Pharmacy: Evidence-Based Approach to NHPs
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Questions and Answers

What is the primary role of the pharmacist with respect to NHPs?

  • To recommend NHPs to patients
  • To provide conventional treatment options only
  • To foster open communication and create a non-threatening environment (correct)
  • To discourage the use of NHPs

    • All NHPs have enough evidence to be routinely recommended.

    False

    What should be included in a medication review?

    What else are you doing/taking to take care of your health?

    According to the objectives, students should be able to evaluate the safety and efficacy of popular NHPs used by Canadians to prevent and treat the _______________.

    <p>common cold</p> Signup and view all the answers

    What is the primary consideration for pharmacists when helping patients make informed choices about NHPs?

    <p>Evidence-based NHP information</p> Signup and view all the answers

    The amount of literature on NHPs is decreasing.

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

    The pharmacist's role is to help patients make informed choices by providing _______________ NHP information.

    <p>evidence-based</p> Signup and view all the answers

    What is the primary goal of including NHPs in the pharmaceutical care process?

    <p>To assess the safety and efficacy of NHPs</p> Signup and view all the answers

    What is the primary mechanism of action of Echinacea on the immune system? (Select all that apply)

    <p>Unclear, but appears to target both nonspecific and specific immune function</p> Signup and view all the answers

    Echinacea has been shown to provide significant benefits for treating colds

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

    What are the four groups of compounds that contribute to the immunomodulatory activity of Echinacea?

    <p>Alkamides, glycoproteins, polysaccharides, and caffeic acid derivatives (CADs)</p> Signup and view all the answers

    Echinacea angustifolia roots contain _______________________ with anti-inflammatory properties

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

    How many RCTs were included in the study on the efficacy of Echinacea for the common cold?

    <p>24</p> Signup and view all the answers

    Echinacea products have been shown to provide significant benefits for preventing colds

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

    Match the following compounds with their potential benefits

    <p>Alkamides = Anti-inflammatory properties Glycoproteins = Activation of macrophages and NK cells Polysaccharides = Activation of macrophages and NK cells Caffeic acid derivatives (CADs) = Anti-viral activity</p> Signup and view all the answers

    What is the conclusion of the Cochrane review of 2014 regarding the use of Echinacea for treating colds?

    <p>Echinacea products have not been shown to provide benefits for treating colds, although, it is possible there is a weak benefit from some Echinacea products</p> Signup and view all the answers

    What is the primary usage of Echinacea according to the pharmacology of Echinacea?

    <p>Immunomodulatory activity</p> Signup and view all the answers

    What is the relative risk reduction of cold episodes suggested by the post hoc pooling of results in the Cochrane Review (2014)?

    <p>10% to 20%</p> Signup and view all the answers

    Echinacea is generally not well-tolerated and has many adverse reactions.

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

    What is the theoretical caution for using Echinacea in certain cases?

    <p>cases of chronic immune dysfunction and autoimmune conditions</p> Signup and view all the answers

    Echinacea may theoretically interfere with __________________ therapy (e.g., cyclosporin, prednisone).

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

    What is the recommended dosage form for Echinacea capsules?

    <p>500-1000mg three times daily</p> Signup and view all the answers

    Echinacea has been reported to have significant changes in CYP enzymes.

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

    What is the recommended dosage form for Echinacea tea?

    <p>2 tsp. (4g of Echinacea) of coarsely powdered herb simmered in 1 cup of boiling water for 10 minutes, daily for 5-7 days</p> Signup and view all the answers

    Echinacea tincture (1:5) should be taken in a daily dose of equivalent to ________________________ dried Echinacea root.

    <p>900mg</p> Signup and view all the answers

    Match the following dosage forms of Echinacea with their recommended daily doses:

    <p>Capsules = 500-1000mg three times daily Expressed juice = 6-9mL daily in divided doses Tincture (1:5) = 0.75 to 1.5mL, gargled then swallowed, 2-5 times per day Tea = 2 tsp. (4g of Echinacea) of coarsely powdered herb simmered in 1 cup of boiling water for 10 minutes</p> Signup and view all the answers

    Echinacea is not recommended for prevention of cold episodes.

