NMT 150 test 1 (1).pdf

Week 1: URTI (bacterial) Therapeutic prescription/methode description BotMed Goals: “H.E.M.P” formula Antimicrobial H - Hydratis (goldenseal) Lymphatic E - Echinacea (purple cone flower) Immunostimulant M -...

Week 1: URTI (bacterial) Therapeutic prescription/methode description BotMed Goals: “H.E.M.P” formula Antimicrobial H - Hydratis (goldenseal) Lymphatic E - Echinacea (purple cone flower) Immunostimulant M - Myrrh Antipyretic P - Phytolacca (Poke Root) Hydrastis - “King of mucus membranes” canadensis - Respiratory tract (goldenseal) - Gastrointestinal tract - Anticatheral state Part: root used Actions: Antimicrobial/fungal/viral/parasite, digestive bitter Chemicals: isoquinoline alkaloids (berberine, hydrastine) Safety: Avoid use - gastric/ stomach ulcers Side effects - may cause GI irritation, nausea, vomiting, diarrhea Echinacea (purple Actions: Immunostimulant cone flower) Indications: Strep throat , colds, vaginal candidiasis, Part used: root and UTI herb Chemicals: Phytochemical (alkylamide, phenolics(caffeic acid), polysaccharides Safety: Caution with autoimmunity Safe with pregnancy ! Commiphora myrrha Actions: - Antimicrobial /fungal/viral/parasitic (Myrrh) - Analgesic - Expectorant Part used: resin - Astringent Indications: Tonsillitis, gingivitis Chemicals: oleoresin, Sesquiterpenes Safety: Do not use with pregnancy Phytolacca Actions: - Lymphatic americana - Emetic (vommit) (poke weed) - Purgative  Indications: Lymphadenopathy, URTI, cancer Part used: root Chemicals: triterpenoid Glycosides, lectins, Pokeweed antiviral protein (PEP) Safety: toxic - may cause violent emesis, cathrisis or death Do not use with pregnancy Usnea barbata Indications : infections (respiratory, topical skin) (Usena) Actions : antimicrobial/fungal/viral/parasite Part: Lichen Chemicals : usnic acid Safety: Pregnancy and lactation not recommended Hepatitis Allium sativum Indications : infections, heart disease (Garlic) Actions: antimicrobial////, antibacterial, antiviral, Part: clove stimulant, expectorant Chemicals: allicin Safety: generally safe Thymus vulgaris Indications: Colds, flu, spastic cough (Thyme) Actions: expectorant, antitussive, antispasmodic Antimicrobial Chemicals: thymol, flavonoids Safety: generally safe … - Toxic (high amounts in essential oils) - Not known in pregnancy Objectives Sugar intake Nutrition Protein intake Honey Probiotics Vitamins D Treatment goals Reduce uncomfortable symptomatic experience Reduce severity and duration of illness  Support full recovery Prevent sequela Prevent re-occurrence following resolution Sugar - To much sugar inhibits the immune system Pro-Inflammatoryproteins(TNF-alpha,CRP,IL-6) Changes to the microbiome Simple carbohydrates can decrease the phagocytic capacity of neutrophils (function not number was altered) - Effects can last up to 5 hours INSTEAD - Look to reducing obvious refined sugars, i.e. cookies, cakes, pastries, candies, sugary beverages, INSTEAD: Protein - A deficiency in dietary protein/ amino acids impairs immune function and increases susceptibility to infection. Amino Acids are important to: - Activate lymph cells - Lymphocyte,antibody/cytokine production Review typical diet to see if meeting dietary goals, consider increasing dietary protein with: Homemade bone broth & Homemade chicken noodle soup Congee made with bone broth, added chicken/ eggs Rice and lentils Homemade Jell-O/ Protein smoothie Honey - antimicrobial properties Decreases inflammation Symptomatic management by easing discomfort Not for infants under 1 yoa, due to risk of Clostridium botulinum Try as: lemon and honey tea, iced lolly, lozenge Probiotics Supports healthy microbiome, especially with/ following antibiotic use Vitamin D VITAMIN D SUPPLEMENTATION Active Form, Vitamin D3 Fat-soluble vitamin, liquid/ gel cap formula taken with food/ main meal  Can dose appropriate to Vitamin D status if known Over 2,000 IU Vitamin D3 = Rx in Ontario Given clear directions with dose and duration, too much can lead to toxicity Pharmacolog Cautions/ info Bactericidal – kills sensitive organisms so that y number of viable organisms falls rapidly after exposure Bacteriostatic – inhibits growth of bacteria but does not kill them PENICILLIN V - Narrow spectrum - Orally taken - (A streptococcal pharyngitis “drug of choice”) - Dose prescribed by weight - effects : GI upset, nausea, vomiting, diarrhea, and rash. In rare instances can cause severe hypersensitivity reactions Amoxicillin - An extended-spectrum penicillin - Essentially a modified version of penicillin that results in greater activity against additional gram-negative bacteria - Generally well tolerated but can cause the same adverse effects as penicillin V - Typically used more often as it is more palatable than penicillin V - Dosed by weight = 50mg/kg (MAX does of 1000mg) CEFADROXIL - A first-generation cephalosporin - May be used if treatment failure with penicillin or in individuals with nonimmediate hypersensitivity to penicillins - Adverse effects include GI upset, nausea, vomiting, diarrhea, hypersensitivity (some cross-reactivity with penicillins) - Adults= 1g/day CEPHALEXIN - A first-generation cephalosporin - Same adverse effect profile as cefadroxil and may also be used if treatment failure with penicillins or in individuals with non immediate hypersensitivity to penicillins - Also available as a suspension Adults: 500 mg BID PO for 10 days  Children: 40 mg/kg/day divided BID PO for 10 days with a maximum daily dose of 1000 mg MACROLIDES Inhibit peptidyl transferase which functions to link amino acids together in the growing peptide chain Also interferes with translocation (movement of the nucleotide from the A position to the P position to allow for reading the next spot on the mRNA) Confers bacteriostatic (stops growth) activity AZITHROMYCIN An alternative for patients who are allergic to penicillin Less likely than other macrolide antibiotics to interact with other drugs Adverse effects include GI upset, nausea, vomiting, diarrhea, rash, QTc interval prolongation. Adults: 500 mg PO for one day, then 250 mg PO daily for 4 days. Children: 12 mg/kg PO for 5 days with a maximum daily dose of 500 mg. 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 Adults: 250 mg BID PO for 10 days Children: 15 mg/kg/day divided BID PO for 10 days with a maximum daily dose of 500 mg. 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. Increased risk of C. difficile colitis Adults: 300 mg TID PO for 10 days Children: 21 mg/kg/day divided TID PO for 10 days with a maximum daily dose of 900 mg Homeopathy Overview of remedies Allium cepa Belladonna Gelsemium sempervirens But there are actually 24 remedies know to help with URTI’s < means worse Belladonna (deadly “violence of attack and suddenness” or aggravated night shade) - Heat (FEVER), redness, throbbing and with burning. Great children's remedy. > means better - Throat red, worse on right side. Tonsils or ameliorated enlarged; throat feels constricted; difficult with deglutition (swallowing) - Worse = in afternoon - Better = leaning head against something - Not thirsty Affinity: brain, head, cardiovascular, fever, appear and disappear suddenly Mental emotions : livley, bubbly personality, sudden fits/anger, hallucinate during nightmares, wilde eye expression Gelsemium Gradual onset of complaints sempervirens - Muscular weakness, may see double... (yellow jasmine) Muscle aches, soreness, pain, heaviness Thirstlessness - “Droopy, dizzy, drowsy, and dull” (influenza, mononucleosis, CFS...) - Very weak with a URTI and high fever, can progress very fast - So weak they can't sit up in bed or they may even fall off the bed!  - May feel confused, intoxicated, have body delusions like their limbs are detached from the body and scattered all over the bed... - May have canker sores (aphthae) and diarrhea (GI infections) - Better: indoors, drinking liquids (but may gag on fluids) - Worse: cold, open air, walking, eating solids (but easier to swallow) Mental emotions; anxiety, stage fright Allium Cepa (red Affinity: mucus membranes (nose, eyes, larynx, onion) bowels) MIND: groggy, sleepy, lethargic – in morning, heat Indifferent, dull, lack of motivation Absent-minded, worse afternoon and coffee GENERALS: Left side, or left to right Neuralgic pains after surgery/amputation/injury Shooting