NMT150 Wk1

Antibiotic Pharmacology

• Antibiotic resistance is responsible for an estimated 2 million infections and 23,000 deaths per year in the United States.
• Approximately half of outpatient antibiotic prescribing in humans might be inappropriate, and at least 30% of outpatient antibiotic prescriptions in the United States are unnecessary.

Mechanisms of Antibiotic Resistance

• Modifications of the antibiotic molecule
• Decreased antibiotic penetration and efflux
• Changes in target sites
• Resistance due to global cell adaptations

Antibiotic Stewardship

• To measure antibiotic prescribing
• To improve antibiotic prescribing by clinicians and use by patients so that antibiotics are only prescribed and used when needed
• To minimize misdiagnoses or delayed diagnoses leading to the underuse of antibiotics
• To ensure that the right drug, dose, and duration are selected when an antibiotic is needed

Definitions

• Bactericidal: kills sensitive organisms so that the number of viable organisms falls rapidly after exposure
• Bacteriostatic: inhibits growth of bacteria but does not kill them

Antimicrobial Spectrum

• Narrow-spectrum: agent is active against a single species or limited group of pathogens
• Broad-spectrum: agent is active against a wide range of pathogens
• Extended-spectrum: agent falls in between (intermediate)

Mechanism of Action

• All beta-lactam antibiotics interfere with bacterial cell wall synthesis
• Inhibition of bacterial transpeptidase (also called penicillin-binding protein) which inhibits peptidoglycan cross-linking making cell wall synthesis impossible
• Generally confers bactericidal activity

Penicillin V

• Narrow-spectrum antibiotic
• Typically administered in an oral suspension
• Adverse effects: GI upset, nausea, vomiting, diarrhea, and rash
• Considered the drug of choice for Group A streptococcal pharyngitis

Penicillin V Dosing

• People over 27 kg: 300 mg TID or 600 mg BID PO for 10 days
• People 27 kg or under: 40 mg/kg/day divided BID or TID for 10 days with a maximum daily dose of 750 mg

Amoxicillin

• Extended-spectrum penicillin
• Essentially a modified version of penicillin that results in greater activity against additional gram-negative bacteria
• Generally well tolerated but can cause the same adverse effects as penicillin V
• Typically used more often as it is more palatable than penicillin V

Amoxicillin Dosing

• Dosed by body weight for all patients
• 50 mg/kg once daily or divided BID PO for 10 days with a maximum daily dose of 1000 mg

Cephalosporins

• A very large group of antibiotics
• The different generations are used to define their antimicrobial spectrum
• Have greater structural diversity which is more resistant to beta-lactamases and increases their range of antimicrobial activity

Cefadroxil

• A first-generation cephalosporin
• May be used if treatment failure with penicillin or in individuals with nonimmediate hypersensitivity to penicillins
• Adverse effects: GI upset, nausea, vomiting, diarrhea, hypersensitivity (some cross-reactivity with penicillins)

Cefadroxil Dosing

• Adults: 1 g/day PO as a single dose or divided BID for 10 days

Cephalexin

• A first-generation cephalosporin
• Same adverse effect profile as cefadroxil and may also be used if treatment failure with penicillins or in individuals with nonimmediate hypersensitivity to penicillins
• Also available as a suspension

Cephalexin Dosing

• Adults: 500 mg BID PO for 10 days
• Children: 40 mg/kg/day divided BID PO for 10 days with a maximum daily dose of 1000 mg

Protein Synthesis Inhibitors

• Prokaryotic ribosomes are composed of a 30S and 50S subunit
• Eukaryotic mRNA translation proteins are far more complex than those in prokaryotic cells

Macrolides

• Inhibit peptidyl transferase which functions to link amino acids together in the growing peptide chain
• Also interfere with translocation (movement of the nucleotide from the A position to the P position to allow for reading the next spot on the mRNA)
• Confers bacteriostatic activity

Azithromycin

• An alternative for patients who are allergic to penicillin
• Less likely than other macrolide antibiotics to interact with other drugs
• Adverse effects: GI upset, nausea, vomiting, diarrhea, rash, QTc interval prolongation

