Yellow Jasmine: Symptoms and Characteristics
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Questions and Answers

Which vitamin is essential for immune responses and can be found in citrus fruits?

  • Vitamin C (correct)
  • Vitamin E
  • Vitamin D
  • Vitamin A

    • What is the primary source of zinc in the diet?

  • Legumes and seeds
  • Meats, poultry, and seafood (correct)
  • Fruits and vegetables
  • Dairy products

    • What is the term for the use of food sources to support immune function?

  • Nutritional immunology
  • Foundational health management (correct)
  • Preventative health plan
  • Dietary immunotherapy

    • Which of the following foods is a good source of probiotics?

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

    What is the consequence of deficiencies in zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, D, and E?

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

    What is the primary benefit of consuming enough nutrients in the diet?

    <p>Supporting overall health</p> Signup and view all the answers

    What is the primary action of Ginkgo biloba?

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

    What is the part used of Glycyrrhiza glabra?

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

    What is the daily therapeutic dose of Ginkgo biloba tincture?

    <p>3-9 mL (1:5 in 40%)</p> Signup and view all the answers

    What is the contraindication of Glycyrrhiza glabra?

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

    What is the daily therapeutic dose of Glycyrrhiza glabra infusion or decoction?

    <p>2-9 g dried root</p> Signup and view all the answers

    What is the indication of Ginkgo biloba?

    <p>Ongoing stress</p> Signup and view all the answers

    What is the main action of the botanical 'Echinacea angustifolia'?

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

    Which botanical is indicated for stress, fatigue, and cold/flu treatment?

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

    What is the main action of the botanical 'Althaea officinalis'?

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

    Which botanical is indicated for cough and has expectorant properties?

    <p>Eucalyptus globulus</p> Signup and view all the answers

    What is the main action of the botanical 'Zingiber officinale'?

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

    Which botanical is contraindicated in stomach/GI ulcers?

    <p>Andrographis paniculata</p> Signup and view all the answers

    What is the part used of the botanical 'Sambucus nigra'?

    <p>Flower/Berries</p> Signup and view all the answers

    Which botanical is indicated for inflamed mucous membranes?

    <p>Althaea officinalis</p> Signup and view all the answers

    What is the combination of botanicals best suited for treating colds?

    <p>Zingiber officinale, Echinacea angustifolia, Baptisia tinctoria</p> Signup and view all the answers

    What is the chemical responsible for the antimicrobial properties of 'Echinacea angustifolia'?

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

    What is a common nutritional issue among patients with rheumatoid arthritis?

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

    Which of the following foods is NOT a common trigger for food allergies?

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

    What is the result of an IgE antibody release in response to a food allergen?

    <p>Histamine release</p> Signup and view all the answers

    What is the primary benefit of a Mediterranean diet in relation to rheumatoid arthritis?

    <p>Improving joint mobility</p> Signup and view all the answers

    Which of the following is a type of vegetarian diet?

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

    What is the role of fish oil in relation to rheumatoid arthritis?

    <p>Reducing inflammation</p> Signup and view all the answers

    What is the expected outcome of an elimination diet in patients with rheumatoid arthritis?

    <p>30-40% improvement</p> Signup and view all the answers

    Which of the following foods is a trigger for RA inflammation?

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

    What is the source of heme iron?

    <p>Animal products</p> Signup and view all the answers

    What is the primary mechanism of action of Acetylsalicylic acid (ASA)?

    <p>Inhibiting COX-1 enzyme</p> Signup and view all the answers

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

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

    What is the primary indication for the use of Misoprostol?

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

    What is the primary action of Bryonia alba in homeopathy?

    <p>Relieving inflammation and dryness</p> Signup and view all the answers

    What is the primary ingredient used in botanic medicine for low back pain?

    <p>Corydalis yanhusuo</p> Signup and view all the answers

    What nutrient is essential for increasing calcium absorption and bone health?

    <p>Vitamin C</p> Signup and view all the answers

    What is the primary risk factor for gastrointestinal bleeding when using NSAIDs?

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

    What is the primary effect of Acetaminophen on COX enzymes?

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

    What is the primary benefit of using Celecoxib over non-selective COX inhibitors?

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

    What is the recommended daily dose of 5-HTP?