pains, following a thin line MODALITIES: Worse: warm room, spring and fall, flowers, evening, cucumber Better: in fresh air (not too cold), onions (may crave) Week 1 tcm = flash cards Week 2 colds and coughs Therapeutic Prescription/ Description Methode Bot Med Echinacea Indications: treat common cold, flu, URTI’s (not shown angustifolia well in research though) (Echinacea ) Actions: immunostimulant, antimicrobial, Chemicals: alkylamides, phenolics, polysaccharides Safety: caution with auto immune disease, safe with pregnancy Pharm: best used at early stages - Decoction: 1 cup simmer 15 mins - Tincture: 1:2,60% , 3-6 ml, 40 ml MAX per week Ginseng Indications: stress, fatigue, cold/flu treatment Korean Ginseng (Panax ginseng) Actions: adaptogen, immunostimulant, antiviral Canadian ginseng Chemicals: steroidal saponins, polysaccharides (Panax quinquefolius) Safety: caution with high blood pressure, korean ginseng is safe with pregnancy Siberian ginseng (Eleutherococcus senticosus) Part used: root Andrographis Indications: Colds, colitis (or infectious diahrea), liver paniculata disease (Andrographs) Actions: immunomodulator, antimmicrobial Part: root Chemicals: diterpene lactones, flavanoids Safety: contraindicated with stomach/GI ulcers/obstructed gull bladders, Side effects = GI irritation potentially Not recommended with pregnancy (but not known) Sambucus nigra Indications: Cold and flu (european Elder flower) Actions: Diaphoretic, antiviral, anti adherence Sambucus Chemicals: Anthocyanin, flavinoids canadensis (canadian Safety: toxicity causes vomiting/diarrhea elderflower) Part used: flower/berries Hedera helix Indications: cough (or acute phlegm) (English Ivy leaf) Actions: expectorant, antitussive, antispasmodic Part: leaf Chemicals: saponins Safety: generally safe toxicity= nausea and vomiting Glycyrrhiza glabra Indications: RTI’s (Licorice) Actions: anti spasmodic, expectorant, antimicrobial Part: root Chemicals: saponins Safety: contradicted with high blood pressure/hypertension, medications for heart Althaea officinalis Indications: inflamed mucous membranes, RTI’s (Marshmallow) Actions: Demulcent Part: root and flowers Chemicals: mucilage Safety: very safe Eucalyptus Indications: RTI’s, GI tract spasms globulus (Eucalyptus) Actions: antitussive, expectorant Part: essential oil Chemicals: monoterpoids Safety: avoid drinking Baptisia tinctoria Indications: common cold (Wild Indigo) Actions: lymphatic, anti microbial, immune stimulant, Part: root anti- catarrhal Chemicals: polysaccharides, glycoproteins, alkaloids  Safety: toxicity can cause GI irritations, hypersalvations, tachypnea, tachycardia, anorexia, respiratory paralysis Pharmacy: Decoction: 1tbsp/cup, simmered 15 min, 1 cup TID Tincture: (1:5,60%) 1-3ml max 60ml per week Dried herb: 1g TID Pharm actions: polysachrides and glycoprotiens stimulate WBC productions, lymphocyte DNA, anti body secretion, excess mucus productions Zingiber officinale Indications: common cold (Ginger) Actions: anti oxidant, anti inflammatory, antimicrobial, diaphoretic, calmative, antispasmodic Chemicals: zingiberene (VO), sesquiterpenes (viral inhibitor), oleoresins (reduce pain/coughing/fever) FYI - fresh ginger stimulates IFN-b antibody release from mucosal surfaces Safety: caution with ulcers, GERD, kidney diseases, bleeding disorders, sensitive stomachs, - Additive effect with anticoagulant medication Pharm: infusion - 1 cup/1g TID (3 times a day) Tincture - (1:5, 90%) 1.5-3ml TID, 60 ml MAX/week Dried herb: 1-10g in divided doses Fresh herb: 5g QD (once a day) Best combo for Ginger, echinacea, wild indigo colds (Zingiber officinale), (Echinacea angustifolia), (Baptisia tinctoria) Nutrition Treatment goals Our Resources... Vitamin C for common cold Zinc Probiotics Diet Vitamin C - Consider bowel tolerance with dosing and potential for osmotic diarrhea & GI upset - Precipitate kidney stones for those susceptible In people with a history of oxalate kidney stones, supplemental vitamin C 1 gram per day appears to increase kidney stone risk by 40%  ZINC (unclear - 30-50 mg/ day for adult (75 mg in study), for effect) specific, limited time period to avoid copper