URTIs: Therapeutic Methods and Herbal Remedies
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Questions and Answers

What is the 'H' in the 'H.E.M.P' formula?

  • Hydratis
  • Hydrastis canadensis
  • Hydratis goldenseal (correct)
  • Hydrastine

    • What is the part of the Hydrastis canadensis plant used in therapy?

  • Leaf
  • Flower
  • Root (correct)
  • Stem

    • What is the action of Echinacea on the body?

  • Immunostimulant (correct)
  • Digestive
  • Immunosuppressant
  • Antimicrobial

    • What is the chemical found in Hydrastis canadensis that contributes to its pharmacological effects?

    <p>Isoquinoline alkaloids (berberine, hydrastine)</p> Signup and view all the answers

    What is the indication for using Echinacea in therapy?

    <p>Strep throat, colds, vaginal candidiasis, UTI</p> Signup and view all the answers

    What is the safety precaution associated with using Hydrastis canadensis?

    <p>Avoid use with gastric/stomach ulcers</p> Signup and view all the answers

    What is the action of Phytolacca (Poke Root) in the 'H.E.M.P' formula?

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

    What is the chemical found in Echinacea that contributes to its pharmacological effects?

    <p>Phenolics (caffeic acid), polysaccharides</p> Signup and view all the answers

    What is the primary action of Curcuma longa?

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

    What is the indication of Capsaicinoids?

    <p>Circulatory deficiencies</p> Signup and view all the answers

    What is the part used of Ginkgo biloba?

    <p>Leaf and fruit</p> Signup and view all the answers

    What is the daily therapeutic dose of Curcuma longa powder?

    <p>8-20 g</p> Signup and view all the answers

    What is the primary action of Ginkgo biloba?

    <p>All of the above</p> Signup and view all the answers

    What is the constituent of Curcuma longa?

    <p>Phenolic antioxidants</p> Signup and view all the answers

    What is the consequence of a deficiency in dietary protein/amino acids?

    <p>Increased susceptibility to infection</p> Signup and view all the answers

    Which of the following is a characteristic of honey?

    <p>Antimicrobial properties and not suitable for infants under 1 year</p> Signup and view all the answers

    What is the main function of probiotics?

    <p>Supporting healthy microbiome</p> Signup and view all the answers

    What is the recommended form of vitamin D supplementation?

    <p>Vitamin D3, fat-soluble vitamin, liquid/gel cap formula</p> Signup and view all the answers

    What is the effect of bactericidal antibiotics?

    <p>Killing sensitive organisms</p> Signup and view all the answers

    What is the typical indication for Penicillin V?

    <p>A streptococcal pharyngitis</p> Signup and view all the answers

    What is the recommended way to take Vitamin D3 supplementation?

    <p>With food or a main meal</p> Signup and view all the answers

    What is the potential risk of taking high doses of Vitamin D3?

    <p>Increased risk of toxicity</p> Signup and view all the answers

    What is the primary effect of a magnesium deficiency on the body?

    <p>Impaired muscle and nerve function</p> Signup and view all the answers

    What is the Upper Tolerable Intake Level (UL) for vitamin C?

    <p>2 g/d</p> Signup and view all the answers

    What is a potential consequence of consuming high amounts of vitamin C?

    <p>Gastric gramping and diarrhea</p> Signup and view all the answers

    Which of the following is a rich source of magnesium?

    <p>Nuts and seeds</p> Signup and view all the answers

    What is a potential health consequence of magnesium deficiency?

    <p>Low back pain</p> Signup and view all the answers

    What is a precaution to consider when consuming high amounts of vitamin C during pregnancy?

    <p>Contraindication due to adverse effects</p> Signup and view all the answers

    What type of iron is found only in animal products, such as meat, fish, and poultry?

    <p>Heme iron</p> Signup and view all the answers

    Which of the following NSAIDs is a COX-2 specific inhibitor?

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

    What is the main concern with COX-1 inhibition in NSAIDs?

    <p>Gastrointestinal side effects</p> Signup and view all the answers

    Which of the following homeopathic remedies is used to treat joint and tendon ailments?

    <p>All of the above</p> Signup and view all the answers

    What is the primary mechanism of action of acetaminophen?

