WRITE A REFLECTION AFTER VIEW THE PPTs

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1. Think back over the class meetings this past week and answer the following three questions. Your answer will be evaluated using the criteria given in the attached file. Please review the criteria before answering these questions.

Write your answers to the questions. The box will expand as you write.

1. What are the top 2 things or “ah ha” moments you took away from this week’s presentations? What sources of information or presentation sparked the “ah ha”? Why was each “ah ha” of interest, relevant, or how did it challenge your current beliefs?

2. How will these items be incorporated into your life or change you health?

3. What remaining questions do you have or what do you wish you learned?

Reflection Rubric Updated (2016)

CriteriaRatingsPts

This criterion is linked to a Learning OutcomeDescription of "ah ha" moments

4.0 pts

Two “ah ha” moments listed

2.0 pts

One "ah ha" listed

0.0 pts

Zero "aha ha" listed

4.0 pts

This criterion is linked to a Learning OutcomeSource

2.0 pts

Specifically identifies lecture or source of the information that sparked each "ah ha"

1.0 pts

Identified one source specifically and omits the other

0.0 pts

Omits sources for each "ah ha"

2.0 pts

This criterion is linked to a Learning OutcomeAnalysis

4.0 pts

Brief explanation about your reactions to EACH of the "ah ha" moments. For example how or why the item was a surprise, revelation, or challenge to previously held ideas/knowledge, etc.

2.0 pts

Only one "ah ha" was explained/analyzed

0.0 pts

No analysis/explanation

4.0 pts

This criterion is linked to a Learning OutcomeApplication

6.0 pts

How you might use or not use each "ah ha" immediately or in the future for yourself or others. If your "ah ha" doesn't lend itself to an application that you can see for yourself, another, or society, so state and explain your perception of such a limitation

3.0 pts

Application of one "ah ha."