deficiency - Take with food to avoid GI upset - GI upset, N&V most likely side-effect - Don’t take at same time as antibiotics to avoid interference with absorption Probiotics - Oral probiotics seen to help with respiratory function - Prevention of respiratory symptoms/infections, otitis media - Potential GI upset, likely dose-dependent - Change in stool habits - Caution selection for product/ brand with dairy allergy Focus on studied strains - To help mitigate/ prevent side-effects of antibiotics To help resolve infections - To help prevent infections.... could be used as part of foundational, preventative health management plan - Diet Sources - Vitamin C – fruits and vegetables, i.e. citrus – lemon and honey tea (~45 mg/ lemon) - Zinc – meats, poultry, seafood, legumes, seeds (33 mg/ 6 medium oysters) - Probiotics – fermented foods, i.e. sauerkraut, kimchi, yogurt, tempeh, - Diet - Enough nutrients - Animal studies have found that deficiencies in zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, D, and E can alter immune responses. - Avoid diets that are limited in variety and nutrients - Western diet: High in refined sugar and red meat, low in vegetables and fruits - Support Microbiome Pharmacology Prevention /info - Typically a pediatric condition (Otitis Media) - Can be caused by both bacteria and viruses and co- infection is common, especially in those who experience chronic, recurrent otitis media  - The most common bacterial pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis Preventative factors include: Vaccination (influenza and S. pneumoniae) as viral upper respiratory tract infections often precede AOM Public health measures may reduce virus transmission leading to a reduction in AOM cases Avoiding exposure to tobacco smoke Breastfeeding - - Spontaneous resolution is seen in a number of cases caused by the top 3 bacterial pathogens - S. pneumoniae – 20% H. influenzae- 50% M. catarrhalis – 75% Spontaneous resolution is seen in a number of cases caused by the top 3 bacterial pathogens S. pneumoniae – 20% H. influenzae- 50% M. catarrhalis – 75% Antibiotic Amoxicillin - Resistance common with s. Pneumonia (need to double dose) - H. influenzae and M. catarrhalis produce beta- lactamases which confer resistance - This is overcome by using a beta-lactamase inhibitor called clavulanate - When antibiotics are used, treatment failure should be considered if symptoms do not improve after 72 hours of treatment **The combination of amoxicillin and clavulanate is typically used for treatment failure or recurrence Diarrhea is commonly noted as an adverse effect of combination therapy** Homeopathy Drosera - #1 cough remedy (for whooping cough) Common sundew - Respiratory illnesses Laryngitis Bronchitis Tuberculosis - Tormenting cough, paroxysms (= fits/attacks), they follow one another quickly – short cough, RINGING cough - Must hold the chest to cough, inability to cough due to the pain - Mind = suspicious of others, easily angered - < evening, after midnight – to 2 am, after drinking, exertion, singing, smoking. Cough  after measles - > WALKING (better) RUMEX CRISPUS MIND Yellow dock Nervous (evening / night) Restless Sad, depressed, aversion to mental work Fear of misfortune GENERAL Sensitive to cold air Copious discharge from mucosa of nose, eyes, whole respiratory tract – sometimes continuous flow < cold air (inhale, talk, laugh, uncovering...), touch or pressure on throat/larynx, temperature changes, motion, morning, and before 11pm > drinking, sucking on candy LOCAL symptoms Dry tickling cough (croup, whooping...) thick mucus in larynx Cough ends in a sneeze Cough entering warm room from cold or vice versa Skin itching on uncovering, undressing (cool air) SPONGIA TOSTA Mind Roasted sponge Sensitive Alternating moods (very cheerful then sad, depressed) Anxiety about heart disease, death, suffocation General Glands/cervical nodes swollen, inflamed < (before) midnight, DRY COLD WIND, cold drinks, warm room, heat > EATING, DRINKING, warm things (the cough), RESTING LOCAL Airways DRY, throat constricted, raw or sore Hoarseness. Asthmatic cough. Cough that won't stop Weak sensation in chest, heart pains, PALPITATIONS, valvular insufficiency, BLOOD CIRCULATION problems IPECACUANHA Main features: (CARAPICHEA - Persistent NAUSEA (and vomiting) IPECACUANHA) - SPASMODIC irritation in chest, stomach (Vagus n.)  - Shortness of breath, gastric disturbances (nausea) - With most complaints - Bright red HEMORRHAGE (rapidly clotting) - Fevers, infections, convulsions - Intense vommiting - Violent cough, spamadic, suffocating - Females vomit befire menses, large clots, miscarriage Mind - Iritiable, impatient, contempt - Anxiety during fever, suffocation, many desires, cant express them, hard to please Week 3 Dermatitis Bot med CALENDULA OFFICINALIS Main Actions: (MARIGOLD / CALENDULA) Antimicrobial, lymphatic, antiseptic, anti-inflammatory, Part: flower heads/pedals vulnerary, demulcent/emollient Chemicals: Flavonoids (isohamnetin & quercetin) & carotenoids (xanthophylls) Saponins, polysaccharides, VO, mucilage & resins Pharmacology: One of the best remedies for local skin problems: rash, eczema, psoriasis, abrasions, etc Stimulates drainage of enlarged and inflamed lymph nodes Polysaccharides and volatile oils have immuno- stimulatory activity Resins display antifungal activity Infusion & tincture for internal use Topical: creams, ointments, poultices, Safety - safe - Be cautious of allergies CENTELLA ASIATICA Main Actions: Anti-inflammatory, CT (Gotu kola) builder, vulnerary, adaptogen, nervine tonic Part: aerial Main Constituents: Saponins (asiaticoside,  madecassoside, brahmoside) Flavonoids (quercetin & kaempferol) Allantoin, Pharmacology: Speeds up skin collagen formation and angiogenesis Increases antioxidant levels within the wound in early staged of - Infusions - Topical creams Saftey - Toxicity (GIT upset, headache, sedation, contact dermatitis - Carcinogenic concerns with long- term topical use due to angiogenesis activity PLANTAGO LANCEOLATA Main Actions: & MAJOR Anti-microbial, lymphatic, anti-inflammatory, Plantain/Toadstool/Ribwort Main Constituents: Part: Leaves Mucilage, tannins, flavonoids Pharmacy: The macerated leaves or fresh juice of the plant are excellent, quick healing Applied topically as a salve, lotion, compress or poultice Safety: Generally a safe herb High doses internally can have laxative effect MATRICARIA RECUTITA Main Actions: (GERMAN CHAMOMILE) Anti-inflammatory, vulnerary, nervine sedative, Part: flower heads Chemicals:  - Volatile oiks - Flavinoids - Sesuiterpene Pharmacology: Flavonoids have anti- allergenic effects d/t inhibition of histamine release Volatile oils (alpha- bisabolol, chamazulene) and flavonoids demonstrate anti- inflammatory, wound-healing and antimicrobial activity Pharmacy Infusion & tincture for internal use Topical: creams, ointments, baths Safety Generally a safe herb, may cause contact dermatitis in cases of allergy or sensitivity Caution in Asteraceae allergy Types of bot applications External - Ointments - creams/lotions - Poultices - Pastes - Bath,steam,compress Internal uses also! Nutrition Focusing on - Fish oil - Vitamin D - Zinc - Vitamin A - Food sensitivity: -59 children with Atopic Dermatitis (AD) eliminated cow’s milk for 4 wks: 80% had improvement. -91 children with AD were placed on an elimination diet:  An improvement in 74%. -50 adults with AD tried 6 wks of a diet that excluded pseudo allergens: 63.5% had positive responses - Zinc - Reduce severity of eczema Found in: Shellfish, beef, and other red meats, Nuts, legumes Vitamin D Cholecalciferol (Vitamin D3) - Synthesis occurs in the epidermis of the skin from UVB - Animal sources: saltwater fish, liver, meats, egg yolks, and fortified foods. Ergocalciferol (Vitamin D2) - Plant sources (mushrooms, alfalfa sprouts) and fortified foods Deficiency shows in psoriasis and AD patients Supplementing vit D reduces inflammation and eczema Fish Oil - Shown to help with eczema (but lacks research) Omega 3 (fish oil, flax/canola oil) Omega 6 (vegetable oil) Omega 9 (olive oil) Fatty acid carbon cahins  Long-chain FAs: 14-24 Cs Medium-chain FAs: 8-12 Cs Short-chain FAs: 4,500 μg RAE (15,000 IU) per day of preformed vitamin A in pregnant women has been associated with birth defects Deficiency: - Delayed growth - Infertility - Increased infections - Night blindness and eye dryness Increase rick deficiency o Hypothyroidism o Fat malabsorptive conditions o Liver or gallbladder disease o Renal disease o Protein malnutrition o Alcoholics 24 patients with eczema received 30,000- 75,000 IU/day of vitamin A: satisfactory results in 75% of  the cases. High doses Contradicted in: - pregnancy /trying to conceive - Renal diseases - Liver diseas - Malnutrition - Alcoholics Pharmacology Corticosteroids Two main subclasses: Glucocorticoids: affect carbohydrate, fat, and protein metabolism and also have anti-inflammatory, immunosuppressive, anti- proliferative, and vasoconstrictive propertie Mineralocorticoids: are primarily involved in electrolyte regulation by modifying renal excretion mechanisms *both receptors are 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 the potency of the TCS Mode of action 1. Once absorbed, interact with an intracellular glucocorticoid receptor, then translocates to the nucleus where a large number of gene transcription changes take place 2. General upregulation of anti-inflammatory mediators  and downregulation of inflammatory mediators 3. Vasoconstrictive effect which reduces delivery of inflammatory mediators and improves erythema 4. Anti-mitotic effect which inhibits cell proliferation and collagen synthesis 5, Immunosuppressant effect Adverse effects (topically): - Many adverse effects - Stinging or burning caused by sensation overstimulating - Dermal atrophy Striae glucocorticoid - Rosacea receptors in skin (can - Perioral dermatitis fix by stimulating Acne mineralocorticoid - Purpura receptors) - Increased hair growth - Often Due to improper - Skin pigment changes use: to high potency - Delayed wound or for too long healing Finger tip units (FTP): 1 finger tip ~.5 g.5 g should cover two adult hands once spread Topical drug vehicles - Topical drugs neede to be compounded to (type of vehicle needed in be stablized,stored, prescription) and for easy delivery Includes: 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 TCS 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 - Low potency drugs should be used on the face and within skin folds as the skin is thinner and more absorption takes place - Medium potency drugs can be used on  the body and scalp - High potency drugs are needed to penetrate the palms and soles - Potency can change depending on vehicle (oinment’s more potent then cream) Homeopathy URTICA URENS Skin (dwarf nettle) Itching, burning, and stinging SWELLING / EDEMA < HEAT STINGING, BURNING pains Insect bites, punctured wounds, splinters Anaphylaxis No/low thirst Sudden, rapidly developing complaints URTICARIA/HIVES with puffy swelling < night, > cold water < HEAT, touch, right side >Cold applications Mind PASSIONATE, intense emotions not easily expressed Simulates Good Mood When Feeling Wretched BUSY (like a bee!), ambitious, restless; AWKWARD (clumsy) Irritable; Quarrelsome JEALOUS; Ailments from grief Fear of birds APATHY; Indifference; Weepy RHUS TOXICODENDRON Affinities: skin, mucous  membranes, fibrous tissue (joints, tendons, sheaths) ITCHY skin, red – chicken pox, herpes, psoriasis, urticaria, cellulitis < at rest (stiffens up, restless), initial movement (but better with continuous motion, as they loosen up), COLD DAMP >heat, HOT BATHS, stretching MIND: busy, restless; dreams of travel, work; superstitious or ritualistic/compulsive behavior Sulphur Skin: Itchy < Heat , red orifices Back: slouching, pain standing Mind: opinionated, critical, independent Nervous person, quick motions, quick-tempered, plethoric, skin very sensitive to weather changes Lean, stooped shoulders, sits/walks stooped, slouches, standing is most uncomfortable position Generals ; Burningdischarges,burningev erywhere,inandout Graphites SKIN – rough, scars, eruptions, cracks, infections Digestive organs, eyes Tendency toward obesity, chilliness, constipation  Mind - Dull, slow, timid, reserved, changeable, easily startled Indecisive, insecure (about consequences) Week 4 Joint pain Bot Med 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 Primary Actions: Hepatic, (Chai