Azithromycin Dosing

• Adults: 500 mg PO for one day, then 250 mg PO daily for 4 days
• Children: 12 mg/kg PO for 5 days with a maximum daily dose of 500 mg

Clarithromycin

• An alternative for patients who are allergic to penicillin
• Same adverse effect profile as azithromycin
• Also available as a suspension
• Increases the levels of some common drugs like atorvastatin, lovastatin, simvastatin, and prednisone

Clarithromycin Dosing

• Adults: 250 mg BID PO for 10 days
• Children: 15 mg/kg/day divided BID PO for 10 days with a maximum daily dose of 500 mg

Lincosamides

• Interfere with translocation like macrolides but do not inhibit peptidyl transferase
• Approximately 4 times more likely to cause Clostridium difficile infections compared to other antibiotics
• Generally bacteriostatic but can be bactericidal at high doses

Clindamycin

• An alternative for patients who are allergic to penicillin
• May be used for treatment in symptomatic patients with multiple, recurrent episodes of pharyngitis
• Commonly causes diarrhea as an adverse effect
• Increased risk of C.difficile colitis

Clindamycin Dosing

• Adults: 300 mg TID PO for 10 days
• Children: 21 mg/kg/day divided TID PO for 10 days with a maximum daily dose of 900 mg

Group A Streptococcus Pharyngitis

• Antibiotic therapy is most beneficial for people who are at high risk of developing acute rheumatic fever and who have confirmed streptococcal infection
• Watchful waiting may be appropriate in patients at low risk for acute rheumatic fever as antibiotics have a minimal impact on the natural course of group A streptococcal pharyngitis
• Antibiotics reduce duration of symptoms by approximately 16 hours
• Given the small benefit, antibiotic therapy could be withheld for 48 – 72 hours in adult patients with more severe symptoms
• Antibiotic therapy is not generally recommended for mild cases

The Science of Safety

• Feelings of safety emerge from internal physiological states regulated by the autonomic nervous system (ANS).
• Humans are on a lifelong quest to feel safe, which is embedded in our DNA and serves as a profound motivator.

Polyvagal Theory

• The Polyvagal Theory, introduced by Stephen Porges, states that feelings of safety are the product of cues of safety, which downregulate autonomic states that support threat reactions and upregulate autonomic states that support interpersonal accessibility and homeostatic functions.

Neuroception

• Neuroception is a neural process that distinguishes environmental and visceral features that are safe, dangerous, or life-threatening.
• It is an individualized, subconscious process that determines our state of activation based on both external and internal cues.

Safety vs Stress

• Safety is not the absence of threat, but the presence of connection.
• The return to safety completes the natural stress cycle.
• The experience of safety can be described as a physiologic state, a perception, and a relational experience.

Importance of Secure Attachment

• Secure attachment in childhood provides a sense of trust and safety, leading to a positive sense of self and the ability to express needs and feelings.
• When adversity comes, the relationship provides safety, comfort, holding, and connection, allowing the child's brain and body to complete the natural stress cycle.

Effects of Adverse Childhood Experiences (ACEs)

• ACEs, developmental and relational trauma, and a lack of nurturing environment can lead to changes in the architecture of the brain and dysregulation of the ANS.
• This can result in numerous negative health outcomes.

Trauma and the Nervous System

• Trauma is an experience, not an event – it's our response to an event rather than the event itself.
• Trauma induces a defensive tensing of body and psyche, a constriction, and a triggering of pain out of keeping with the present stimulus.

Developmental Trauma

• Trauma can occur when a child's need for attuned attention and responsive interaction with the parent is unmet, even if there is no intentional abuse.
• Early experiences shape our lifelong view of the world and our unconscious window through which we see and understand our environment.

The Interconnection of Biological, Emotional, and Social Systems

• Our emotional system is inseparable from the physiological apparatus responsible for our nervous system, gut, immune defenses, and hormonal functioning.
• Social relationships impact our biological and emotional systems, as we are innately biopsychosocial creatures.