0.0 pts

No applications noted

6.0 pts

This criterion is linked to a Learning OutcomeGrammar and Spelling

2.0 pts

Proper use of grammar and spelling

1.0 pts

Some grammar and spelling mistakes, but reflection is otherwise well-written

0.0 pts

Many grammar and spelling mistakes. Reflection is difficult to read

2.0 pts

This criterion is linked to a Learning OutcomeFollow-up Question

2.0 pts

Questions or items you wish you learned from this week listed

0.0 pts

No questions or items you wish you learned described

2.0 pts

Total Points: 20.0

Unformatted Attachment Preview

Herbs and Natural Remedies Gail D. Anderson PhD, RPh gaila@uw.edu 1 Alternative vs Complementary • Complementary Medicine – Used together with conventional medicine • Alternative Medicine – Used in place of conventional medicine 2 10 most common complementary health approaches among adults - 2012 Guided Imagery 1.7% Progressive relaxation 2.1% Homeopathy 2.2% Special diets Massge Meditation Chiropractic or Osteopathic Manipulation Yoga, Tai Chi, or Qi Gong Deep Breathing 3.0% 6.9% 8.0% 8.4% 10.1% 10.9% Natural Products Clarke TC et al. National Health Statisitcs Report 2015 17.7% 3 Types of Natural Products • • • • • • • • Herbals (botanicals) Vitamins and Minerals Probiotics Traditional Chinese Medicines Ayurvedic Medicines Homeopathic Medicines Functional Foods/Nutraceuticals Miscellaneous “natural” products (e.g. glucosamine melatonin ) 4 Dietary Supplements • No “therapeutic claims” unless approved by FDA • No “health claims” unless approved by FDA • Limited “structure/function” claims allowed if there is some evidence to support them. • FDA must show product is unsafe 5 Examples of Structure/Function claims • • • • • • • • • • Healthy heart Maintains a healthy circulatory system Promotes healthy joint cartilage Supports natural resistance against infection Restores normal bowel function Maintains intestinal health Helps to support your immune system Improves memory & concentration Enhances mental focus Helps you relax – For structure-function claims, label must have a disclaimer: “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease” 6 • Heidi is a 20 year old college student who develops a burning sensation while urination. • She is diagnosed with a urinary tract infection (UTI). A culture came back finding the presence of E.coli. • She is prescribed amoxicillin- 500 mg twice daily for 7 days. • This is her 3rd UTI and the last time she took amoxicillin she developed a yeast infection. • Heidi asked her pharmacist about drinking cranberry juice to treat the UTI instead of taking another antibiotic. 7 Cranberry “For urinary tract health” 8 Top 40 Selling Herbal Supplements in US Mainstream Multi-Outlet Channel in 2017 Rank Herbal % change from 2016 Rank Herbal % change from 2016 9% 13 Yohimbe -5% 1 Horehound* 2 Echinacea 23% 14 Saw Palmetto 11 % 3 Cranberry -8% 15 Elderberry 35% 4 Ivy Leaf 30% 16 Valerian -18% 5 Turmeric 47% 17 Milk Thistle 1% 6 Black Cohosh -11% 18 Garlic -1% 7 Garcinia -17% 19 Boswellia 10% 8 Green Tea -30% 20 Senna 18% 9 Ginger 5% 21 Ginkgo 2% 10 Fenugreek 34% 22 Cinnamon 11 Flaxseed/oil -11% 23 Rhodiola 12 Aloe 6% 24 Coconut Oil -13 % 8% -35% * Horehound is primary ingredient in many throat lozenges HerbalGram 2018:119:62-71 9 Cranberry Juice • 88% water and a mixture of organic acids, Vitamin C, flavonoids, anthocyanidins, catechins and triterpinoids. o The biological active sub-fraction of the cranberry is composed of 248 individual constituents. o Several proanthocyanidins are most likely the active compounds. • Due to the bitterness of the cranberry extract, cranberry juice is usually administered as cranberry juice cocktail. • The cocktail is a mixture of cranberry juice, sweetener, water and Vit C. • The cranberry juice cocktails contain a wide range of percent of cranberry concentrate (25% - 80%) which may contribute to the variability in the results of the clinical studies. • No widely accepted standardization for cranberry supplements. 10 Cranberry juice and Treatment of UTI? • There is no evidence for effectiveness in UTI treatment. – The in vitro antimicrobial activity has been tested against a wide variety of bacteria. – No useful antimicrobial activity has been found. 11 Cranberry and Prevention of UTI? Long history of use in the prevention of UTI • Bacterial infection o o o 50% of women experience at least one UTI in their lifetime. (50 fold predominance compared to adult men) Recurrent UTIs occur in 1/3 of all women after the first episode. Incidence in males increases with age > 65. • 70-95% of all uncomplicated UTIs caused by E.Coli o o The bacteria involved in UTI usually originates from the intestinal flora. Adherence to uroepithelium is first step in colonization and growth with infection. 