hu) alterative, anti-inflammatory, hepatoprotective Part Used: Root Constituents: Triterpene Daily Therapeutic Dose saponins, sterols, volatile oils, Tincture: 6–12 mL (1:5 in polysaccharides 40%) Daily Therapeutic Dose Infusion or Decoction: 3–12 g Safety: Avoided in cold conditions or constitutions. Safety rating during pregnancy and lactation not established. Boswellia serrata Primary Actions: Antimicrobial, anti- (Frankincense) inflammatory, astringent Constituents: Resins, boswellic acid, Part used: Resin volatile oils Indications: Inflammatory joint Daily Therapeutic Dose Tincture: 2– conditions, IBD, topical antimicrobial 4 mL (1:5 in 90%)Botanicals in Joint Cautions/Contraindications: Pain Considered safe, though not generally Daily Therapeutic Dose Infusion or taken internally in large Decoction: Best as powder or as amounts. encapsulated supplement. Suggested dose 300– 3000 mg. Capsicum frutescens Primary Actions: Stimulant, (Cayenne) circulatory tonic, rubefacient, sialagogue, libido tonic. Constituents: Capsaicinoids Part used: dried or powdered (capsaicin), steroidal saponins fruit Indications: Circulatory deficiencies, arthritic conditions, pain relief, Daily Therapeutic Dose Tincture: 1– depression. 5 mL (1:5 in 25%) Daily Therapeutic Dose Infusion or Decoction: 1–2 g powder (potency of starting material Curcuma longa Primary Actions: Anti-inflammatory, (Turmeric) mild antimicrobial, carminative, circulatory tonic Constituents: Phenolic antioxidants, Part used: root curcumin, volatile oils, starches Indications: General inflammatory Daily Therapeutic Dose Tincture: 8– conditions, OA and RA, possibly 24 mL (1:5 in 30%) cancer lesions (topical), Daily Therapeutic Dose Infusion or stomach ulcers and dyspepsia Decoction: 8–20 g dried root or powder Ginkgo biloba Primary Actions: Circulatory tonic, (Ginkgo) vasodilator, anti-inflammatory, anticoagulant (as an antiplatelet activator factor [PAF]) Part used: leaf and fruit nootropic, mild astringent. Daily Therapeutic Dose Tincture: 3– Constituents: Flavonoid glycosides, 9 mL (1:5 in 40%) terpene lactones (gingkolides) Daily Therapeutic Dose Infusion or Decoction: 4–10 g dried leaf Cautions/Contraindications: Though not toxic, may cause stomach discomfort or cramping Glycyrrhiza glabra Primary Actions: Adaptogen, (Licorice) particularly to the adrenals; anti- inflammatory, demulcent, antiviral, hypertensive Part used: root Constituents: Triterpene saponins Daily Therapeutic Dose Tincture: 3– (glycyrrhizin), glycyrrhetinic acid, 9 mL (1:5 in 40%) chalcones Daily Therapeutic Dose Infusion or Decoction: 2–9 g dried root Indications: Ongoing stress, hypotension, asthma, eczema, chronic or acute bronchitis, emphysema, URTI, post-viral cough, stomach ulcers (mostly DGL) Cautions/Contraindications: CI in hypertension. Preg A, Lact C. Harpagophytum procumbens Primary Actions: Anti-inflammatory, (Devil’s claw) antirheumatic, mild anodyne, hepatic Constituents: Iridoid glycosides Part used: root (harpagoside), phenolic acids, quinone Daily Therapeutic Dose Tincture: 3– 6 mL (1:5 in 40%) Cautions/Contraindications: Daily Therapeutic Dose Infusion or Considered safe, though research Decoction: 4–12 g dried root inconclusive. Preg B, Lact C. Hypericum perforatum (St. Primary Actions: Uplifting nervine, John’s wort) antiviral, anti-inflammatory, vulnerary Constituents: Volatile oils, hyperforin, naphthodianthones (hypericin), flavonoids Part used: aerial parts Indications: Mood dysregulation, neuralgia, anxiety, viral infections Cautions/Contraindications: Daily Therapeutic Dose Tincture: 2– Sensitization may occur at higher 10 mL (1:5 in 40%) doses of the herb or its extract Daily Therapeutic Dose Infusion or Decoction: 2–4 g Polygonum cuspidatum (Japanese Primary Actions: Anti-inflammatory, Knotweed) hepatic, anti-microbial, laxative, astringent, anti-oxidant Part used: root Constituents: anthraquinone glycosides, tannins, resveratrol Daily Therapeutic Dose Tincture: 6– Indications: Any joint pain. 12 mL (1:5 in 40%) Inflammatory and auto-immune Daily Therapeutic Dose Infusion or conditions: RA, psoriasis, lupus. Decoction: 9–15 g dried herb Hepatitis, stagnant menses, fibroids, endometriosis. Any condition of difficult urination. Lyme.  