    <p>Little effect on COX-1 or COX-2</p> Signup and view all the answers

    What is the primary concern with using NSAIDs in the elderly?

    <p>All of the above</p> Signup and view all the answers

    What is the main benefit of using COX-2 specific inhibitors over non-specific NSAIDs?

    <p>Reduced risk of gastrointestinal side effects</p> Signup and view all the answers

    What is the primary function of vitamin C in the body?

    <p>To increase calcium absorption</p> Signup and view all the answers

    What is the primary concern with using acetaminophen in high doses?

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

    What is the primary indication for using Corydalis yanhusuo in botanical medicine?

    <p>Pain relief</p> Signup and view all the answers

    What is the primary function of glucocorticoids?

    <p>Influence on carbohydrate, fat, and protein metabolism</p> Signup and view all the answers

    What is the primary function of mineralocorticoids?

    <p>Modifying renal excretion mechanisms</p> Signup and view all the answers

    In which of the following conditions are high doses of corticosteroids contradicted?

    <p>Pregnancy or trying to conceive</p> Signup and view all the answers

    What is the common backbone for all types of corticosteroids?

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

    What can increase the potency of topical corticosteroids?

    <p>Fluorinating or esterifying certain carbons in the four-ring backbone</p> Signup and view all the answers

    In which of the following conditions are corticosteroids used with caution?

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

    What is a common receptor for both glucocorticoids and mineralocorticoids?

    <p>Skin receptors</p> Signup and view all the answers

    What is the effect of corticosteroids on protein metabolism?

    <p>Breakdown of protein</p> Signup and view all the answers

    What is the main difference between a lacto-ovo-vegetarian diet and a vegan diet?

    <p>The allowance of milk and eggs in the lacto-ovo-vegetarian diet</p> Signup and view all the answers

    What is the potential benefit of omega-3 fatty acid supplements for individuals with rheumatoid arthritis (RA)?

    <p>Reducing morning stiffness</p> Signup and view all the answers

    Which food group is a rich source of folate?

    <p>Legumes and green vegetables</p> Signup and view all the answers

    Why do doctors often prescribe folate supplements to individuals taking methotrexate?

    <p>To counteract the destruction of folate by methotrexate</p> Signup and view all the answers

    What is the reason for adding 1.4 mg/kg of folate to food products in Canada since 1998?

    <p>To prevent neural tube defects</p> Signup and view all the answers

    What is a common complication in patients with chronic inflammatory joint conditions such as rheumatoid arthritis (RA)?

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

    What are the two types of iron mentioned in the text?

    <p>Heme and non-heme iron</p> Signup and view all the answers

    What is the relationship between omega-3 fatty acids and joint pain in individuals with rheumatoid arthritis (RA)?

    <p>Omega-3 fatty acids decrease joint pain</p> Signup and view all the answers

    What is the primary action of Boswellia serrata?

    <p>Antimicrobial, anti-inflammatory, astringent</p> Signup and view all the answers

    What is the part of the Boswellia serrata plant used in therapy?

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

    What is the recommended daily dose of Boswellia serrata in powder or supplement form?

    <p>300-3000 mg</p> Signup and view all the answers

    What is the primary action of Capsicum frutescens?

    <p>Stimulant, circulatory tonic, rubefacient</p> Signup and view all the answers

    What is the constituents of Boswellia serrata?

    <p>Resins, boswellic acid, volatile oils</p> Signup and view all the answers

    What is the primary consequence of consuming vitamin C above the Upper Tolerable Intake Level (UL)?

    <p>Gastric cramping, diarrhea, and bloating</p> Signup and view all the answers

    What is the caution associated with using Boswellia serrata?

    <p>Not generally taken internally in large amounts</p> Signup and view all the answers

    Which of the following foods is a rich source of magnesium?

    <p>Nuts and seeds</p> Signup and view all the answers

    What is the primary effect of a magnesium deficiency on the body?

    <p>Impaired muscle and nerve function</p> Signup and view all the answers

    What is a potential health consequence of magnesium deficiency?

    <p>Low back pain</p> Signup and view all the answers

    What is the Upper Tolerable Intake Level (UL) for vitamin C?

    <p>2 g/d</p> Signup and view all the answers

    What is a precaution to consider when consuming high amounts of vitamin C during pregnancy?