    <p>200-400 mg/day</p> Signup and view all the answers

    What is the role of B vitamins in the body?

    <p>Involved in both anabolic and catabolic cellular processes</p> Signup and view all the answers

    What is the recommended daily dose of Magnesium?

    <p>200-600 mg/day</p> Signup and view all the answers

    What is the recommended daily dose of Vitamin D?

    <p>1000-2500 IU/day</p> Signup and view all the answers

    What is the primary symptom of Arsenicum Album?

    <p>Intense burning</p> Signup and view all the answers

    What is the time when Arsenicum Album symptoms worsen?

    <p>Between 12-3 am</p> Signup and view all the answers

    What is the primary benefit of SAMe?

    <p>Reduces anxiety and depression</p> Signup and view all the answers

    What is the ramp-up strategy for SAMe?

    <p>Ramp up slowly to the maximum dose</p> Signup and view all the answers

    What is the maximum daily dose of clarithromycin for children?

    <p>500 mg</p> Signup and view all the answers

    What is the primary mechanism of action of lincosamides?

    <p>Interfering with translocation</p> Signup and view all the answers

    What is the common adverse effect of clindamycin?

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

    What is the primary reason for using clindamycin in patients with pharyngitis?

    <p>It is an alternative for patients allergic to penicillin</p> Signup and view all the answers

    What is the effect of clarithromycin on certain medications?

    <p>Increases their levels</p> Signup and view all the answers

    What is the primary concern with using lincosamides?

    <p>They increase the risk of Clostridium difficile infections</p> Signup and view all the answers

    What is the dose of azithromycin for adults?

    <p>500 mg PO for one day, then 250 mg PO daily for 4 days</p> Signup and view all the answers

    What is the dose of clarithromycin for children?

    <p>12 mg/kg PO for 5 days</p> Signup and view all the answers

    What is the primary mechanism of action of glucocorticoids?

    <p>They interact with intracellular glucocorticoid receptors and translocate to the nucleus</p> Signup and view all the answers

    What is the effect of glucocorticoids on cell proliferation and collagen synthesis?

    <p>They inhibit cell proliferation and collagen synthesis</p> Signup and view all the answers

    What is the common adverse effect of topical glucocorticoid use due to overstimulation of glucocorticoid receptors in the skin?

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

    What is the purpose of using a finger tip unit (FTP) in topical glucocorticoid therapy?

    <p>To estimate the amount of glucocorticoid needed to cover a particular area</p> Signup and view all the answers

    Which of the following topical glucocorticoid vehicles is most effective but least preferred due to its greasy texture?

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

    What is the main indication for the use of Urtica urens in homeopathy?

    <p>Skin conditions with itching, burning, and stinging</p> Signup and view all the answers

    What is the main indication for the use of Rhus toxicodendron in homeopathy?

    <p>Skin conditions with itching, redness, and inflammation</p> Signup and view all the answers

    What is the key action of Bupleureum chinensis in botanic medicine?

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

    What is the primary consideration when choosing the potency of a topical glucocorticoid?

    <p>The location of the skin condition</p> Signup and view all the answers

    What is the primary goal of treating rheumatoid arthritis with botanic medicine?

    <p>To reduce inflammation and promote circulation</p> Signup and view all the answers

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

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

    What is the primary benefit of vitamin D in relation to bone health?

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

    Which of the following is a type of proteolytic enzyme?

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

    What is the primary mechanism of action of GABA derivatives?

    <p>Bind to voltage-gated calcium channels</p> Signup and view all the answers

    What is the primary indication for the use of muscle relaxants?

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

    Which of the following is a contraindication for the use of vitamin D?

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

    What is the primary benefit of using proteolytic enzymes in inflammatory conditions?

    <p>Reduces inflammation</p> Signup and view all the answers

    Which of the following is a common adverse effect of GABA derivatives?

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

    What is the primary mechanism of action of Baclofen?

    <p>Acts as a GABA receptor agonist</p> Signup and view all the answers

    Which of the following homeopathic remedies is used to treat diarrhea and abdominal cramps?

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

    What is the indication of Turmeric?

    <p>General inflammatory conditions, OA and RA, possibly cancer lesions</p> Signup and view all the answers

    What is the daily therapeutic dose of Cayenne Infusion or Decoction?