Healing from Trauma

• Trauma can be healed, and a trauma-informed perspective can support us in building healthy relationships with our patients.

Causes of Disease

• Identifying the cause of disease is crucial for the patient, as it allows for advice on how to avoid, minimize, or prevent its reoccurrence.
• The cause of disease is not just the diagnosis, but the underlying factors that led to the disharmony.
• Examples of causes of disease include dietary habits, lifestyle, relationships, environment, sleep, and physical exercise.

Balance as a Key to Health

• Balance is essential for maintaining health, and any long-term imbalance can become a cause of disease.
• Examples of imbalance include:
  • Too much rest (too little physical activity)
  • Too much physical activity
  • Too much work
  • Too much or inadequate sexual activity
  • Unbalanced emotions
  • Extreme climatic conditions

Internal Causes of Disease

• Emotional strain is a significant internal cause of disease.
• Internal emotions affect the internal organs first, whereas external causes of disease affect the Exterior first.
• Emotions include:
  • Anger
  • Joy
  • Sadness
  • Worry
  • Pensiveness
  • Fear
  • Shock

View of Emotions

• In Chinese Medicine, emotions can be a cause of disease, and emotional strain affects the internal organs.
• In Western Medicine, emotions affect the brain, which then sends impulses down the nervous system.

Effects of Emotions on Qi

• Each emotion has a specific effect on Qi:
  • Anger makes Qi rise
  • Joy slows Qi
  • Sadness dissolves Qi
  • Worry knots Qi
  • Pensiveness knots Qi
  • Fear makes Qi descend
  • Shock scatters Qi
• All emotions have a tendency to cause some stagnation of Qi after some time.

Emotions and Qi Stagnation

• When Qi stagnates, it may lead to Blood stagnation.
• Remember the relationship between Qi and Blood.

Specific Emotions

• Joy: Excessive excitement and craving, which disturbs the Mind and may even displace it from Heart Blood. Symptoms include palpitations, overexcitability, insomnia, restlessness, and a red tip on the tongue.
• Anger: Includes resentment, repressed anger, irritability, frustration, rage, hatred, indignation, animosity, or bitterness. Anger makes Qi rise and can cause symptoms such as headaches, dizziness, tinnitus, neck stiffness, red blotches on the front part of the neck or a red face.
• Sadness: Weakens the Lungs, affects the Heart, and can cause symptoms such as breathlessness, tiredness, a feeling of discomfort in the chest, depression, or crying.
• Worry: Knots Qi, affects both Lungs and Spleen, and can cause symptoms such as an uncomfortable feeling in the chest, slight breathlessness, tensing of the shoulders, dry cough, weak voice, sighing, and a pale complexion.
• Pensiveness: Similar to worry, includes brooding, constantly thinking about certain events or people, nostalgic hankering after the past, and excessive mental work. Symptoms include poor appetite, epigastric discomfort, abdominal pain, distension, tiredness, and a pale complexion.
• Fear: Includes chronic fear and anxiety and sudden fright. Fear depletes Kidney Qi, makes Qi descend, and can cause symptoms such as nocturnal enuresis in children and incontinence of urine or diarrhea in adults.
• Shock: Suspends Qi, affects Heart and Kidneys, and can cause symptoms such as palpitations, breathlessness, and insomnia.

External Causes of Disease

• External Pathogenic factors: Cold, Heat, Wind, Dampness
• Bacteria and viruses in relation to ‘Wind’
• Climate as a cause of disease
• Climatic factors as patterns of disharmony
• Artificial ‘climates’ as causes of disease
• Fever

Introduction to Traditional Chinese Medicine (TCM)

• This e-learning series reviews NMT100, covering Yin and Yang, Vital Substances, and 5 Elements.
• The course is divided into 12 weeks, covering TCM theories, organ functions, and point actions.

Yin and Yang

• Yin (陰) represents overcast weather, feminine, moon, cloudy, and negative electrical charge.
• Yang (陽) represents positive electrical charge, sun, and masculine.
• Yin is associated with material, descending, producing form, and growing below, while Yang is associated with immaterial, rising, producing energy, and generating above.