    <p>Contradiction of vitamin C</p> Signup and view all the answers

    What is the sensation associated with Kalium Carbonicum?

    <p>Anxiety in the epigastric pit (Solar plexus)</p> Signup and view all the answers

    What is the characteristic of Magnesium Phosphate?

    <p>The Great Antispasmodic Remedy</p> Signup and view all the answers

    What is the recommended approach for treating depression?

    <p>Engaging in physical activity</p> Signup and view all the answers

    What is the characteristic of Anger?

    <p>Strong pressure towards the pelvis</p> Signup and view all the answers

    What is the effect of Kalium Carbonicum on the body?

    <p>Relieves anxiety in the epigastric pit (Solar plexus)</p> Signup and view all the answers

    What is the characteristic of Magnesium Phosphate in terms of pain relief?

    <p>Need to move consistently from pain</p> Signup and view all the answers

    What is the affinity of Kalium Carbonicum?

    <p>Articular system and CNS</p> Signup and view all the answers

    What is the characteristic of Bot Med in Week 6 Depression?

    <p>A warming adaptogen, Hepatic/Alterative</p> Signup and view all the answers

    What is the effect of a magnesium deficiency on the body?

    <p>Impairs muscle and nerve function</p> Signup and view all the answers

    What is the Upper Tolerable Intake Level (UL) for vitamin C?

    <p>2 g/d</p> Signup and view all the answers

    Which of the following is a rich source of magnesium?

    <p>Nuts and seeds</p> Signup and view all the answers

    What is a potential consequence of consuming high amounts of vitamin C during pregnancy?

    <p>Contradiction in pregnancy</p> Signup and view all the answers

    What is the effect of vitamin C deficiency on the body?

    <p>Impairs iron metabolism</p> Signup and view all the answers

    Which of the following vegetables is a rich source of vitamin C?

    <p>Red peppers</p> Signup and view all the answers

    What is the primary difference between a lacto-ovo-vegetarian diet and a vegan diet?

    <p>The inclusion of milk and eggs</p> Signup and view all the answers

    What is the benefit of omega-3 fatty acid supplements for individuals with rheumatoid arthritis (RA)?

    <p>Reducing morning stiffness</p> Signup and view all the answers

    Which of the following food groups is a rich source of folate?

    <p>All of the above</p> Signup and view all the answers

    Why do doctors often prescribe folate supplements to individuals taking methotrexate?

    <p>To counteract the destruction of folate by methotrexate</p> Signup and view all the answers

    What is the primary concern for individuals with rheumatoid arthritis (RA) regarding iron?

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

    What is a common condition associated with rheumatoid arthritis?

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

    What is the effect of omega-3 fatty acid supplements on experimental arthritis?

    <p>They prevent or improve the condition</p> Signup and view all the answers

    What is the recommended daily intake of folate in Canada to prevent neural tube defects?

    <p>1.4 mg/kg</p> Signup and view all the answers

    Which of the following foods is a common trigger for food allergy?

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

    What is the effect of a food allergy on the body?

    <p>Release of IgE antibody</p> Signup and view all the answers

    What is the benefit of consuming green vegetables, mushrooms, and legumes?

    <p>They are rich in folate</p> Signup and view all the answers

    Which of the following diets has been shown to improve function, joint mobility, and pain in rheumatoid arthritis?

    <p>Mediterranean diet</p> Signup and view all the answers

    What is the role of food in rheumatoid arthritis?

    <p>Trigger for inflammation</p> Signup and view all the answers

    Which of the following nutrients is important for patients with rheumatoid arthritis?

    <p>All of the above</p> Signup and view all the answers

    What is the effect of eliminating certain foods from the diet on rheumatoid arthritis?

    <p>Improvement in symptoms in 30-40% of patients</p> Signup and view all the answers

    What is the role of nutrition in rheumatoid arthritis?

    <p>Important for maintaining overall health</p> Signup and view all the answers

    What type of bacteria produce beta-lactamases, which confer resistance to antibiotics?

    <p>H.influenzae and M.catarrhalis</p> Signup and view all the answers

    What is the typical indication for using a combination of amoxicillin and clavulanate?

    <p>Treatment failure or recurrence of pneumonia</p> Signup and view all the answers

    What is a common adverse effect of combination therapy with amoxicillin and clavulanate?

