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CAM Therapies in Hepatology
38 Questions
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CAM Therapies in Hepatology

Created by
@FashionableSanJose

Questions and Answers

What percentage of adults with liver disease used CAM therapies in the prior year, according to a specific study?

  • 41% (correct)
  • 50%
  • 25%
  • 33%

    • What is a primary reason why patients with liver disease use CAM therapies?

  • To enhance conventional medication effects
  • To treat anxiety or depression (correct)
  • To prevent hepatotoxicity
  • To alleviate liver disease symptoms

    • What is a potential risk associated with using herbal supplements in hepatology?

  • Reduced risk of drug interactions
  • Increased risk of hepatotoxicity (correct)
  • Enhanced liver function
  • Improved mental health

    • What is a key learning outcome for students regarding phytotherapies with hepatoprotective properties?

    <p>Recognize the evidence base of milk thistle</p> Signup and view all the answers

    What is a common mechanism through which drug interactions occur with CAM interventions?

    <p>Enzyme inhibition</p> Signup and view all the answers

    Why is it essential to discuss the phytochemical profile of grapefruit and St John's Wort in the context of drug interactions?

    <p>To identify potential drug interactions</p> Signup and view all the answers

    According to the provided information, what is the most common herb used for 'liver detoxification' in Ireland?

    <p>Milk thistle</p> Signup and view all the answers

    The passage mentions that milk thistle is often used to treat which condition?

    <p>Hepatitis</p> Signup and view all the answers

    What is the primary constituent of milk thistle responsible for its purported antihepatotoxic effects?

    <p>Silymarin</p> Signup and view all the answers

    Which of the following is NOT a proposed mechanism of action for milk thistle's antihepatotoxic effects?

    <p>Stimulation of immune response</p> Signup and view all the answers

    According to the Cochrane hepato-biliary group review, what is the efficacy of milk thistle for various liver disorders?

    <p>Ineffective</p> Signup and view all the answers

    What is the typical daily treatment dose of milk thistle for liver conditions?

    <p>400mg</p> Signup and view all the answers

    Based on the text, what is a valid clinical outcome for assessing the efficacy of milk thistle treatment?

    <p>Improvement in liver function tests</p> Signup and view all the answers

    Which of the following statements accurately reflects the evidence base for milk thistle's effectiveness in treating liver disorders?

    <p>The evidence is inconclusive and requires further research.</p> Signup and view all the answers

    What is the primary concern regarding the findings about milk thistle's effectiveness for liver diseases?

    <p>The findings are largely derived from one trial of short duration.</p> Signup and view all the answers

    Which component in artichoke leaf is recognized as anti-hepatotoxic?

    <p>Cynaropicrin</p> Signup and view all the answers

    What traditional medicinal use is associated with gentian root?

    <p>Treatment of jaundice and stimulation of appetite</p> Signup and view all the answers

    Which substance makes up a significant portion of dandelion's constituents?

    <p>Inulin</p> Signup and view all the answers

    What is the primary action attributed to turmeric in traditional medicine?

    <p>Hepatic stimulant</p> Signup and view all the answers

    Which of the following is NOT a recognized traditional use of bitters like artichoke leaf and gentian?

    <p>Strengthening bone density</p> Signup and view all the answers

    What major flaw is noted about the traditional uses of herbs for liver disorders?

    <p>Most have no clinical research support.</p> Signup and view all the answers

    Which bitter receptor stimulation is linked to appetite stimulation?

    <p>Gentiopicroside activation</p> Signup and view all the answers

    Which component of grapefruit is primarily concentrated in the peel and is known to activate furanocoumarins?

    <p>Bergamottin</p> Signup and view all the answers

    What is the primary effect of furanocoumarins on CYP apoprotein?

    <p>Irreversibly binds and eliminates activity</p> Signup and view all the answers

    Which of the following drugs is least likely to be affected by grapefruit juice based on the provided information?

    <p>Ibuprofen</p> Signup and view all the answers

    What is the range of bergamottin concentration found in different brands of grapefruit juice?

    <p>1.0 - 36.6 µmol/L</p> Signup and view all the answers

    Which of the following flavonoids is now considered less significant in the context of grapefruit's drug interaction mechanisms?

    <p>Naringin</p> Signup and view all the answers

    Which intermediate is formed during the metabolic activation of furanocoumarins?

    <p>γ-Ketoenal intermediate</p> Signup and view all the answers

    What common characteristic do the drugs amiodarone and rivaroxaban share in relation to grapefruit juice?

    <p>Both are impacted by grapefruit juice</p> Signup and view all the answers

    What is the possible implication of grapefruit juice on drug exposure levels?