Functions of Yin and Yang

• Yin functions: cooling, nourishing, providing space for rest, and creating space for conception.
• Yang functions: warming, transforming, protecting, moving, and holding.

Qi (氣)

• Qi is the root of the human body, essential for growth and development.
• Qi functions: promoting, warming, defending, checking, nourishing, and Qi Hua (organ function).

Types of Qi

• Yuan Qi (Source Qi)
• Gu Qi (Food Qi)
• Zong Qi (Gathering Qi)
• Ying Qi (Nutritive Qi)
• Wei Qi (Protective Qi)
• Zang-Fu (Organ) Qi

Blood

• Formed from Food Qi, acted upon by Yuan Qi, and completed by the Heart.
• Blood functions: nourishment, moisture, movement of eyes and limbs, nourishing hair, sinews, bones, and bowels, and housing the mind.

Blood and Organs

• The Heart governs Blood creation.
• The Spleen supports keeping Blood in its place.
• The Liver stores Blood.

5 Element Theory

• Generating Cycle: Wood creates Fire, Fire creates Earth, Earth creates Metal, Metal creates Water, and Water creates Wood.
• Controlling Cycle: Fire controls Metal, Earth controls Water, Metal controls Wood, Water controls Fire, and Wood controls Earth.
• Insulting Cycle: opposite of the controlling cycle, occurring when an element is weaker than its controller.

5 Element Chart

• Element: Wood, Fire, Earth, Metal, Water
• Yin Organs: Liver, Heart, Spleen, Lung, Kidney
• Yang Organs: Gall Bladder, Small Intestine, Stomach, Large Intestine, Bladder
• Seasons: Spring, Summer, Between Seasons, Fall, Winter
• Colours: Green, Red, Yellow, White, Black
• Senses: Eyes, Tongue, Mouth/Lips, Nose, Ears
• Tissues: Sinews, Vessels, Muscles, Skin, Bones
• Emotions: Anger, Joy, Worry, Sadness, Shock/Fear
• Taste: Sour, Bitter, Sweet, Pungent, Salty

Naturopathic Therapeutics - Putting it Together

• Review framework of delivery and expectations for Thursday 'Putting It Together' sessions
• Active learning session to review, consider, and apply weekly material
• Collaborate with colleagues, learn from each other's perspectives, and review considerations for a comprehensive Naturopathic treatment plan

Thursday Sessions

• Provide a ND clinician's perspective and clinical considerations
• Translate learned concepts into practical application for future patients
• Ask questions and offer an opportunity for integration and application of lessons
• Support success of open-book, formative quizzes

Key Take-Aways

• Respect different approaches and acknowledge own biases and assumptions
• Recognize that knowing how to advise patients is just as important as knowing the treatment itself

Evidence-Based Practice

• Image source: https://uha.blob.core.windows.net/accelerate/attachments/ck4ae1b6v0nu70no6hzxsxe71-ebp-header-01.0.125.1000.500.full.png

Patient-Centered Care

• Image source: https://www.saintelizabeth.com/getmedia/3b053be0-3313-45e5-8aea-872781c0b76d/Practical-Guide-for-Implementing-PCC-Education-for-PSWs-October-2013.pdf.aspx

Evidence Pyramid

• Image source: https://library.triton.edu/c.php?g=433673&p=3720267

Treatment Plan

• Necessary elements:
  • Practitioner's contact information
  • Date
  • Patient's name
  • Treatment suggestions with clear rationale, expected benefit, possible side effects, cost, alternatives, and risk of not treating
• Treatment goals
• Modalities considered
• 3 treatment recommendations (herbs, supplements, etc.)
• Nutritional guidance
• Lifestyle guidance
• Collaborative care/medical guidance
• Follow-up considerations

Guiding Principles of Naturopathic Medicine

• First, do no harm
• The Vis (stimulate and support immune function)
• Treat the whole person
• Identify and address the root cause
• Doctor as teacher
• Prevention and health promotion