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

    What is Drosera commonly used to treat?

    <p>Whooping cough and respiratory illnesses</p> Signup and view all the answers

    What is a characteristic of the cough experienced by individuals who may benefit from Drosera?

    <p>Ringing cough with paroxysms</p> Signup and view all the answers

    What is the mental state of individuals who may benefit from Drosera?

    <p>Suspicious and easily angered</p> Signup and view all the answers

    When should treatment failure be considered when using antibiotics to treat pneumonia?

    <p>After 72 hours of treatment</p> Signup and view all the answers

    What is the typical time of day when symptoms worsen in individuals who may benefit from Drosera?

    <p>Evening and after midnight</p> Signup and view all the answers

    Which of the following foods is a rich source of magnesium?

    <p>Green leafy vegetables</p> Signup and view all the answers

    What is the primary function of proteolytic enzymes?

    <p>To reduce inflammation and symptoms related to inflammatory conditions</p> Signup and view all the answers

    What is the recommended daily dose of vitamin D?

    <p>1000 IU/day</p> Signup and view all the answers

    Which of the following is a GABA derivative?

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

    What is the mechanism of action of Baclofen?

    <p>It binds to the beta subunit of GABA receptors</p> Signup and view all the answers

    What is the primary indication for using Methocarbamol?

    <p>Muscle spasticity</p> Signup and view all the answers

    What is the effect of GABA derivatives on the body?

    <p>They decrease the rate of action potentials</p> Signup and view all the answers

    Which of the following is a homeopathic remedy?

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

    What is the primary concern with using Methocarbamol in combination with other CNS depressants?

    <p>It may increase the risk of CNS depression</p> Signup and view all the answers

    What is the recommended daily dose of magnesium?

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

    Study Notes

    URTI (Bacterial) Therapeutic Prescription/Method Description

    • BotMed: Goals are described by the "H.E.M.P" formula, which stands for:
      • H - Hydrastis (Goldenseal): Antimicrobial, Lymphatic, and Immunostimulant.
      • E - Echinacea (Purple Cone Flower): Immunostimulant.
      • M - Myrrh: Antipyretic.
      • P - Phytolacca (Poke Root): Antipyretic.

    Hydrastis (Goldenseal)

    • Part used: Root.
    • Actions: Antimicrobial, fungal, viral, and parasitic, digestive, and bitter.
    • Chemical Constituents: Isoquinoline alkaloids (Berberine, Hydrastine).
    • Safety:
      • Avoid use in gastric/stomach ulcers.
      • Side effects: GI irritation, nausea, vomiting, diarrhea.

    Echinacea (Purple Cone Flower)

    • Part used: Root and Herb.
    • Actions: Immunostimulant.
    • Indications: Strep throat, colds, vaginal candidiasis, UTI.
    • Chemical Constituents: Phytochemical (Alkylamide, Phenolics (Caffeic acid), Polysaccharides).
    • Safety:
      • Caution with autoimmunity.
      • Safe with pregnancy.

    Protein

    • Importance: A deficiency in dietary protein/amino acids impairs immune function and increases susceptibility to infection.
    • Actions: Activate lymph cells, lymphocyte, antibody/cytokine production.
    • Recommendations: Review typical diet to ensure meeting dietary goals, consider increasing dietary protein with homemade bone broth, chicken noodle soup, congee, rice, and lentils, and protein smoothie.

    Honey

    • Actions: Antimicrobial, decreases inflammation, symptomatic management.
    • Contraindications: Not for infants under 1 year old due to the risk of Clostridium botulinum.
    • Recommendations: Try as lemon and honey tea, iced lolly, lozenge.

    Probiotics

    • Actions: Supports healthy microbiome, especially with/after antibiotic use.

    Vitamin D

    • Actions: Vitamin D supplementation.
    • Active Form: Vitamin D3.
    • Fat-soluble vitamin: Liquid/gel cap formula taken with food/main meal.
    • Cautions: Can dose appropriate to Vitamin D status if known, over 2,000 IU Vitamin D3 = Rx in Ontario, clear directions with dose and duration to avoid toxicity.

    Pharmacology

    • Cautions/Info: Bactericidal (kills sensitive organisms) and Bacteriostatic (inhibits growth of bacteria but does not kill them).
    • Penicillin V: Narrow spectrum, orally taken, dose prescribed by weight, GI upset, nausea, vomiting, diarrhea, and rash.