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

    What is the primary goal of including NHPs in the pharmaceutical care process?

    <p>To assess the safety and efficacy of NHPs</p> Signup and view all the answers

    What is the primary consideration for pharmacists when helping patients make informed choices about NHPs?

    <p>The weighs of safety and efficacy of NHP options</p> Signup and view all the answers

    What is the role of the pharmacist in fostering open communication with patients?

    <p>To create a non-threatening environment for patients</p> Signup and view all the answers

    What is the primary objective of including NHPs in the pharmaceutical care process?

    <p>To evaluate the safety and efficacy of popular NHPs</p> Signup and view all the answers

    What is the primary consideration for pharmacists when evaluating the safety and efficacy of NHPs?

    <p>The weighs of safety and efficacy of NHP options</p> Signup and view all the answers

    What is the primary role of the pharmacist in the pharmaceutical care process?

    <p>To evaluate the safety and efficacy of popular NHPs</p> Signup and view all the answers

    What is the primary objective of the pharmaceutical care process?

    <p>To help patients make informed choices about NHPs</p> Signup and view all the answers

    What is the primary consideration for pharmacists when helping patients make informed choices about NHPs?

    <p>The weighs of safety and efficacy of NHP options</p> Signup and view all the answers

    What is the primary goal of including NHPs in the pharmaceutical care process?

    <p>To assess the safety and efficacy of NHPs</p> Signup and view all the answers

    What is the primary role of the pharmacist in fostering open communication with patients?

    <p>To create a non-threatening environment for patients</p> Signup and view all the answers

    What is the conclusion of the Cochrane review of 2014 regarding the use of Echinacea for preventing colds?

    <p>Echinacea has no significant effect on the prevention of cold episodes.</p> Signup and view all the answers

    What is the relative risk reduction of cold episodes suggested by the post hoc pooling of results in the Cochrane Review (2014)?

    <p>10% to 20%</p> Signup and view all the answers

    What is the theoretical caution for using Echinacea in certain cases?

    <p>Chronic immune dysfunction and autoimmune conditions</p> Signup and view all the answers

    What is the recommended dosage form for Echinacea capsules?

    <p>500-1000mg three times daily</p> Signup and view all the answers

    What is the daily dose of Echinacea tincture (1:5) equivalent to?

    <p>900mg dried Echinacea root</p> Signup and view all the answers

    What is the recommended dosage form for Echinacea tea?

    <p>2 tsp (4g) of coarsely powdered herb</p> Signup and view all the answers

    What is the potential interaction of Echinacea with immunosuppressant therapy?

    <p>Echinacea may theoretically interfere with immunosuppressant therapy</p> Signup and view all the answers

    What is the common adverse reaction of Echinacea?

    <p>Allergic reactions</p> Signup and view all the answers

    What is the effect of Echinacea on CYP enzymes?

    <p>Echinacea theoretically affects CYP enzymes, but it is likely not clinically significant</p> Signup and view all the answers

    What is the tolerability of Echinacea?

    <p>Echinacea is well-tolerated with few adverse reactions</p> Signup and view all the answers

    What is the primary mechanism of action of Echinacea on the immune system?

    <p>Targeting both nonspecific and specific immune function</p> Signup and view all the answers

    Which of the following compounds has been shown to have anti-inflammatory properties in Echinacea?

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

    What was the conclusion of the Cochrane review of 2014 regarding the use of Echinacea for treating colds?

    <p>Echinacea products have not been shown to provide benefits for treating colds</p> Signup and view all the answers

    How many RCTs were included in the study on the efficacy of Echinacea for the common cold?

    <p>24 RCTs</p> Signup and view all the answers

    What is the primary role of alkamides in Echinacea?