Scenario: Suggest Top 3 EBM Treatment Suggestions

• Work in groups to discuss and design a treatment plan
• Be ready to present with rationale
• Consider different scenarios:
  • 5-year-old child patient
  • Unvaccinated 10-year-old patient
  • Patient with a vegan diet

Lifestyle and Health Promotion

• Sleep and immune function:
  • Sleep supports innate and adaptive immunity
  • Increased production of cytokines at night to support recovery
  • Helps strengthen immune memory
• Stress and immune function:
  • Temporal parameters of stressors can elicit beneficial changes in immune system
  • Chronic stress can affect immune system in a detrimental way
• Individual assessment of sleep quantity and quality, as well as management of life stressors, can lead to other treatment goals and meaningful approaches to care

Salt Water Gargle

• A form of self-care, at-home hydrotherapy
• Highly accessible and cost-effective
• Safe for various causes of sore-throat
• Symptomatic relief with anti-inflammatory effect, while addressing infection by changing pH of environment
• Recipe: ½ tsp salt + 8 oz water

Nutrition for Immune Support and Healthy Function

• Considerations for providing nutritional guidance include sugar intake, protein intake, honey, probiotics, vitamins D and C, and zinc.

Treatment Goals

• Reduce uncomfortable symptomatic experience
• Reduce severity and duration of illness
• Support full recovery
• Prevent sequela
• Prevent re-occurrence following resolution

Dietary Sugar

• Excessive sugar intake can have a deleterious effect on immune function, especially when fighting a bacterial infection
• Sugar intake can lead to: • Pro-inflammatory proteins (TNF-alpha, CRP, IL-6) • Changes to the microbiome • Decreased phagocytic capacity of neutrophils (function not number was altered) • Effects can last up to 5 hours

Reducing Sugar Intake

• Eat whole fruits or blended in smoothies for natural sweetness
• Fill up with whole fruits, vegetables, healthy protein, fiber, and complex carbs
• For a sore throat, try making a homemade iced lolly made from herbal tea and lemon instead of ice cream

Dietary Protein

• A deficiency in dietary protein/amino acids impairs immune function and increases susceptibility to infection
• Amino acids are important for: • Activating T-lymphocytes, B-lymphocytes, NK cells, and macrophages • Lymphocyte proliferation • Production of antibodies and cytokines

Ensuring Enough Protein

• Review typical diet to see if meeting dietary goals, consider increasing dietary protein with: • Homemade bone broth and homemade chicken noodle soup • Congee made with bone broth, added chicken/eggs • Rice and lentils • Homemade Jell-O/protein smoothie

Honey for Healing

• Natural antimicrobial properties
• Decreases inflammation
• Symptomatic management by easing discomfort
• Not for infants under 1 year old due to the risk of Clostridium botulinum
• Try as: lemon and honey tea, iced lolly, lozenge

Probiotics

• Supports healthy microbiome, especially with/ following antibiotic use
• Safe and well-tolerated
• Streptococcus salivarius K12 (SsK12) may offer specific support with Strep throat infection, but more research is needed

Vitamin D

• Vitamin D supplementation has been shown to enhance neutrophil killing of pathogenic streptococcal bacteria
• Vitamin D supplementation also dampens excessive inflammatory responses and apoptosis
• Vitamin D has chemotherapeutic potential against streptococcal infections

Vitamin D Supplementation

• Active form: Vitamin D3 (cholecalciferol)
• Fat-soluble vitamin, liquid/gel cap formula taken with food/main meal
• Can dose appropriate to Vitamin D status if known
• Over 2,500 IU Vitamin D3 = Rx in Ontario (Over 1,000 IU in BC)
• Given clear directions with dose and duration, too much can lead to toxicity

Vitamin C

• The total efficacy, the time for symptom amelioration, and the time for healing were better with vitamin C supplementation than with antiviral therapy alone
• Vitamin C could be used as a supplementary therapy along with antiviral regimens to relieve patients from symptoms of the common cold
• Upper tolerable intake level (UL) for vitamin C is 2 g/d
• Most common adverse effects of high doses of oral vitamin C are gastrointestinal