    Curcuma longa (Turmeric)

    • Primary Actions: Anti-inflammatory, mild antimicrobial, carminative, circulatory tonic.
    • Constituents: Phenolic antioxidants, Curcumin, volatile oils, starches.
    • Indications: General inflammatory conditions, OA and RA, possibly cancer lesions (topical), stomach ulcers, and dyspepsia.

    Ginkgo biloba (Ginkgo)

    • Primary Actions: Circulatory tonic, vasodilator, anti-inflammatory, anticoagulant (as an antiplatelet activator factor [PAF]), nootropic, mild astringent.
    • Constituents: Heme iron (derived from hemoglobin and myoglobin, found only in animal products).
    • Indications: Non-Heme Iron, Meats, Beans, dark greens, leafy veggies, dried fruits, blackstrap molasses, and enriched foods.

    Pharmacology (NSAIDs)

    • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):
      • Non-specific COX inhibitors (e.g., Acetylsalicylic Acid (ASA), Ibuprofen).
      • COX-2 Specific Inhibitors (e.g., Celecoxib).
      • Non-specific COX inhibitors without anti-inflammatory effect (e.g., Acetaminophen).
    • Cautions/Info: The biggest issue with COX-1 inhibition is with GI function, particularly mucus secretion in the stomach.
    • Acetylsalicylic Acid (ASA):
      • Causes irreversible inhibition of COX by covalent bond of acetyl group.
      • Dosing: adults: 325-650mg Q4H (MAX 4g/day).
      • Lasts 6 hours, GI irritation, ulcers, bleeding, tinnitus, hypersensitivity reactions.
    • Ibuprofen:
      • Dosing: adults: 200-400mg Q6-8 hours PO, maximum 1200mg/day.
      • Onset of action: 30-60 minutes, duration of action: 4-6 hours.
    • Acetaminophen:
      • Dosing: adults: 325-650mg Q4H PO, maximum 4g/day.
      • Onset of action: under 1 hour, duration of action: 4-6 hours.
    • Celecoxib:
      • Dosing: 100mg BID PO or 200mg daily PO for osteoarthritis.
      • Selective COX-2 inhibitor, potent anti-inflammatory activity without significant GI toxicity.

    Gastroprotection Strategies

    • Using COX-2 selective NSAIDs:
      • Increased risk of cardiovascular disease and mortality.
    • Using Prostaglandin Analogues:
      • Misoprostol.
    • Using Proton Pump Inhibitors:
      • Omeprazole.

    Homeopathy

    • Bryonia alba (White Bryony):
      • Affinities: acts on tendons, ligaments, or connective tissue.
      • Causes inflammation and dryness, worse with motion, better with rest and strong pressure.
    • Rhus tox (Poison Ivy):
      • Affinities: joint/tendon/muscle ailment with stiffness.
      • Skin: face, scalp, genitals, glands, nerves, mucus membranes, red skin, itchy, herpes.
      • Worse with wet, cold air, motion, better from continued motion, change in position, hot drinks.
    • Ledum (Marsh Tea):
      • Acute gouty pain of ankle and knee.
      • Worse with heat, in bed at night, motion, better with cold, soaking in cold water.

    Low Back Pain

    • Bot Med: Same botanicals as joint pain, with exceptions of Corydalis yanhusuo.
    • Corydalis yanhusuo (Yan Hou So):
      • Actions: analgesic, hepatic, warming, calminative.
      • Constituents: alkaloids, volatile oils.
      • Indications: any pain, safety: do not use in pregnancy, drowsiness with high dose.

    Nutrition

    • Focuses: Vitamin C, Magnesium, Proteolytic enzymes, Vitamin D.
    • Vitamin C:
      • Increases calcium absorption, strong bones/healing, fractures/wounds.
      • Risk of deficiency: children < 1 year, the elderly, especially those in nursing homes, low fruit and vegetable intake, cigarette smokers, people with gastro-esophageal reflux disease.
      • Sources: fruits, veggies, Upper tolerable intake level (UL) for vitamin C is 2g/d.
    • Magnesium:
      • Deficiency is one of the main causes of low back pain.
      • Supports muscle and nerve function, a deficiency is directly related to impaired muscle and nerve function that can affect the back.
      • Sources: nuts, seeds, legumes, whole grains, especially oats.

