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?

Isoquinoline alkaloids (berberine, hydrastine) Signup and view all the answers

What is the indication for using Echinacea in therapy?

Strep throat, colds, vaginal candidiasis, UTI Signup and view all the answers

What is the safety precaution associated with using Hydrastis canadensis?

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

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

Antipyretic Signup and view all the answers

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

Phenolics (caffeic acid), polysaccharides Signup and view all the answers

What is the primary action of Curcuma longa?

Anti-inflammatory Signup and view all the answers

What is the indication of Capsaicinoids?

Circulatory deficiencies Signup and view all the answers

What is the part used of Ginkgo biloba?

Leaf and fruit Signup and view all the answers

What is the daily therapeutic dose of Curcuma longa powder?

8-20 g Signup and view all the answers

What is the primary action of Ginkgo biloba?

All of the above Signup and view all the answers

What is the constituent of Curcuma longa?

Phenolic antioxidants Signup and view all the answers

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

Increased susceptibility to infection Signup and view all the answers

Which of the following is a characteristic of honey?

Antimicrobial properties and not suitable for infants under 1 year Signup and view all the answers

What is the main function of probiotics?

Supporting healthy microbiome Signup and view all the answers

What is the recommended form of vitamin D supplementation?

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

What is the effect of bactericidal antibiotics?

Killing sensitive organisms Signup and view all the answers

What is the typical indication for Penicillin V?

A streptococcal pharyngitis Signup and view all the answers

What is the recommended way to take Vitamin D3 supplementation?

With food or a main meal Signup and view all the answers

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

Increased risk of toxicity Signup and view all the answers

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

Impaired muscle and nerve function Signup and view all the answers

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

2 g/d Signup and view all the answers

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

Gastric gramping and diarrhea Signup and view all the answers

Which of the following is a rich source of magnesium?

Nuts and seeds Signup and view all the answers

What is a potential health consequence of magnesium deficiency?

Low back pain Signup and view all the answers

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

Contraindication due to adverse effects Signup and view all the answers

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

Heme iron Signup and view all the answers

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

Celecoxib Signup and view all the answers

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

Gastrointestinal side effects Signup and view all the answers

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

All of the above Signup and view all the answers

What is the primary mechanism of action of acetaminophen?

Little effect on COX-1 or COX-2 Signup and view all the answers

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

All of the above Signup and view all the answers

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

Reduced risk of gastrointestinal side effects Signup and view all the answers

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

To increase calcium absorption Signup and view all the answers

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

Hepatic toxicity Signup and view all the answers

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

Pain relief Signup and view all the answers

What is the primary function of glucocorticoids?

Influence on carbohydrate, fat, and protein metabolism Signup and view all the answers

What is the primary function of mineralocorticoids?

Modifying renal excretion mechanisms Signup and view all the answers

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

Pregnancy or trying to conceive Signup and view all the answers

What is the common backbone for all types of corticosteroids?

Hydrocortisone Signup and view all the answers

What can increase the potency of topical corticosteroids?

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

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

Malnutrition Signup and view all the answers

What is a common receptor for both glucocorticoids and mineralocorticoids?

Skin receptors Signup and view all the answers

What is the effect of corticosteroids on protein metabolism?

Breakdown of protein Signup and view all the answers

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

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

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

Reducing morning stiffness Signup and view all the answers

Which food group is a rich source of folate?

Legumes and green vegetables Signup and view all the answers

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

To counteract the destruction of folate by methotrexate 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?

To prevent neural tube defects Signup and view all the answers

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

Anemia Signup and view all the answers

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

Heme and non-heme iron Signup and view all the answers

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

Omega-3 fatty acids decrease joint pain Signup and view all the answers

What is the primary action of Boswellia serrata?

Antimicrobial, anti-inflammatory, astringent Signup and view all the answers

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

Resin Signup and view all the answers

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

300-3000 mg Signup and view all the answers

What is the primary action of Capsicum frutescens?

Stimulant, circulatory tonic, rubefacient Signup and view all the answers

What is the constituents of Boswellia serrata?