    <p>1-2 g powder</p> Signup and view all the answers

    What is the primary action of Ginkgo biloba?

    <p>Circulatory tonic, vasodilator, anti-inflammatory</p> Signup and view all the answers

    What is the part used of Cayenne?

    <p>Dried or powdered fruit</p> Signup and view all the answers

    What is the daily therapeutic dose of Turmeric Tincture?

    <p>8-24 mL</p> Signup and view all the answers

    What is the primary action of Cayenne?

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

    What are the two main subclasses of corticosteroids?

    <p>Glucocorticoids and Mineralocorticoids</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

    What is the backbone for all types of corticosteroids?

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

    What is the effect of fluorinating or esterifying certain carbons in the four-ring backbone of corticosteroids?

    <p>Increasing the potency of the corticosteroids</p> Signup and view all the answers

    In which population is the use of high doses of corticosteroids contradicted?

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

    What is the primary function of glucocorticoids?

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

    Where are the receptors for both glucocorticoids and mineralocorticoids found?

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

    What is the mechanism of action of corticosteroids?

    <p>Binding to specific receptors and modifying gene expression</p> Signup and view all the answers

    What is the recommended dose of difficile colitis for adults?

    <p>300 mg TID PO for 10 days</p> Signup and view all the answers

    What is the characteristic of Belladonna in homeopathy?

    <p>Violence of attack and suddenness</p> Signup and view all the answers

    What is the affinity of Belladonna in homeopathy?

    <p>Brain, head, cardiovascular, fever</p> Signup and view all the answers

    What is the symptom of Belladonna in homeopathy when the throat is affected?

    <p>Throat feels constricted, difficult deglutition</p> Signup and view all the answers

    When do Belladonna symptoms worsen?

    <p>In the afternoon</p> Signup and view all the answers

    What is the mental emotion of Belladonna in homeopathy?

    <p>Lively, bubbly personality</p> Signup and view all the answers

    What is the characteristic of Gelsemium sempervirens in homeopathy?

    <p>Gradual onset of complaints</p> Signup and view all the answers

    What is the symptom of Gelsemium sempervirens in homeopathy?

    <p>Muscular weakness, may see double</p> Signup and view all the answers

    What is the primary characteristic of a lacto-ovo-vegetarian diet?

    <p>Meats are avoided, but milk and eggs are allowed</p> Signup and view all the answers

    What is the benefit of omega-3 fatty acids in relation to rheumatoid arthritis?

    <p>They reduce joint pain and morning stiffness</p> Signup and view all the answers

    Why do doctors often prescribe folate supplements to patients with rheumatoid arthritis?

    <p>Because methotrexate, a common RA medication, destroys folate</p> Signup and view all the answers

    What is the common nutritional issue among patients with rheumatoid arthritis?

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

    What is the primary benefit of fish oil in relation to rheumatoid arthritis?

    <p>It reduces joint pain and morning stiffness</p> Signup and view all the answers

    What type of iron is commonly found in meat?

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

    What is the primary reason for adding folate to certain foods in Canada?

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

    What is the characteristic of a vegan diet?

    <p>All products originating from animals are avoided</p> Signup and view all the answers

    What is the primary goal of the 'H.E.M.P' formula in BotMed?

    <p>To support the immune system and combat infection</p> Signup and view all the answers

    What is the primary action of Hydrastis canadensis in BotMed?

    <p>Antimicrobial, antifungal, and antiviral</p> Signup and view all the answers

    What is a contraindication for the use of Hydrastis canadensis?

    <p>Gastric or stomach ulcers</p> Signup and view all the answers

    What is the primary action of Echinacea in BotMed?

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

    What is a safety consideration for the use of Echinacea?

    <p>Use with caution in individuals with autoimmune disorders</p> Signup and view all the answers

    What is the part used of Hydrastis canadensis?

    <p>Root only</p> Signup and view all the answers

    What is Phytolacca commonly referred to as?

    <p>Poke Root</p> Signup and view all the answers

    What is the primary indication for the use of Phytolacca?

    <p>Upper respiratory tract infections</p> Signup and view all the answers

    What is the primary action of Withania somnifera?

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

    Which of the following constituents is found in Withania somnifera?

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

    What is the recommended daily dose of Omega 3 fatty acids for beneficial effects on depression?