12 Cranberry: Pharmacology • The mechanism of effect in UTI was initially thought to be urine acidification but large quantities of juice does not lower pH. • Cranberry appears to work by inhibiting the adhesion of uropathogenic E. coli (and possibly other pathogens also) to the uroepithelium, blocking colonization and the subsequent infection. o Adhesion inhibitors are known to be present in cranberry juice (CJ) but not in other juices. • Cranberry extracts have also been shown to inhibit growth and biofilm producing capability of Gram positive bacterial pathogens. • May have antioxidant and anti-inflammatory activity. 13 Cranberries for preventing urinary tract infections • • • Cochrane Review of 24 trials Both positive and negative studies were included Products studied – – – – Cranberry juice (11 studies) Cranberry tablets or capsules (9 studies) Liquid cranberry juice concentrate (2 studies) Comparative studies (2 studies) • Conclusion – Overall, cranberry products did not decrease the number of patients with UTI compared to placebo/control. – No increased risk of adverse effects. Jepson RG et al . Cochrane Database Syst Rev : 2012 10:CD001321 14 Cranberry: Summary • Efficacy – Conflicting evidence for benefit for UTI prevention – Limitations with variable “dose” and possibly inadequate dose may be responsible for the negative results found in most recent studies with standardized cranberry juice cocktail and capsules. • Products containing more than 36 mg of A-type proanthocyanidins may be efficacious. Look for standardized products if possible. • Safety – Good. However, adherence to the juice is poor (∼50% drop out); therefore cranberry extract may be preferable. 15 • Don has had at least one “cold” per quarter during his sophomore year, which aggravates his asthma symptoms. • His asthma treatment includes a daily inhaled corticosteroid and he uses an albuterol rescue inhaler as needed. • Don heard that using Echinacea extract 4 times daily would help prevent future colds. • He asked his pharmacist whether or not there is any benefit and/or risk when using Echinacea extract? 16 Echinacea Echinacea species are perennials that belong to the aster family (Asteraceae), native to mid-western North America. 17 Echinacea: Botanical Aspects • Nine related plant species identified and 3 are used medicinally – Echinacea angustifolia • Used first by Native Americans for several conditions including respiratory infections and snakebite poisoning. – Echinacea purpurea • Most commonly used species. • First cultivated by Madaus, an herbalist in Germany in 1938. – Echinacea pallida • Echinacea products are available commercially as tablets, capsules or liquid formulations. • Contain extracts from the whole plant or parts of plant (roots or aerial parts). 18 Echinacea: Use • Oral echinacea preparations are widely used in the US and Europe for the treatment and prevention of the common cold, influenza and other upper respiratory tract infections. • Topically, echinacea has been used for gingivitis, boils, abscesses, skin wounds and ulcers, burns, eczema, psoriasis, bee stings, snake and mosquito bites and hemorrhoids. 19 Top 40 Selling Herbal Supplements in US Mainstream Multi-Outlet Channel in 2017 Rank Herbal % change from 2016 Rank Herbal % change from 2016 1 Horehound 9% 13 Yohimbe -5% 2 Echinacea 23% 14 Saw Palmetto 11 % 3 Cranberry -8% 15 Elderberry 35% 4 Ivy Leaf 30% 16 Valerian -18% 5 Turmeric 47% 17 Milk Thistle 1% 6 Black Cohosh -11% 18 Garlic -1% 7 Garcinia -17% 19 Boswellia 10% 8 Green Tea -30% 20 Senna 18% 9 Ginger 5% 21 Ginkgo 2% 10 Fenugreek 34% 22 Cinnamon 11 Flaxseed/oil -11% 23 Rhodiola 12 Aloe 6% 24 Coconut Oil -13 % 8% -35% HerbalGram 2018:119:62-71 20 Echinacea: Pharmacology • In vitro and in vivo (cell and animal studies) – Immunomodulatory – Enhancement of macrophage function – Antiviral activity – Antifungal activity – Anti-inflammatory activity 21 Echinacea: Chemistry • Contains alkylamides, volatile oils, phenolic compounds (cichoric acid, caftaric acid, echinacoside) and high molecular weight polysaccharides – Phenols inhibits steps in the development of inflammation. – Cichoric acid has immunostimulatory properties. – Potential role of other components is unknown. • The 3 species contain varied amounts of each constituent depending on the plant part extracted and method of extraction. F. Toselli. Life Science 2009:85:97-106 22 Echinacea for prevention or treatment of the common cold? • Cochrane Review included 24 double blind placebo controlled trials with 4,631 participants with a variety of Echinacea preparations based on different species, parts of plants and extraction methods. No studies with multi-components were included. • Results – Prevention: A pooled