NMT150 Wk1

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Questions and Answers

What is the recommended dose of Clindamycin for children with difficile colitis?

10 mg/kg/day divided TID PO for 10 days

15 mg/kg/day divided TID PO for 7 days

30 mg/kg/day divided TID PO for 5 days

21 mg/kg/day divided TID PO for 10 days with a maximum daily dose of 900 mg (correct)

Who benefits the most from antibiotic therapy for Group A streptococcal pharyngitis?

Only patients with severe symptoms

All patients with Group A streptococcal pharyngitis

Patients at high risk of acute rheumatic fever (correct)

Patients at low risk of acute rheumatic fever

By how many hours do antibiotics reduce the duration of symptoms in Group A streptococcal pharyngitis?

72 hours

16 hours (correct)

24 hours

48 hours

What is the primary goal of antibiotic therapy in Group A streptococcal pharyngitis?

To prevent acute rheumatic fever Signup and view all the answers

In which patients is watchful waiting an appropriate approach for Group A streptococcal pharyngitis?

Patients at low risk of acute rheumatic fever Signup and view all the answers

What is the recommended duration of antibiotic therapy for difficile colitis?

10 days Signup and view all the answers

What is the maximum daily dose of Clindamycin for children with difficile colitis?

900 mg Signup and view all the answers

In which cases is antibiotic therapy not generally recommended for Group A streptococcal pharyngitis?

Mild cases Signup and view all the answers

For how long can antibiotic therapy be withheld in adult patients with severe symptoms of Group A streptococcal pharyngitis?

48 – 72 hours Signup and view all the answers

What is the recommended dose of Clindamycin for adults with difficile colitis?

300 mg TID PO for 10 days Signup and view all the answers

What happens when our early environment is unreliable or hurtful?

We develop a limited view of the world, perceiving threat even when there isn't any Signup and view all the answers

What is the relationship between our emotional system and physiological apparatus?

They are inseparable and impacted by our social relationships Signup and view all the answers

What is the impact of our social relationships on our emotional system and physiological apparatus?

They have a significant impact on our emotional system and physiological apparatus Signup and view all the answers

What is the perspective of Dr. Gabor Maté on trauma?

Trauma can be healed, and it is a wound that can be addressed Signup and view all the answers

What is the benefit of taking a trauma-informed perspective in healthcare?

It supports the development of healthy relationships with patients Signup and view all the answers

What is the impact of adverse childhood experiences (ACEs) on our health?

They have a significant impact on our health, leading to increased stress and trauma Signup and view all the answers

What is the role of social relationships in our biopsychosocial functioning?

They are a crucial component of our biopsychosocial functioning, influencing our emotional, social, and physical health Signup and view all the answers

What is the key to understanding our biopsychosocial functioning?

Recognizing the interconnection between our biological, emotional, and social functioning Signup and view all the answers

What is the consequence of developing a limited view of the world due to an unreliable or hurtful early environment?

We are more likely to perceive threat even when there isn't any Signup and view all the answers

What is the importance of considering the impact of our early environment on our view of the world?

It is very important, as our early environment can shape our perception of threat and safety Signup and view all the answers

What is pensiveness characterized by?

Constantly thinking about certain events or people Signup and view all the answers

What does fear deplete in the body?

Kidney Qi Signup and view all the answers

What is the effect of mental shock on the body?

It depletes Heart Qi Signup and view all the answers

What are external pathogenic factors that can cause disease?

Cold, Heat, Wind, Dampness Signup and view all the answers

What is the concept in TCM that is equivalent to bacteria and viruses in Western medicine?

Wind Signup and view all the answers

What is the effect of fear on Qi?

It makes Qi descend Signup and view all the answers

What is the effect of mental shock on the Heart?

It makes the Heart smaller Signup and view all the answers

What is a characteristic of pensiveness?

Nostalgic hankering after the past Signup and view all the answers

What is the relationship between fear and Kidney Qi?

Fear depletes Kidney Qi Signup and view all the answers

What is the concept in TCM that is related to climate and weather?

Wind Signup and view all the answers

What is the controlling element of Metal?

Water Signup and view all the answers

Which element is associated with the season of Spring?

Wood Signup and view all the answers

What is the result of an element 'back-lashing' its controller?

Insulting cycle Signup and view all the answers

Which organ is associated with the Fire element?

Heart Signup and view all the answers

What is the emotion associated with the Water element?

Fear Signup and view all the answers

What is the relationship between Fire and Earth?

Fire is the mother of Earth Signup and view all the answers

Which element is associated with the taste of Sour?

Wood Signup and view all the answers

What is the result of Water controlling Fire?

Fire becomes weaker Signup and view all the answers

Which element is associated with the sense of Hearing?

Ears Signup and view all the answers

What is the colour associated with the Earth element?

Yellow Signup and view all the answers

What is the role of sleep in immune function?

It strengthens immune memory and supports innate and adaptive immunity Signup and view all the answers

What is the effect of chronic stress on the immune system?

It can have a detrimental effect Signup and view all the answers

What is the benefit of salt water gargle?

It has an anti-inflammatory effect and changes the pH of the environment Signup and view all the answers

Why is individual assessment of sleep quantity and quality important?

It can help identify obstacles to health and healing Signup and view all the answers

What is the impact of chronic stress on the immune system?