    <p>1-4 g EPA+DHA/Day</p> Signup and view all the answers

    What is the main focus of nutrition in relation to mood regulation?

    <p>Diet, spices, and microbiome</p> Signup and view all the answers

    Which of the following is a notable nutrient in relation to mood regulation?

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

    What is the benefit of a Mediterranean diet in relation to rheumatoid arthritis?

    <p>Reduces risk of rheumatoid arthritis by 33%</p> Signup and view all the answers

    What is the primary benefit of Withania somnifera in relation to fatigue?

    <p>Increases energy levels</p> Signup and view all the answers

    What is the precaution to consider when using Withania somnifera?

    <p>Pregnancy category C</p> Signup and view all the answers

    Study Notes

    Yellow Jasmine

    • Associated with muscle aches, soreness, pain, and heaviness
    • Characterized by thirstlessness, feelings of being "droopy, dizzy, drowsy, and dull"
    • Often accompanied by influenza, mononucleosis, and Chronic Fatigue Syndrome (CFS)
    • May exhibit extreme weakness, inability to sit up in bed, and confusion
    • May experience body delusions, such as feeling like limbs are detached from the body
    • May have canker sores and diarrhea (GI infections)
    • Better when indoors, drinking liquids (although may gag on fluids)
    • Worse when in cold, open air, walking, or eating solids

    Allium Cepa (Red Onion)

    • Affinity for mucus membranes (nose, eyes, larynx, bowels)
    • Characterized by mental emotions of anxiety and stage fright
    • Physical symptoms include:
      • Grogginess, sleepiness, and lethargy, especially in the morning
      • Indifference, dullness, and lack of motivation
      • Absent-mindedness, worsened in the afternoon and by coffee
    • Physical complaints:
      • Left-sided or left-to-right neuralgic pains after surgery/amputation/injury
      • Shooting pains following a thin line
    • Worse in warm rooms, spring and fall, evenings, and around flowers and cucumber
    • Better in fresh air (not too cold) and when consuming onions (may crave)

    Botanical Medicine

    • Echinacea angustifolia:
      • Treats common cold, flu, and URTIs
      • Actions: immunostimulant, antimicrobial
      • Chemicals: alkylamides, phenolics, polysaccharides
      • Safety: caution with autoimmune disease, safe in pregnancy
    • Ginseng (Panax ginseng):
      • Treats stress, fatigue, and cold/flu
      • Actions: adaptogen, immunostimulant, antiviral
      • Chemicals: steroidal saponins, polysaccharides
      • Safety: caution with high blood pressure, safe in pregnancy
    • Andrographis paniculata:
      • Treats colds, colitis, and liver disease
      • Actions: immunomodulator, antimicrobial
      • Chemicals: diterpene lactones, flavanoids
      • Safety: contraindicated with stomach/GI ulcers, obstructed gallbladders; not recommended in pregnancy
    • Sambucus nigra (European Elder flower):
      • Treats cold and flu
      • Actions: diaphoretic, antiviral, anti-adherence
      • Chemicals: anthocyanin, flavinoids
      • Safety: toxicity causes vomiting/diarrhea
    • Other botanicals:
      • Hedera helix (English Ivy leaf): treats cough and acute phlegm
      • Glycyrrhiza glabra (Licorice): treats RTIs, anti-inflammatory, expectorant
      • Althaea officinalis (Marshmallow): treats inflamed mucous membranes, RTIs
      • Eucalyptus globulus (Eucalyptus): treats RTIs, GI tract spasms
      • Baptisia tinctoria (Wild Indigo): treats common cold, lymphatic, anti-microbial, immune stimulant
      • Zingiber officinale (Ginger): treats common cold, antioxidant, anti-inflammatory, antimicrobial, diaphoretic

    Best Combination for Colds

    • Ginger, Echinacea, and Wild Indigo

    Nutrition

    • Vitamin C: found in fruits and vegetables, citrus fruits (45 mg/lemon)
    • Zinc: found in meats, poultry, seafood, legumes, seeds (33 mg/6 medium oysters)
    • Probiotics: found in fermented foods, sauerkraut, kimchi, yogurt, tempeh
    • Diet Sources: animal studies show that deficiencies in zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, D, and E can alter immune responses

    Glycyrrhiza glabra (Licorice)