    <p>Anti-inflammatory properties</p> Signup and view all the answers

    What is the effect of glycoproteins, polysaccharides, and caffeic acid derivatives on macrophages and NK cells?

    <p>Activation of macrophages and NK cells</p> Signup and view all the answers

    What is the conclusion of the Cochrane review of 2014 regarding the use of Echinacea for preventing colds?

    <p>The evidence is unclear for the use of Echinacea for preventing colds</p> Signup and view all the answers

    What is the mechanism of action of Echinacea on the immune system?

    <p>Targeting both nonspecific and specific immune function</p> Signup and view all the answers

    How many treatment comparisons were included in the Cochrane review of 2014 for the treatment of colds with Echinacea?

    <p>15 treatment comparisons</p> Signup and view all the answers

    What is the effect of Echinacea on cold episodes?

    <p>No effect on cold episodes</p> Signup and view all the answers

    The amount of literature on NHPs is decreasing.

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

    The primary role of the pharmacist is to prohibit the use of NHPs.

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

    All patients should be discouraged from using NHPs.

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

    Echinacea has been shown to have a significant impact on the prevention of colds.

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

    The pharmacist's primary goal is to recommend NHPs to patients.

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

    Pharmacists should only discuss NHPs with patients who initiate the conversation.

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

    Echinacea is generally well-tolerated and has few adverse reactions.

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

    The standards of evidence for NHPs are lower than for conventional treatments.

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

    Pharmacists should only assess NHPs that have a significant amount of evidence supporting their use.

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

    The primary objective of the pharmaceutical care process is to promote the use of NHPs.

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

    Echinacea has been shown to provide significant benefits for preventing and treating colds.

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

    Alkamides are found in the aerial parts of Echinacea purpurea.

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

    Glycoproteins have anti-inflammatory properties.

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

    Echinacea has been shown to have a significant effect on the duration of colds.

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

    Echinacea products have been shown to provide benefits for treating colds in multiple trials.

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

    Caffeic acid derivatives are found in the roots of Echinacea purpurea.

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

    Echinacea has been shown to have a significant effect on the prevention of colds.

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

    Polysacchardies have anti-inflammatory properties.

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

    The primary mechanism of action of Echinacea on the immune system is clear.

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

    Echinacea products have been shown to provide benefits for treating colds in a wide variety of preparations.

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

    Echinacea has been shown to provide significant benefits for preventing colds.

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

    Echinacea products have been reported to have significant changes in CYP enzymes, which is clinically significant.

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

    Echinacea is generally well-tolerated with few adverse reactions.

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

    Theoretical caution is recommended when using Echinacea in cases of chronic immune dysfunction and autoimmune conditions.

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

    The post hoc pooling of results in the Cochrane Review (2014) suggests a relative risk reduction of 50% to 60% in cold episodes.

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

    Echinacea may theoretically interfere with antibiotic therapy.

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

    The recommended dosage form for Echinacea tea is 1 tsp of coarsely powdered herb simmered in 1 cup of boiling water for 5 minutes.

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

    Echinacea tincture (1:5) should be taken in a daily dose of equivalent to 500mg dried Echinacea root.

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

    The Cochrane Review (2014) found a statistically significant difference in the number of patients with at least one cold episode.

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

    Echinacea has been shown to have significant benefits for treating colds.

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

    Study Notes

    Evidence-based Approach to NHPs

    • The role of the pharmacist is to foster open communication and create a non-threatening environment where patients can disclose CAM/NHP use and ask questions.
    • Pharmacists should include in their medication review: "What else are you doing/taking to take care of your health?"

    Role of the Pharmacist

    • Help patients make informed choices about NHPs by providing evidence-based NHP information.
    • Standards of evidence for NHPs are the same as for conventional treatments, but few NHPs have enough evidence to be routinely recommended.