Vitamin C and Uric Acid

• Increasing vitamin C intake does cause an increase in the urinary excretion of uric acid
• A large 20-year prospective study showed a decreased risk of gout with increased vitamin C intake from both food and supplemental sources

Zinc

• Zinc has been evaluated as a potential treatment for the common cold
• Zinc was found to shorten the duration of cold symptoms compared to placebo
• Zinc was more effective in adults than in children
• Adverse events such as bad taste and nausea were more common in the zinc group than in the placebo group

Health Canada and NHPS

• Proper manufacturing – without contamination and incorrect ingredients
• Appropriate labelling
• Supported health claims
• 8 Digit NPN, or DIN-HM

Herbal Remedies for Strep Throat

• H E M P formula: a classic formula used for infections, including strep throat, containing Goldenseal, Echinacea, Myrrh, and Phytolacca (Poke root)
• Goldenseal:
  • Latin name: Hydrastis canadensis
  • Family: Ranunculaceae
  • Part used: Root
  • Actions: Antimicrobial (Antibacterial, Antiviral, Antifungal, Antiparasitic), Digestive bitter
  • Main indications: Inflammation and infections of the respiratory tract, gastrointestinal tract
  • Phytochemicals: Isoquinoline alkaloids (berberine, hydrastine), Flavonolignans
  • Safety: Contra-indications: Gastritis & stomach ulcers, obstructed gallbladder; Side-Effects: May cause GI irritation leading to nausea, vomiting, and diarrhea; Pregnancy & lactation - unsafe
• Echinacea:
  • Latin name: Different species are used, including Echinacea purpurea, Echinacea angustifolia, and Echinacea pallida
  • Family: Asteraceae
  • Part used: Root and Herb
  • Actions: Immuno-stimulant
  • Main indications: Strep throat, Prevent and treat the common cold, flu, and upper respiratory tract infections (URIs), Vaginal candidiasis, Urinary tract infections
  • Phytochemicals: Alkylamide, Phenolics: Caffeic acid derivatives (Echinacoside), Polysaccharides, Ketoalkenes
  • Safety: Caution: auto-immune disease (Theoretical); Pregnancy & lactation - safe
• Myrrh:
  • Latin name: Commiphora myrrha
  • Family: Burseraceae
  • Part used: Resin
  • Actions: Antimicrobial (Antibacterial, Antiviral, Antifungal, Antiparasitic), Analgesic, Expectorant, Astringent
  • Main indications: Tonsilitis, Gingivitis
  • Phytochemicals: Oleoresin, Sesquiterpenes (Furanosesquiterpenoids)
  • Safety: Pregnancy - not recommended
• Poke Weed:
  • Latin name: Phytolacca americana
  • Family: Phytolaccaceae
  • Part used: Root
  • Main indications: Lymphadenopathy, Infections associated with swollen lymph nodes
  • Phytochemicals: Unknown
  • Safety: Unknown

Essential Oils

• Thyme & Oregano:
  • Steam distillation: extraction process that allows one to obtain pure essential oils from a plant
  • Thyme and Oregano essential oils are rich in monoterpenes (thymol, carvacrol) that inhibit Streptococcus pyogenes
• Research:
  • In vitro trials: tested individual herbs for antibacterial properties
  • Only Hydrastis had antibacterial activity against gram-negative Staphylococcus epidermis
  • Other herbs had no antibacterial activity

References

• Books:
  • Barnes J, Anderson LA, Phillipson JD. Herbal Medicines, 3rd ed. London: Pharmaceutical Press, 2007
  • Bone K. Principles and Practice of Phytotherapy. Edinburgh: Churchill Livingstone, 2000
  • Felter HW, Lloyd JU. King's American Dispensatory. 1898
  • Hoffman D. Medical Herbalism. Rochester, Vermont: Healing Arts Press, 2003

Materia Medica

• Aims to outline the main keynotes of 60 remedies, including major polychrests and frequently prescribed remedies in acute cases.