    • Primary actions: adaptogen, anti-inflammatory, demulcent, antiviral, hypertensive
    • Part used: root
    • Constituents: triterpene saponins, glycyrrhizin, glycyrrhetinic acid, chalcones
    • Indications: ongoing stress, hypotension, asthma, eczema, chronic or acute bronchitis, emphysema, URTI, post-viral cough, stomach ulcers (mostly DGL)
    • Cautions/Contraindications: hypertension, pregnancy, lactation, difficult urination, Lyme disease

    Considerations

    • Malnutrition common among patients with rheumatoid arthritis

    • Food allergy: release of IgE antibody, mistaking food for pathogen

    • Common food allergies: eggs, milk, fish, shellfish, peanuts, tree nuts, wheat

    • Vegan/vegetarian diet: little evidence, but may improve function, joint mobility, and pain in RA### Iron Sources

    • Heme iron: derived from hemoglobin and myoglobin, found only in animal products (meat, fish, poultry, oysters, and clams)

    • Non-Heme iron: found in meats, beans, dark greens, leafy veggies, dried fruits, blackstrap molasses, and enriched foods (flour, breads, pastas, and cereals)

    NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

    • Most commonly prescribed medications for pain and inflammation
    • Make up 5-10% of all medications prescribed each year
    • Up to 96% of patients over 65 use NSAIDs in the family practice setting

    COX Inhibitors

    • Non-specific COX inhibitors: acetylsalicylic Acid (ASA) and ibuprofen
    • COX-2 specific inhibitors: celecoxib
    • Non-specific COX inhibitors without anti-inflammatory effect: acetaminophen

    Acetylsalicylic Acid (ASA)

    • Causes irreversible inhibition of COX by covalent bond of acetyl group
    • Dosing: 325-650mg Q4H (every 4 hours), maximum 4g/day
    • Lasts 6 hours, hits in 1 hour
    • Contraindicated in children with viral infections
    • GI irritation, ulcers, bleeding, and tinnitus are adverse effects
    • High doses can cause hyperventilation, fever, dehydration, metabolic acidosis, and impairment of hemostasis
    • Hypersensitivity reactions are uncommon but potentially fatal

    Ibuprofen

    • Dosing: 200-400mg Q6-8 hours PO, maximum 1200mg/day
    • Onset of action: 30-60 minutes, duration of action: 4-6 hours
    • Adverse effects include GI irritation, nausea, dyspepsia, bleeding, hepatic toxicity, and renal toxicity

    Acetaminophen

    • Dosing: 325-650mg Q4H PO, maximum 4g/day
    • Onset of action: under 1 hour, duration of action: 4-6 hours
    • Little anti-inflammatory effect, may explain analgesic and antipyretic effect
    • Risks include rapid absorption from the gut, minimal plasma protein binding, and toxic intermediate formation

    Celecoxib

    • Dosing: 100mg BID PO or 200mg daily PO for osteoarthritis
    • Selective COX-2 inhibitor with potent anti-inflammatory activity without significant GI toxicity
    • Increased risk of cardiovascular disease and mortality

    Gastroprotection Strategies

    • Using COX-2 selective NSAIDs
    • Using prostaglandin analogues (e.g., misoprostol)
    • Using proton pump inhibitors (e.g., omeprazole)

    Homeopathy

    • Bryonia alba (white bryony): acts on tendons, ligaments, or connective tissue, causes inflammation and dryness
    • Rhus tox (Poison ivy): acts on joints, tendons, and muscles, causes stiffness and skin issues
    • Ledum (Marsh tea): acts on acute gouty pain in the ankle and knee

    Low Back Pain (Botanical Medicine)

    • Same potanicals as joint pain, with exceptions of Corydalis yanhusuo
    • Corydalis yanhusuo (yan hou so): analgesic, hepatic, warming, and calminative properties

    Nutrition

    • Focuses on Vitamin C, Magnesium, Proteolytic enzymes, and Vitamin D
    • Vitamin C: increases calcium absorption, strong bones, and healing, risk of deficiency in certain populations