It affects multiple components of the immune system in a detrimental way Signup and view all the answers

What is the role of sleep in cytokine production?

It increases cytokine production at night to support recovery Signup and view all the answers

Why is individual assessment of stress management important?

It can help identify obstacles to health and healing Signup and view all the answers

What is the importance of considering sleep and stress in patient care?

It is important for all patients to identify obstacles to health and healing Signup and view all the answers

What is the effect of sleep on immune memory?

It strengthens immune memory Signup and view all the answers

What is the benefit of salt water gargle in addressing infection?

It changes the pH of the environment to combat infection Signup and view all the answers

What was the mean difference in days for the shortening of cold symptoms in adults when taking zinc compared to placebo?

-2.63 days Signup and view all the answers

What is an important consideration when making a dietary treatment recommendation?

All of the above Signup and view all the answers

What is a requirement for natural non-prescription products in Canada?

8 Digit NPN or DIN-HM and proper manufacturing Signup and view all the answers

How many trials were included in the meta-analysis evaluating zinc as a treatment for the common cold?

17 trials Signup and view all the answers

What was the mean difference in days for the shortening of cold symptoms in children when taking zinc compared to placebo?

-0.26 days Signup and view all the answers

What is a common adverse event associated with taking zinc for the common cold?

Bad taste Signup and view all the answers

What is the source of the information on natural non-prescription products in Canada?

Health Canada Signup and view all the answers

What is the total number of participants in the meta-analysis evaluating zinc as a treatment for the common cold?

2121 participants Signup and view all the answers

What is the overall effect of zinc on the duration of cold symptoms?

Zinc shortens cold symptoms Signup and view all the answers

What is a key consideration in making a dietary treatment recommendation?

All of the above and individual preferences Signup and view all the answers

According to the HEMP formula study, which herb demonstrated antibacterial activity against gram-negative Staphylococcus epidermidis?

Hydrastis Signup and view all the answers

What is the active compound in Goldenseal that inhibits Streptococcus pyogenes?

Berberine Signup and view all the answers

Which of the following herbal extracts has been shown to inactivate Streptococcus pyogenes?

Echinacea purpurea Signup and view all the answers

Which herb was not found to have antibacterial activity in the study?

Poke weed Signup and view all the answers

What is the active compound in Usnea that inhibits Streptococcus pyogenes?

Usnic acid Signup and view all the answers

Which of the following herbs has been shown to exhibit antibacterial activity against Streptococcus mutans, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumonia?

Myrrh Signup and view all the answers

Which of the following herbal oils has been shown to exhibit potent antibacterial activity against Streptococcus pyogenes?

Thyme oil Signup and view all the answers

Which of the following compounds is responsible for the antibacterial activity of Garlic?

Allicin Signup and view all the answers

Which herbal medicine book references the antibacterial properties of herbs?

Herbal Medicines, 3rd ed. Signup and view all the answers

Which of the following authors is associated with the book 'The Complete German Commission E Monographs'?

All of the above Signup and view all the answers

What is a characteristic of Baptisia tinctoria?

Patient feels confused, intoxicated, and has body delusions Signup and view all the answers

What is the key difference between Allium cepa and Euphrasia officinale?

Allium cepa has an acrid nasal discharge, while Euphrasia officinale has a bland nasal discharge Signup and view all the answers

What is the affinity of Allium cepa?

Mucous membranes and nerves Signup and view all the answers

What is the mental state of a patient who needs Allium cepa?

Groggy, sleepy, and lethargic Signup and view all the answers

What is the characteristic pain pattern of Allium cepa?

Shooting pains, following a thin line Signup and view all the answers

What is the effect of warm rooms on Allium cepa patients?

Aggravation of symptoms Signup and view all the answers

What is the modality of Allium cepa in terms of fresh air?

Better in fresh air Signup and view all the answers

What is the characteristic of Allium cepa's laryngeal symptoms?

Tickling and pain from coughing Signup and view all the answers

What is the characteristic of Allium cepa's headache?

Worsened by closing the eyes Signup and view all the answers

What is the effect of onions on Allium cepa patients?

Amelioration of symptoms Signup and view all the answers

What is the primary mechanism of excretion for lipid-soluble drug metabolites and glucuronide-conjugates?

Liver into bile and feces Signup and view all the answers

What is the term for a substance that initiates a physiological response when combined with a receptor?

Agonist Signup and view all the answers

What is the therapeutic index (TI) of a drug?

LD50 / ED50 Signup and view all the answers

What should be included in a prescription?

Date, patient's name, drug name, directions, and refill authorization Signup and view all the answers

Why is it recommended to use generic names when prescribing?

They are standard across all jurisdictions Signup and view all the answers

What should be avoided when writing prescriptions?

Using abbreviations Signup and view all the answers

What is the primary goal of a drug chart?

To outline the treatment plan and monitoring Signup and view all the answers

What is the term for a substance that interferes with or inhibits the physiological action of another substance?

Antagonist Signup and view all the answers

What is the term for when two substances use the same binding site on a receptor?

Competitive Signup and view all the answers

What is the term for when a substance binds to a receptor away from the active binding site, altering the physiological effect?

Allosteric Signup and view all the answers

Study Notes

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.

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

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.