Resins, boswellic acid, volatile oils Signup and view all the answers

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

Gastric cramping, diarrhea, and bloating Signup and view all the answers

What is the caution associated with using Boswellia serrata?

Not generally taken internally in large amounts Signup and view all the answers

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

Nuts and seeds Signup and view all the answers

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

Impaired muscle and nerve function Signup and view all the answers

What is a potential health consequence of magnesium deficiency?

Low back pain Signup and view all the answers

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

2 g/d Signup and view all the answers

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

Contradiction of vitamin C Signup and view all the answers

What is the sensation associated with Kalium Carbonicum?

Anxiety in the epigastric pit (Solar plexus) Signup and view all the answers

What is the characteristic of Magnesium Phosphate?

The Great Antispasmodic Remedy Signup and view all the answers

What is the recommended approach for treating depression?

Engaging in physical activity Signup and view all the answers

What is the characteristic of Anger?

Strong pressure towards the pelvis Signup and view all the answers

What is the effect of Kalium Carbonicum on the body?

Relieves anxiety in the epigastric pit (Solar plexus) Signup and view all the answers

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

Need to move consistently from pain Signup and view all the answers

What is the affinity of Kalium Carbonicum?

Articular system and CNS Signup and view all the answers

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

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

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

Impairs muscle and nerve function Signup and view all the answers

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

2 g/d Signup and view all the answers

Which of the following is a rich source of magnesium?

Nuts and seeds Signup and view all the answers

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

Contradiction in pregnancy Signup and view all the answers

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

Impairs iron metabolism Signup and view all the answers

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

Red peppers Signup and view all the answers

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

The inclusion of milk and eggs Signup and view all the answers

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

Reducing morning stiffness Signup and view all the answers

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

All of the above Signup and view all the answers

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

To counteract the destruction of folate by methotrexate Signup and view all the answers

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

Anemia Signup and view all the answers

What is a common condition associated with rheumatoid arthritis?

Malnutrition Signup and view all the answers

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

They prevent or improve the condition Signup and view all the answers

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

1.4 mg/kg Signup and view all the answers

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

Eggs Signup and view all the answers

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

Release of IgE antibody Signup and view all the answers

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

They are rich in folate Signup and view all the answers

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

Mediterranean diet Signup and view all the answers

What is the role of food in rheumatoid arthritis?

Trigger for inflammation Signup and view all the answers

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

All of the above Signup and view all the answers

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

Improvement in symptoms in 30-40% of patients Signup and view all the answers

What is the role of nutrition in rheumatoid arthritis?

Important for maintaining overall health Signup and view all the answers

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

H.influenzae and M.catarrhalis Signup and view all the answers

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

Treatment failure or recurrence of pneumonia Signup and view all the answers

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

Diarrhea Signup and view all the answers

What is Drosera commonly used to treat?

Whooping cough and respiratory illnesses Signup and view all the answers

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

Ringing cough with paroxysms Signup and view all the answers

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

Suspicious and easily angered Signup and view all the answers

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

After 72 hours of treatment Signup and view all the answers

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

Evening and after midnight Signup and view all the answers

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

Green leafy vegetables Signup and view all the answers

What is the primary function of proteolytic enzymes?

To reduce inflammation and symptoms related to inflammatory conditions Signup and view all the answers

What is the recommended daily dose of vitamin D?

1000 IU/day Signup and view all the answers

Which of the following is a GABA derivative?

Pregabalin Signup and view all the answers

What is the mechanism of action of Baclofen?

It binds to the beta subunit of GABA receptors Signup and view all the answers

What is the primary indication for using Methocarbamol?

Muscle spasticity Signup and view all the answers

What is the effect of GABA derivatives on the body?

They decrease the rate of action potentials Signup and view all the answers

Which of the following is a homeopathic remedy?

Colocynthis Signup and view all the answers

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

It may increase the risk of CNS depression Signup and view all the answers

What is the recommended daily dose of magnesium?

400 mg/day 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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This quiz covers the therapeutic methods and herbal remedies for Upper Respiratory Tract Infections (URTI) caused by bacteria, including the 'H.E.M.P' formula and its components.