    Antibiotics

    • Azithromycin: 500 mg PO for one day, then 250 mg PO daily for 4 days for adults; 12 mg/kg PO for 5 days with a maximum daily dose of 500 mg for children.
    • Clarithromycin: an alternative for patients who are allergic to penicillin; same adverse effect profile as azithromycin; also available as a suspension; increases the levels of some common drugs like atorvastatin, lovastatin, simvastatin, and prednisone.
    • Clarithromycin dosage: 250 mg BID PO for 10 days for adults; 15 mg/kg/day divided BID PO for 10 days with a maximum daily dose of 500 mg for children.
    • Lincosamides: interfere with translocation like macrolides but do not inhibit peptidyl transferase; approximately 4 times more likely to cause Clostridium difficile infections compared to other antibiotics; generally bacteriostatic but can be bactericidal at high doses.
    • Clindamycin: an alternative for patients who are allergic to penicillin; may be used for treatment in symptomatic patients with multiple, recurrent episodes of pharyngitis; commonly causes diarrhea as an adverse effect.

    Glucocorticoids

    • Mechanism of action: interact with an intracellular glucocorticoid receptor, then translocate to the nucleus where a large number of gene transcription changes take place.
    • Effects:
      • General upregulation of anti-inflammatory mediators and downregulation of inflammatory mediators.
      • Vasoconstrictive effect which reduces delivery of inflammatory mediators and improves erythema.
      • Anti-mitotic effect which inhibits cell proliferation and collagen synthesis.
      • Immunosuppressant effect.
    • Adverse effects (topically):
      • Many adverse effects caused by overstimulating glucocorticoid receptors in skin.
      • Stinging or burning sensation.
      • Dermal atrophy Striae.
      • Rosacea.
      • Perioral dermatitis.
      • Acne.
      • Purpura.
      • Increased hair growth.
      • Skin pigment changes.
      • Delayed wound healing.
    • Finger tip units (FTP): 1 finger tip ~0.5 g; 5 g should cover two adult hands once spread.

    Topical Drug Vehicles

    • Types of vehicles:
      • Creams: most used but least effective; preferred because no residue is left; additives can cause irritation.
      • Gel: alcohol-based (can cause stinging); good for hairy areas/oily skin.
      • Lotion: alcohol-based (can cause stinging); good for larger hairy areas/oily skin; evaporates well.
      • Ointment: thick/greasy; least preferred but most effective; emollient effect; no-little irritation.
      • Foam: an aerosolized oil-based formulation; allows for application to hard-to-reach areas; tends to leave a greasy residue.
    • Potency: divided into 7 classes; Class 1: highest potency (“super/ultra high class”); Class 2: high; Class 3 – medium-high; Class 4/5 - medium; Class 6/7 – low potency.

    Homeopathy

    • Urtica urens (dwarf nettle):
      • Skin: itching, burning, and stinging.
      • Swelling/edema < heat.
      • Insect bites, punctured wounds, splinters.
      • Anaphylaxis.
      • No/low thirst.
      • Sudden, rapidly developing complaints.
      • Urticaria/hives with puffy swelling.
    • Rhus toxicodendron:
      • Affinities: skin, mucous membranes, fibrous tissue (joints, tendons, sheaths).
      • Itchy skin, red – chicken pox, herpes, psoriasis, urticaria, cellulitis.
      • < at rest (stiffens up), initial movement (but better with continuous motion).
      • COLD DAMP.
      • >heat, HOT BATHS, stretching.
    • Sulphur:
      • Skin: itchy < heat, red orifices.
      • Back: slouching, pain standing.
      • Mind: opinionated, critical, independent.
    • Graphites:
      • Skin: rough, scars, eruptions, cracks, infections.
      • Digestive organs, eyes.
      • Tendency toward obesity, chilliness, constipation.
      • Mind: dull, slow, timid, reserved, changeable, easily startled.

    Botanical Medicine

    • Key actions: hepatic, anti-inflammatory.

    • Treat RA as you would any condition of immune-mediated inflammation.

    • Treat OA or degenerative conditions by promoting circulation.

    • More inflammation: favour hepatics.

    • More swelling: favour diuretics.

    • Feeling of cold in the joints: use cayenne internally and topically.

    • Bupleureum chinensis (Chai hu):

      • Primary Actions: hepatic, alterative, anti-inflammatory, hepatoprotective.
      • Part Used: Root.
      • Constituents: Triterpene saponins, sterols, volatile oils, polysaccharides.
      • Daily Therapeutic Dose: Tincture: 6–12 mL (1:5 in 40%); Infusion or Decoction: 3–12 g.
      • Safety: Avoided in cold conditions or constitutions.