    Echinacea (Echinacea purpurea; Echinacea angustifolia; Echinacea pallida)

    • Pharmacology: Echinacea appears to target both nonspecific and specific immune function, with 4 groups of compounds contributing to immunomodulatory activity: alkamides, glycoproteins, polysaccharides, and caffeic acid derivatives.
    • Alkamides have anti-inflammatory properties and are found in roots of E. angustifolia and the roots + aerial parts of E. purpurea, while glycoproteins, polysaccharides, and caffeic acid derivatives have been shown to activate macrophages and NK cells, and have anti-viral activity.

    Efficacy for the Common Cold

    • 24 RCTs including 33 comparisons of echinacea with a control group (n= 4631) have been conducted to study the treatment and/or prevention of the common cold.
    • Cochrane review (2014): Echinacea products have not been shown to provide benefits for treating colds, although there is possible weak benefit from some Echinacea products.

    Treatment of Colds

    • Cochrane review (2014): Only one of the seven treatment trials reporting data on the duration of colds showed a significant effect of Echinacea over placebo.

    Prevention of Colds

    • Cochrane review (2014): None of the 12 prevention comparisons reporting the number of patients with at least one cold episode found a statistically significant difference.
    • However, a post hoc pooling of results suggests a relative risk reduction of 10% to 20%.

    Echinacea: Cautions

    • Generally well-tolerated with few AEs reported, but theoretical caution is needed in cases of chronic immune dysfunction and autoimmune conditions.
    • Adverse reactions: uncommon, but include allergic reactions which vary from mild to anaphylactic.
    • Drug Interactions: theoretically may interfere with immunosuppressant therapy (e.g., cyclosporin, prednisone); reports of changes in CYP enzymes (likely not clinically significant).

    Echinacea: Dose

    • Depends on the dosage form and standardization, with a wide range of doses tested in studies, including:
      • Capsules (of powdered herb): 500-1000mg three times daily, for five to seven days.
      • Expressed juice: 6-9mL daily in divided doses, for five to seven days.
      • Tincture (1:5): 0.75 to 1.5mL, gargled then swallowed, 2-5 times per day, for five to seven days.
      • Tea: 2 tsp. (4g of Echinacea) of coarsely powdered herb simmered in 1 cup of boiling water for 10 minutes, daily for 5-7 days.

    Evidence-based Approach to NHPs

    • The role of the pharmacist is to foster open communication and create a non-threatening environment where patients can disclose CAM/NHP use and ask questions.
    • Pharmacists should include in their medication review: "What else are you doing/taking to take care of your health?"

    Role of the Pharmacist

    • Help patients make informed choices about NHPs by providing evidence-based NHP information.
    • Standards of evidence for NHPs are the same as for conventional treatments, but few NHPs have enough evidence to be routinely recommended.

    Echinacea (Echinacea purpurea; Echinacea angustifolia; Echinacea pallida)

    • Pharmacology: Echinacea appears to target both nonspecific and specific immune function, with 4 groups of compounds contributing to immunomodulatory activity: alkamides, glycoproteins, polysaccharides, and caffeic acid derivatives.
    • Alkamides have anti-inflammatory properties and are found in roots of E. angustifolia and the roots + aerial parts of E. purpurea, while glycoproteins, polysaccharides, and caffeic acid derivatives have been shown to activate macrophages and NK cells, and have anti-viral activity.

    Efficacy for the Common Cold

    • 24 RCTs including 33 comparisons of echinacea with a control group (n= 4631) have been conducted to study the treatment and/or prevention of the common cold.
    • Cochrane review (2014): Echinacea products have not been shown to provide benefits for treating colds, although there is possible weak benefit from some Echinacea products.

    Treatment of Colds

    • Cochrane review (2014): Only one of the seven treatment trials reporting data on the duration of colds showed a significant effect of Echinacea over placebo.

    Prevention of Colds

    • Cochrane review (2014): None of the 12 prevention comparisons reporting the number of patients with at least one cold episode found a statistically significant difference.
    • However, a post hoc pooling of results suggests a relative risk reduction of 10% to 20%.