Keynotes of a Remedy

• Symptoms strongly associated with the general trends and features frequently seen in a remedy
• May include Characteristic Symptoms (SRP symptoms, for Strange-Rare-Peculiar) and affinities of a remedy or be common
• Usually accented with CAPITAL LETTERS, bold letters, italics, or color (especially online)

Sulphur

• Skin: itchy, red orifices, and burning
• Back: pain from standing, slouches, and stooped
• Mind: opiniated, critical, and independent

Belladonna

• Violence of attack and suddenness of onset
• Associated with:
  • Hot, red skin
  • Flushed face
  • Glaring eyes
  • Throbbing carotids
  • Excited mental state
  • Hyperesthesia of all senses
  • Delirium
  • Restless sleep
  • Convulsive movements
  • Dryness of mouth and throat with aversion to water
  • Neuralgic pains that come and go suddenly
• Symptoms:
  • Throat pain that usually comes on quickly
  • Painful swallowing
  • Red and swollen tonsils, sometimes with white patches or streaks of pus
  • Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate)
  • Swollen, tender lymph nodes in the neck
  • Fever
  • Headache
  • Rash
  • Nausea or vomiting, especially in younger children
  • Body aches

Belladonna (Atropa b., Deadly Nightshade)

• Solanaceae (nightshade) family
• Affinity:
  • Brain, head
  • Cardiovascular system
  • Fevers
  • Sudden intense symptoms, acute, appear and disappear suddenly
  • Mental/emotional symptoms:
    • Lively, vibrant personality, with sudden fits and tantrums
    • Tries to run away, hide from hallucinations during fevers or nightmares
    • Wild expression and eyes, dilated pupils, shiny glassy eyes when sick

Belladonna General Symptoms

• Pains: throbbing, pulsating, hammering, bursting, stabbing, burning
• Heat, redness, inflammation, congestion (head, lungs)
• Dryness
• No thirst, in fever, or constant desire to drink
• Modalities:
  • Worse: afternoon, night, motion, jar, light touch, draft, walking in wind, shiny bright objects, light, noise, right side
  • Better: leaning head against something, bending the part back or inward, while standing, in bed, in morning, with warmth

Gelsemium

• Mucous membranes
• CNS/motor nerves
• Symptoms:
  • Flu-like symptoms
  • Weakness
  • Infectious mononucleosis
  • Trigeminal neuralgia
• General symptoms:
  • Gradual onset of complaints
  • Muscular weakness
  • Muscle aches, soreness, pain, heaviness
  • Thirstlessness
  • "Droopy, dizzy, drowsy, and dull"
• Modalities:
  • Better: open air, closing the eyes, bending forward
  • Worse: in sun, heat, summer, damp weather, before thunderstorm, from bad news, emotions, excitement, periodically
• Mental symptoms:
  • Anticipatory anxiety
  • Stage fright
  • Examination funk
  • Timidity in public
  • Cowardice
  • Diarrhea from fear

Gelsemium Differential...Baptisia Tinctoria

• Very weak with a URTI and high fever, can progress very fast
• Symptoms:
  • Confusion
  • Intoxicated feeling
  • Body delusions
  • Canker sores and diarrhea
  • Better: indoors, drinking liquids
  • Worse: cold, open air, walking, eating solids

Allium Cepa (Red Onion)

• Affinity: mucous membranes (nose, eyes, larynx, bowels) and nerves
• Keynote: nasal discharge is acrid and burns the nostrils and upper lip area, but the tears are bland
• Symptoms:
  • Sore throat: burning
  • Lump in the throat
  • Larynx: tickling, pain from coughing
  • Hoarseness
  • Headache: worse from closing the eyes
• Mind:
  • Groggy
  • Sleepy
  • Lethargic
  • Indifferent
  • Dull
  • Lack of motivation
• General symptoms:
  • Left side, or left to right
  • Neuralgic pains after surgery/amputation/injury
  • Shooting pains, following a thin line
• Modalities:
  • Worse: warm room, spring and fall, flowers, evening, cucumber
  • Better: in fresh air (not too cold), onions (may crave)

Pharmacology

• The study of drugs and their effects on life, considering "drugs" as any exogenous chemical.
• The goal of pharmacology is to understand the mechanisms by which drugs interact with biologic systems.