post-hoc analysis suggests a relative risk reduction of 10-20%. – Treatment: Only 2 of 6 treatment trials found a difference in duration of cold. Therefore, the overall evidence of an effect of echinacea on treatment is weak. Karsch-Völk et al. Cochrane Database Syst Rev. 2014: DOI: 10.1002/14651858 23 Echinacea: Safety • Rare allergy – Risk of rash in children may outweigh benefit due to lack of evidence of treatment benefit in children. • There are a few case reports of echinacea induced hepatitis. • Theoretically, do not use in patients with conditions where immunomodulation may not be desirable, i.e. lupus, rheumatoid arthritis, cancer, HIV. No case reports suggesting safety issues. Heitmann et al. Eur J Clin Pharmacol 2016:72:623-630 24 Echinacea: Summary • Conflicting Clinical Efficacy Data and Conclusions – Cochrane Review: • Small preventative effect with a weak evidence of a possible effect on treatment of common cold. – Natural medicine: • Possibly effective for common cold • All other indications for echinacea have “insufficient reliable evidence to rate”. • Due to the different types (species) and parts (flowers roots, both) used and different manufacturing methods (drying, alcoholic extraction or pressing out juices), and combination products, it is difficult to draw strong conclusions about Echinacea effectiveness. 25 Echinacea: Summary • Product: Total phenolic compounds (∼ 4%) • Dosing – Depends on the formulation and product. – Refer to the doses/products used in positive studies. • Questions remaining include – Which product? Tincture? Tablets? Pressed juice? Softcaps? – Roots? Flowering tops? – E. purpurea? E. angustaifolia? E. pallida? 26 “Immune Support” 27 • Julie, an 18 year old college freshman, is struggling to adapt to living at the UW in the dorms. • She reports feeling depressed, having trouble sleeping and getting motivated enough to attend classes. • Her roommate suggests that she try St. John’s wort (SJW) 300 mg three times daily. • Her only other medications are a multi-vitamin and an oral contraceptive pill. • Julie asked her pharmacist, what are the risk/benefits of self-treating with SJW. 28 St. John’s Wort Hypericum perforatum Flowers and buds harvested early in the blooming season. Commercially available extracts are prepared by soaking dried, crushed flowers in methanol. 29 Top 40 Selling Herbal Supplements in US Mainstream Multi-Outlet Channel in 2017 Rank Herbal % change from 2016 Rank Herbal % change from 2016 25 Ginseng -3% 33 Wheatgrass/Barley 44% 26 Horney Goat Weed -2% 34 Bioflavonoid Complex -18% 27 Red Yeast Rice -5% 35 Yerba Mate -26% 28 Guarana -5% 36 Maca -26% 29 Fennel 7% 37 St. John’s wort -4% 30 Plant Sterols -28% 38 Horsetail -3% 31 Acai -20% 39 Chia -27% 32 Green Coffee -38% 40 Evening Primerose Oil -4% HerbalGram 2018:119:62-71 30 St. John’s Wort • Chemistry – Contains at least 10 active constituents that may contribute to anti-depressive activity. • Hypericin – Most common ingredient used for standardization • Hyperforin – Only ingredient found in brains of rodents after oral administration of alcoholic extract. • Flavonoids (i.e. quercitrin, rutin) 31 St. John’s Wort: Pharmacology Antidepressant activity has been demonstrated in different animal models of depression. — Studies in experimental models (in vitro and in vivo) have shown that the extract can: – Inhibit the uptake of norepinephrine, serotonin and GABA in CNS synapses in a concentration-related manner. – Be a non-selective inhibitor of monoamines. – Down-regulate β-adrenergic receptors. – Increase dopamine activity in pre-frontal cortex. – Modulate the L-glutamate pathway. – Interact with the neuroendrocrine system. — 32 St. John’s Wort: Evidence • Depression – Widely prescribed in Europe for depression – Commission E “approved” for psychological disturbances, depression, anxiety, nervous unrest; and topically as an oil for bruises, myalgia and burns. – Over 27 double-blind placebo-controlled trials have demonstrated an anti-depressive effect in mild to moderate depression. – However, a large NIH funded clinical trial comparing SJW, sertraline (Zoloft) and placebo in patients with major depression disorder failed to confirm efficacy. • Very large placebo rate. 33 The increasing placebo effect in clinical trials of major depression significantly reduces the power to determine whether or not an anti-depressant is effective. JAMA 2002:287:1840-47 34 St. John’s Wort: Safety • Photosensitivity – Has been shown in animal models – Clinically, high dose and female sex are risks factors – Is not a problem at usual doses:
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Excellent resource! Really helped me get the gist of things.

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