremely important. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Herbal Therapy Aloe Black cohosh Chamomile Echinacea Ephedra Topically for pain, inflammation, itching Black cohosh Reduce symptoms of PMS, dysmenorrhea, menopause Chamomile Anti-inflammatory and antispasmodic effects Echinacea Nonspecific immunostimulant Ephedra Bronchodilator, nasal decongestant Aloe may have hypoglycemic effects. Echinacea may interfere with immunosuppressive therapy. Ephedra is contraindicated in patients with heart conditions, hypertension, diabetes, and thyroid disease. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Herbal Therapy (cont’d) Feverfew Reduce frequency and severity of migraines Garlic Lower serum cholesterol and triglycerides Ginger Alleviate nausea and vomiting Ginkgo Treat short-term memory loss, headache, dizziness, tinnitus, emotional instability Ginseng Unsubstantiated claims to increase resistance to stress and disease Feverfew, garlic, ginger, and ginkgo reduce platelet aggregation. Ginseng may affect platelet aggregation and blood coagulation. Ginkgo is often used by geriatric patients. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Herbal Therapy Goldenseal Green tea Saw palmetto St. John’s wort Antiseptic and astringent Green tea Improve cognitive performance Saw palmetto Reduce DHT levels associated with BPH St. John’s wort Treat mild depression; wound healing Valerian Used for restlessness, promotes sleep Goldenseal may have weak antibacterial properties and may stimulate the immune system to help fight a cold. Watch for serotonin syndrome with St. John’s wort. Do not confuse valerian with valium. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Other Dietary Supplements Coenzyme Q10 Creatine Gamma-hydroxybutyrate (GHB) Lycopene Melatonin Policosanol Omega-3 fatty acids S-adenosylmethionine (SAM-e) Creatine is used as a performance enhancing substance. GHB (“rave drug”) can cause death, and was banned by the FDA in 1990. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.