Absorption

• Drugs need to get from the site of administration to a target tissue.
• Most drugs are absorbed by passive diffusion.
• Some drugs use physiological transport processes.
• Absorption is dependent on the route of administration.

Effect of pH

• Many drugs are weak acids or bases.
• Only non-ionized forms of drugs can easily pass through a lipid bilayer.
• The digestive tract has two significant pH compartments: stomach (pH ~1) and small intestines (pH ~7).

Bioavailability

• The fraction of the administered dose of a drug that reaches the systemic circulation in an active form.
• Influenced by several factors.
• Intravenously administered drugs are 100% bioavailable by definition.

Distribution

• Influenced by size of the organ, blood flow, drug solubility, and protein binding.

Metabolism

• Aka biotransformation, the enzyme-catalyzed conversion of drugs to their metabolites.
• Most of this takes place in the liver, but other organs also contain drug-metabolizing enzymes.
• The primary goal is to inactive or detoxify foreign substances and prepare them for excretion.

First Pass Effect

• Drugs absorbed via the gut reach the liver via the portal vein before entering the systemic circulation.
• The degree to which the drug is inactivated by liver enzymes prior to entering the systemic circulation substantially alters the drug's bioavailability.

Phase 1 Metabolism

• Primary goal is to introduce or open up a binding site for hydrophilic compounds to be added later by phase 2 mechanisms.
• Oxidative reactions by far the most common, primarily involving the microsomal cytochrome P450 (CYP450) system.

Phase 2 Metabolism

• Not all drugs require phase 1 metabolism prior to phase 2, but most do.
• These reactions essentially conjugate a water-soluble molecule to the spot opened up by phase 1 reactions.
• In many instances, this means conjugating something to an available hydroxyl group.

Enterohepatic Circulation

• Glucuronide conjugates are excreted in bile.
• Some commensal gut bacteria have glucuronidase enzymes that can cleave the glucuronide off the metabolite, resulting in the parent drug being reabsorbed.

Elimination

• Most water-soluble drug metabolites are excreted by the kidneys.
• Various mechanisms exist throughout the sections of the nephron.
• Lipid-soluble drugs are excreted in the distal tubule if they're small enough.
• Lipid-soluble drug metabolites and glucuronide-conjugates are excreted by the liver into bile and excreted in feces.

Pharmacodynamics

• The study of a drug's mechanism of action.
• Drug-receptor characterization and mechanics.
• Signal transduction mechanisms.

Definitions

• Agonist: a substance that initiates a physiological response when combined with a receptor.
• Antagonist: a substance that interferes with or inhibits the physiological action of another substance.
• Competitive: used to describe when two substances use the same binding site on a receptor.
• Allosteric: used to describe when a substance binds to a receptor away from an active binding site but still alters the physiological effect.

Measures of Safety

• Therapeutic Index (TI): a measure of a drug's safety, calculated as LD50 / ED50.
• LD50: the dose at which a drug causes death in 50% of individuals (animals).
• ED50: the dose at which a drug causes a therapeutic response in 50% of individuals (humans).

Prescribing Standards

• Generic name: the most suitable drug name to use, standard across all jurisdictions.
• Brand name: a registered trademarked name of a drug used in marketing.

Prescription Requirements

• Date
• Name and address of patient
• Name, strength, quantity, and form of drug or ingredient(s)
• Directions for use (include frequency or interval or maximum daily use)
• Refill authorization (number and interval between refills)
• Name and college ID of practitioner
• Signature of practitioner

Prescribing Standards

• It is generally advised to write full words as much as possible and to avoid abbreviations.
• Never abbreviate the drug name.
• Use generic names unless you specifically want a brand name drug dispensed.

Drug Charting

• Date
• Related subjective and objective symptoms
• Assessment
• Purpose and/or goal(s) of medication(s)
• Name, dose, dosage form, and quantity of medication prescribed
• Monitoring plan
• Informed consent