    • Cayenne:

      • Primary Actions: circulatory, anti-inflammatory, antipyretic.
      • Part Used: dried or powdered fruit.
      • Constituents: Capsaicinoids (capsaicin), steroidal saponins.
      • Daily Therapeutic Dose: Tincture: 1–5 mL (1:5 in 25%); Infusion or Decoction: 1–2 g powder.
      • Indications: Circulatory deficiencies, arthritic conditions, pain relief, depression.

    • Curcuma longa (Turmeric):

      • Primary Actions: Anti-inflammatory, mild antimicrobial, carminative, circulatory tonic.
      • Part Used: Root.
      • Constituents: Phenolic antioxidants, curcumin, volatile oils, starches.
      • Daily Therapeutic Dose: Tincture: 8–24 mL (1:5 in 30%); Infusion or Decoction: 8–20 g dried root or powder.
      • 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.
      • Part Used: Leaf and fruit.
      • Constituents: Flavonoids, terpenoids, alkylphenols, carbohydrates.
      • Daily Therapeutic Dose: Tincture: 10–20 mL (1:5 in 40%); Infusion or Decoction: 5–10 g dried leaf or powder.
      • Indications: Circulatory deficiencies, memory and cognitive impairment, tinnitus, vertigo, and peripheral vascular disease.### Magnesium Deficiency

    • Muscle tremor, spasms, cramps, and tetany

    • Chest tightness and shortness of breath

    • Palpitations and cardiac arrhythmias

    • Anxiety, depression, fatigue, insomnia

    • Loss of appetite, nausea, and vomiting

    Food Sources of Magnesium

    • Barley and brown rice
    • Most vegetables, especially green leafies, corn, and carrots
    • Seafood and dairy products
    • Coffee and tea, cocoa and chocolate

    Proteolytic Enzymes

    • Effective at reducing inflammation and symptoms related to inflammatory conditions
    • Types:
      • Proteinases: protease, bromelain, papain, nattokinase
      • Lipases: lipase
      • Carbohydrases: amylase, lactase, alpha-galactosidase, cellulase

    Vitamin D

    • Improves absorption of calcium
    • Deficiency 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
    • Vitamin C: 1000 mg/day
    • Magnesium: 400 mg/day
    • Proteolytic enzymes:
      • Bromelain: 1,200-2,000 GDU
      • Fungal protease: 100,000-200,000 HUT
      • Nattokinase: 2,000-4,000 FIP
      • Papain: 3,000,000-6,000,000 PU
      • Serrapeptase: 80,000-160,000 SPU
    • Vitamin D: 1000 IU/day

    Pharmacologic Options

    • Acetaminophen and NSAIDs
    • GABA derivatives
    • Muscle relaxants
    • Opioids

    GABA Derivatives

    • Pregabalin and Gabapentin
    • 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

    Adverse Effects of GABA Derivatives

    • Most common: sedation, ataxia, tremor, dizziness, dry mouth, weight gain
    • May also cause GI upset, peripheral edema, and vision changes
    • Cannot be abruptly discontinued – dose should be tapered over a minimum of 1 week to avoid withdrawal effects

    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 any 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
    • A very broad term that includes drugs of a number of different drug classes
    • All muscle relaxants are not recommended for those over the age of 65

    Antispasmodics

    • Decrease muscle spasm associated with pain
    • Reduce muscle rigidity/spasticity that interferes with therapy or function
    • Examples: Methocarbamol and Baclofen

    Methocarbamol

    • Dosing: 1 g QID PO
    • Mechanism of action: dependent on its CNS depressant activity by blocking spinal polysynaptic reflexes, decreasing nerve transmission, and prolonging the refractory period of muscle cells
    • Adverse effects: can cause drowsiness, dry mouth, dizziness, fatigue, nausea, and constipation
    • Combination with other CNS depressants or opioids can increase the risk of CNS depression

    Baclofen

    • Dosing: Initial dose: 5 mg TID PO, increase gradually to a maximum of 20 mg TID
    • Mechanism of action: a GABA receptor agonist specific for the beta subunit which is primarily expressed on pre- and post-synaptic neurons
    • Adverse effects: sedation, muscle weakness, nausea, dizziness, and in rare cases, hepatotoxicity
    • Potential additive CNS depression with other drugs like opioids and benzodiazepines