    <p>It may enhance drug interactions reducing exposure levels</p> Signup and view all the answers

    Which of the following statements accurately describes the potential interaction between curcumin and conventional medications, based on the provided content?

    <p>Curcumin primarily interacts with conventional medications through pharmacodynamic mechanisms, affecting the concentration of the drug at its site of action.</p> Signup and view all the answers

    Based on the provided information, which of the following patient groups is NOT specifically identified as being at higher risk for drug interactions with herbal products like curcumin?

    <p>Patients with a history of allergic reactions to herbal products.</p> Signup and view all the answers

    What is a potential implication of curcumin's ability to inhibit several transcription factors?

    <p>Curcumin's potential as an anticancer drug lead may be enhanced due to its impact on transcription factors.</p> Signup and view all the answers

    Which of the following is a key message regarding the evaluation of evidence-based drug-herbal interactions?

    <p>A combination of data sources, including in vitro studies, animal studies, and case reports, is necessary to evaluate evidence-based drug-herbal interactions.</p> Signup and view all the answers

    Based on the information provided, what is the main rationale behind the statement that drug-herbal interactions need to be considered as carefully as conventional drug-drug interactions?

    <p>Herbal products can interact with conventional drugs in similar ways, potentially altering their effectiveness or safety.</p> Signup and view all the answers

    Which of the following is NOT listed as a potential application of curcumin in traditional medicine?

    <p>Antioxidant agent.</p> Signup and view all the answers

    Which of the following statements best describes the reason for recommending caution with curcumin use in patients at either end of the age spectrum?

    <p>Older adults and children have altered drug metabolism, which may increase the risk of drug interactions with curcumin.</p> Signup and view all the answers

    Which of the following resources is mentioned as a valuable resource for information on drug-herb interactions?

    <p>Mosby's Handbook of Drug-Herb and Drug-Supplement Interactions.</p> Signup and view all the answers

    Study Notes

    CAM Therapies in Hepatology

    • CAM therapies are used by 41% of patients with liver disease, commonly for anxiety, depression, fatigue, and substance use
    • Herbs and supplements are the most common modalities encountered, but some are potentially hepatotoxic
    • Many patients are on multi-drug regimens, making CAM interactions possible

    Milk Thistle

    • Originates from Silybum marianum
    • Constituents: mixture of flavonolignans, including silybin
    • Claimed mode of action: antihepatotoxic effect, inhibition of toxin binding and activation, and enhanced glutathione and protein synthesis
    • Applications: mild hypolipidaemic effect, treatment of hepatitis and cirrhosis at a dose of 400mg daily
    • Efficacy: Cochrane review (2005) found it to be ineffective for various liver disorders, but safe and well-tolerated
    • Commission E considers it safe and effective for toxic liver damage and supportive treatment in chronic inflammatory liver disease and hepatic cirrhosis

    Liver Disorders: Use of Bitters

    • Traditional use, largely unsupported by evidence-base
    • Examples:
      • Artichoke Leaf: anti-hepatotoxic, cholagogue, and cholesterol-lowering effects
      • Gentian: stimulates bitter receptors, promoting salivation and appetite
      • Dandelion: hepatic stimulant, diuretic, tonic, and anti-rheumatic
      • Turmeric: antihepatotoxic, anti-inflammatory, antispasmodic, hypoglycaemic, and hypocholesterolaemic

    Overview of Drug Interactions

    • Mechanisms of interaction:
      • Pharmacodynamic (PD): altering the concentration-dependent activity of a therapeutic molecule at the site of action
      • Pharmacokinetic (PK): altering the ADME of a conventional drug
    • Interactions between herbal and conventional medicines need to be considered as carefully as those between conventional drugs

    Particular Risk Groups for Drug Interactions

    • Patients with chronic disease, who use multiple medications—particularly those with a narrow therapeutic range
    • Patients with genetic variance in drug metabolism
    • Patients with impaired organ function
    • Patients at either end of the age spectrum

    Evidence-Based Drug-Herbal Interactions

    • Sources:
      • Known or suspected pharmacologic activity
      • Data derived from in vitro or animal studies
      • Isolated case reports lacking full information
    • Grapefruit components:
      • Furanocoumarins (bergamottin and 6',7'-dihydroxybergamottin)
      • Flavonoids (naringin and naringenin)
    • FC activation: irreversibly binds to CYP apoprotein, eliminating enzymatic activity
    • Variability in juices: naringin, bergamottin, and 6',7'-dihydroxybergamottin concentrations vary across brands
    • Grapefruit juice affects >80 drugs, increasing their levels, including anticoagulants, antiarrhythmics, and statins.

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    Description

    Explore the use of Complementary and Alternative Medicine (CAM) therapies in Hepatology, including herbs and supplements, for patients with liver disease.

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