    Contraindications of High Doses of Corticosteroids

    • Pregnancy and trying to conceive
    • Renal diseases
    • Liver diseases
    • Malnutrition
    • Alcoholics

    Pharmacology of Corticosteroids

    • Two main subclasses: glucocorticoids and mineralocorticoids
    • Glucocorticoids:
      • Affect carbohydrate, fat, and protein metabolism
      • Have anti-inflammatory, immunosuppressive, anti-proliferative, and vasoconstrictive properties
    • Mineralocorticoids:
      • Primarily involved in electrolyte regulation
      • Modify renal excretion mechanisms
    • Both receptors are found in the skin
    • Hydrocortisone provides the backbone for all types of corticosteroids
    • Fluorinating or esterifying certain carbons in the four-ring backbone can increase potency

    Boswellia Serrata (Frankincense)

    • Primary actions: antimicrobial, anti-inflammatory, astringent
    • Constituents: resins, boswellic acid, volatile oils
    • Part used: resin
    • Indications: inflammatory joint conditions, IBD, topical antimicrobial
    • Daily therapeutic dose: 2-4 mL (1:5 in 90%) tincture or 300-3000 mg powder/supplement

    Capsicum Frutescens (Cayenne)

    • Primary actions: stimulant, circulatory tonic, rubefacient, sialagogue, libido tonic

    Diets

    • Lacto-ovo vegetarian diet: avoids meats, allows milk and eggs
    • Vegan diet: avoids all products originating from animals

    Fatty Acids

    • Omega-3 fatty acids:
      • Prevent or improve experimental arthritis
      • Reduce joint pain and morning stiffness in RA
    • Sources: fish oil, green veggies, mushrooms, strawberries, oranges

    Folate

    • Common RA medication methotrexate destroys folate
    • Sources: green veggies, mushrooms, legumes, strawberries, oranges
    • Required addition of 1.4 mg/kg in Canada since 1998 to prevent neural tube defects

    Iron

    • Anemia is common in patients with chronic inflammatory joint conditions such as RA
    • 2 types of iron: veggie sources (red peppers, parsley, broccoli, etc.)
    • Upper tolerable intake level (UL) for vitamin C is 2 g/d
    • Contraindicated in pregnancy above 2 grams due to risk of oxalate stone formation and iron metabolism diseases

    Magnesium

    • Deficiency is a main cause of low back pain
    • Supports muscle and nerve function
    • Sources: nuts and seeds, legumes and whole grains (especially oats)
    • Anger and strong pressure on the lower back are relieved with heat and flexing the thigh toward the pelvis

    Kalium Carbonicum (Potassium Carbonate)

    • Affinities: articular system, CNS, circulatory system
    • Sensations: anxiety in epigastric pit (solar plexus)
    • Better with heat, when sitting
    • Craving for sweets, thick secretions, weakness, and worse between 2-4 am

    Magnesium Phosphate

    • "The Great Antispasmodic Remedy"
    • Cramps in calves, sciatica, feet feel tender
    • Better with heat, need to move consistently from pain, anger, vexation

    Week 6 Depression

    • Key action: warming adaptogen, hepatic/alterative
    • Physical activity is the most effective treatment for depression
    • Herbs acting as stimulants can be used, expecting stronger herbs at bigger doses.

    Pneumonia

    • Combination of amoxicillin and clavulanate is typically used for treatment failure or recurrence
    • Diarrhea is commonly noted as an adverse effect of combination therapy
    • H. influenzae and M. catarrhalis produce beta-lactamases, which confer resistance, and this is overcome by using a beta-lactamase inhibitor called clavulanate

    Homeopathy

    • Drosera (Common sundew) is the #1 cough remedy for whooping cough
    • It is also used for respiratory illnesses, such as laryngitis, bronchitis, and tuberculosis
    • Characteristics of Drosera include:
      • Tormenting cough, paroxysms, short cough, and ringing cough
      • Must hold the chest to cough, inability to cough due to pain
      • Suspicious of others, easily angered
      • Worsened in the evening, after midnight, and triggered by drinking, exertion, singing, and smoking
    • Colocynthis (bitter cucumber) is used for:
      • Diarrhea
      • Affinity for smooth muscles of the GI tract, peripheral nervous system, and cranial nerves
      • Characterized by violent cramping, feeling like muscle being pulled, followed by numbness