    Homeopathy

    • Colocynthis: contains cucurbitacin glycosides, affinity for smooth muscles of GI, diarrhea, and peripheral nervous system and cranial nerves
    • 5 HTP: 200-400 mg/day, found in turkey, chicken, milk, potatoes, pumpkin, sunflower seeds, turnip and collard greens, and seaweed
    • SAM E: showing good results in studies treating depression, 200 mg twice a day up to 400 mg three times a day, ramp up slowly
    • B vitamins: important role in anabolic and catabolic cellular processes, may reduce anxiety and depression, and benefit at-risk populations for stress
    • Magnesium: deficiency common among depressed patients, 200-600 mg/day
    • Vitamin D: reduce risk of depression, but non-strong enough evidence, 1000-2500 IU/day
    • Arsenicum Album: intense burning, significant weakness, extreme sensitivity to cold, worse between 12-3 am from cold, better with heat, cannot rest until house is in order

    Botanical Medicine (BotMed)

    • H.E.M.P formula: Hydrastis (goldenseal), Echinacea (purple cone flower), Myrrh, Phytolacca (Poke Root)
    • Hydrastis canadensis (goldenseal):
    • Part used: root
    • Actions: Antimicrobial, fungal, viral, parasitic, digestive bitter
    • Chemicals: isoquinoline alkaloids (berberine, hydrastine)
    • Safety: Avoid use with gastric/stomach ulcers, may cause GI irritation, nausea, vomiting, diarrhea
    • Echinacea (purple cone flower):
    • Part used: root and herb
    • Actions: Immunostimulant
    • Indications: Strep throat, colds, vaginal candidiasis, UTI
    • Chemicals: Phytochemicals (alkylamides, phenolics, polysaccharides)
    • Safety: Caution with autoimmunity, safe with pregnancy and difficile colitis

    Homeopathy

    • Overview of remedies: Allium cepa, Belladonna, Gelsemium sempervirens (24 remedies known to help with URTIs)
    • Belladonna (deadly nightshade):
    • < means worse or aggravated with heat, fever, redness, throbbing, and burning
    • > means better or ameliorated with leaning head against something
    • Actions: Brain, head, cardiovascular, fever, appears and disappears suddenly
    • Mental emotions: lively, bubbly personality, sudden fits/anger, hallucinate during nightmares, wild eye expression
    • Gelsemium sempervirens:
    • Gradual onset of complaints
    • Actions: Muscular weakness, may see double
    • Contraindications: pregnancy, trying to conceive, renal diseases, liver disease, malnutrition, alcoholics

    Pharmacology

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

    Nutrition and Supplements

    • Lacto-ovo-vegetarian diet: avoids meats, allows milk and eggs
    • Vegan diet: avoids all products originating from animals
    • Fatty acids:
    • Omega-3 fatty acids seem to prevent or improve experimental arthritis
    • Omega-3 fatty acid supplements for RA have been widely studied
    • Fish oil has been shown to reduce joint pain and morning stiffness
    • Folate:
    • Sources in food: green veggies, mushrooms, legumes, strawberries, oranges
    • Common RA medication, methotrexate, destroys folate
    • Doctors often prescribe folate supplements for those on this medication
    • Iron:
    • Anemia is common in patients with chronic inflammatory joint conditions such as RA
    • 2 types of iron
    • Withania somnifera (Withania):
    • Primary Actions: Adaptogen, hypotensive, immune modulator, anti-inflammatory, nootropic
    • Constituents: Steroidal lactones (withanolides), alkaloids
    • Indications: Fatigue, nervous exhaustion, chronic inflammatory disease, anemia, lowered libido, convalescence, hypothyroid presentations
    • Cautions/Contraindications: Considered safe, Preg B, Lact C
    • SAM-E, Omega 3 FA, 5 HTP, B vitamins, Magnesium, Vitamin D, Anti-oxidants, Saffron, Turmeric, Mediterranean diet, Probiotics and non-probiotic treatments are also notable for nutrition and mood regulation
    • Diet and mood regulation: blood sugar balance, weight management, stimulants, food sensitivities

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