    Echinacea: Cautions

    • Generally well-tolerated with few AEs reported, but theoretical caution is needed in cases of chronic immune dysfunction and autoimmune conditions.
    • Adverse reactions: uncommon, but include allergic reactions which vary from mild to anaphylactic.
    • Drug Interactions: theoretically may interfere with immunosuppressant therapy (e.g., cyclosporin, prednisone); reports of changes in CYP enzymes (likely not clinically significant).

    Echinacea: Dose

    • Depends on the dosage form and standardization, with a wide range of doses tested in studies, including:
      • Capsules (of powdered herb): 500-1000mg three times daily, for five to seven days.
      • Expressed juice: 6-9mL daily in divided doses, for five to seven days.
      • Tincture (1:5): 0.75 to 1.5mL, gargled then swallowed, 2-5 times per day, for five to seven days.
      • Tea: 2 tsp. (4g of Echinacea) of coarsely powdered herb simmered in 1 cup of boiling water for 10 minutes, daily for 5-7 days.

    Evidence-based Approach to NHPs

    • The role of the pharmacist is to foster open communication and create a non-threatening environment where patients can disclose CAM/NHP use and ask questions.
    • Pharmacists should include in their medication review: "What else are you doing/taking to take care of your health?"

    Role of the Pharmacist

    • Help patients make informed choices about NHPs by providing evidence-based NHP information.
    • Standards of evidence for NHPs are the same as for conventional treatments, but few NHPs have enough evidence to be routinely recommended.

    Echinacea (Echinacea purpurea; Echinacea angustifolia; Echinacea pallida)

    • Pharmacology: Echinacea appears to target both nonspecific and specific immune function, with 4 groups of compounds contributing to immunomodulatory activity: alkamides, glycoproteins, polysaccharides, and caffeic acid derivatives.
    • Alkamides have anti-inflammatory properties and are found in roots of E. angustifolia and the roots + aerial parts of E. purpurea, while glycoproteins, polysaccharides, and caffeic acid derivatives have been shown to activate macrophages and NK cells, and have anti-viral activity.

    Efficacy for the Common Cold

    • 24 RCTs including 33 comparisons of echinacea with a control group (n= 4631) have been conducted to study the treatment and/or prevention of the common cold.
    • Cochrane review (2014): Echinacea products have not been shown to provide benefits for treating colds, although there is possible weak benefit from some Echinacea products.

    Treatment of Colds

    • Cochrane review (2014): Only one of the seven treatment trials reporting data on the duration of colds showed a significant effect of Echinacea over placebo.

    Prevention of Colds

    • Cochrane review (2014): None of the 12 prevention comparisons reporting the number of patients with at least one cold episode found a statistically significant difference.
    • However, a post hoc pooling of results suggests a relative risk reduction of 10% to 20%.

    Echinacea: Cautions

    • Generally well-tolerated with few AEs reported, but theoretical caution is needed in cases of chronic immune dysfunction and autoimmune conditions.
    • Adverse reactions: uncommon, but include allergic reactions which vary from mild to anaphylactic.
    • Drug Interactions: theoretically may interfere with immunosuppressant therapy (e.g., cyclosporin, prednisone); reports of changes in CYP enzymes (likely not clinically significant).

    Echinacea: Dose

    • Depends on the dosage form and standardization, with a wide range of doses tested in studies, including:
      • Capsules (of powdered herb): 500-1000mg three times daily, for five to seven days.
      • Expressed juice: 6-9mL daily in divided doses, for five to seven days.
      • Tincture (1:5): 0.75 to 1.5mL, gargled then swallowed, 2-5 times per day, for five to seven days.
      • Tea: 2 tsp. (4g of Echinacea) of coarsely powdered herb simmered in 1 cup of boiling water for 10 minutes, daily for 5-7 days.

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