    Nutrition

    • Malnutrition is common among patients with rheumatoid arthritis
    • Specific diets that can help include:
      • Fish oil
      • Folate
      • Iron
    • Foods that can trigger inflammation:
      • Red meat
      • Dairy
      • Nightshade vegetables (potatoes, eggplant, tomatoes, peppers)
    • The Mediterranean diet can improve function, joint mobility, and pain in rheumatoid arthritis
    • Vegan/vegetarian diets may help, but there is limited evidence

    Fatty Acids

    • Omega-3 fatty acids seem to prevent or improve experimental arthritis
    • Omega-3 fatty acid supplements, particularly fish oil, have been widely studied and shown to reduce joint pain and morning stiffness

    Folate

    • A common RA medication, methotrexate, destroys folate
    • Sources of folate include:
      • Green vegetables
      • Mushrooms
      • Legumes
      • Strawberries
      • Oranges

    Iron

    • Anemia is common in patients with chronic inflammatory joint conditions, such as RA
    • Two types of iron:
      • Veggies (red peppers, parsley, broccoli, Brussels sprouts, asparagus, kale)
      • Upper tolerable intake level (UL) for vitamin C is 2 g/d, which can help iron absorption
    • Iron deficiency can cause gastric cramping, diarrhea, and bloating, among other symptoms

    Magnesium

    • Deficiency is one of the main causes of low back pain
    • Supports muscle and nerve function
    • Sources include:
      • Nuts and seeds
      • Legumes and whole grains (oats, barley, brown rice)
      • Most vegetables (green leafy, corn, carrots)
      • Seafood and dairy products
      • Coffee and tea, cocoa, and chocolate
    • Deficiency can cause:
      • Muscle tremors, spasms, cramps, and tetany
      • Chest tightness and shortness of breath
      • Palpitations and cardiac arrhythmias
      • Anxiety, depression, fatigue, insomnia, and loss of appetite

    Proteolytic Enzymes

    • Effective at reducing inflammation and symptoms related to inflammatory conditions (chronic pain, osteoarthritis)
    • Types include:
      • Protease (protein)
      • Lipase (lipids)
      • Amylase, lactase, alpha-galactosidase, and cellulase (carbs)

    Vitamin D

    • Improves absorption of calcium, which is good for bones and lower back pain
    • Deficiency is seen in LBP patients
    • Skin production depends on:
      • Length of exposure to the sun
      • Amount of bare skin exposed
      • Season and time of day
      • Level of latitude
      • Degree of pigmentation
      • Age

    Pharmacologic Options

    • Acetaminophen and NSAIDs
    • GABA derivatives (Pregabalin, Gabapentin)
    • Muscle relaxants (antispasmodics, antispastics)
    • Opioids

    GABA Derivatives

    • Pregabalin and Gabapentin are typically reserved for soft tissue and hyperalgesic pain
    • Act centrally, not fully understood mod of action
    • Similar structure to GABA but do not interact with GABA
    • Modes of action:
      • Bind α2δ1 receptors of voltage-gated calcium channels
      • Modify calcium entry and reduce neurotransmitter release

    Gabapentin

    • Initial dose: 300-400 mg/day PO, divided TID
    • Can increase at weekly intervals to a maximum of 3600 mg/day, divided TID
    • Should not be taken with mineral supplements or antacids as this may decrease bioavailability

    Pregabalin

    • Initial dose: 50-150 mg daily PO, divided BID
    • May increase weekly by 50-150 mg/day to a maximum of 600 mg/day, divided BID
    • Does not have significant interactions and is typically preferred as it is taken twice a day vs three times a day with gabapentin

    Muscle Relaxants

    • Loosely differentiated into antispasmodics and antispastics
    • Two types:
      • Antispasmodics (Benzodiazepines or non-benzodiazepines)
      • Methocarbamol (non-benzodiazepine antispasmodic)
    • Baclofen (GABA receptor agonist specific for the beta subunit)
    • All muscle relaxants are not recommended for those over the age of 65

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