Cautions/Contraindications: Acts as a stimulating laxative. Do not use in pregnancy. May cause nausea or stomach pain. Nutrition Considerations Nutritional status Role of food as a trigger -Malnutrition is common Specific diets among patients with Fish oil rheumatoid arthritis Folate Iron Food allergy Release of IgE antibody: body mistakes a food for a Common foods: pathogen → triggers - Eggs histamine release (right after - Milk eating) - Fish - Shellfish (shrimp, - IgG also elevated scallops, and crab) - Sensitivities more - Peanuts common but harder to - Tree nuts (walnuts, track than an allergie pecans) - Elimination diet shown - Wheat Soy Sesame to help 30-40% patient with RA Foods for RA inflammation: - Red meat - Dairy - Nightshade veggies - Potatoes - Eggplant - Tomatoes - Peppers Mediterranean diet - Improve function, joint mobility, and pain in RA Vegan/vegetarian diet - Little evidence Major types of vegetarian diets are: 1. lacto-ovo-vegetarian diet: In lacto-ovo vegetarianism, meats are avoided, while milk and eggs are allowed. 2. vegan diet: In the vegan diet, all products originating from animals are avoided Fatty acids o Omega-3 fatty acids seem to prevent or improve experimental arthritis. o Omega-3 fatty acid supplements for RA have been widely studied. Fish oil, in particular, has been shown to reduce joint pain, as well as morning stiffness. Folate - A common RA medication, methotrexate, destroys folate. Sources in food: That’s why doctors will often - Green veggies prescribe folate supplements - Mushrooms for those on this medication. - Legumes - Strawberries, oranges Fyi- Since 1998, to help prevent neural tube defects, Canada requires the addition of 1.4 mg/kg Iron - Anemia is common in patients with chronic inflammatory joint conditions such as RA. 2 types of iron 1. Heme iron - derived from hemoglobin and myoglobin and thus found only in animal products, such as meat, fish, poultry, oysters, and clams. - 50-60% of the iron in animal products occurs in the heme form. 2. Non-Heme Iron - Meats - Beans, dark greens - Leafy veggies, dried fruits - Blackstrap molasses - o Enriched foods:  flour, breads, pastas, and cereals - are fortified with Fe Pharmacology NSAIDs (non - opioid NonSteroidal Anti- analgesics/anti- Inflammatory Drugs (NSAIDs) inflammatories) - Non-specific COX inhibitor like -most commonly prescribed acetylsalicylic Acid medications for pain and (ASA) and ibuprofen inflammation - COX-2 Specific -They make up 5 – 10% of all Inhibitors like medications prescribed each celecoxib year - Non-specific COX -Up to 96% of patients over inhibitors without anti- the age of 65 use NSAIDs in inflammatory effect the family practice setting like acetaminophen The biggest issue with COX-1 inhibition is with GI function, particularly mucus secretion in the stomach COX-1 inhibition leads to ulcers and increases the risk for major GI bleeds ASA and Ibuprofen have significant COX-1 inhibitor activity and are known to have a substantial risk for dose dependent GI side effects Celecoxib is substantially more specific to COX-2 and lacks the GI side effects Both classes still increase the risk of cardiovascular disease and mortality Acetylsalicylic acid (ASA) - Causes irreversible inhibition of COX by Dosing covalent bond of adults : 325 - 650mg acetyl group Q4H(every 4 hours) (MAX - Creates non 4g/day) competitive Lasts 6 hours inhibition Hits in 1 hour - Short plasma half life as it is rapidly hydrolyzed to salicylic - Contraindicated in acid by plasma esterase children with viral infections - Eliminated in the urine after - GI conjugation (primarily to irritation/ulcers/bleedi glycine) Rate of excretion is ng affected by urine pH - Tinnitus – early sign of salicylate toxicity - Alkalinizing urine will - High doses can cause increase ionization and hyperventilation, increase elimination in fever, dehydration, overdose scenarios metabolic acidosis, impairment of hemostatis - Hypersensitivity reactions are uncommon but potentially fatal - 5% cross reactivity to other NSAIDs Adverse effects include: Ibuprofen GI irritation, nausea, dyspepsia, bleeding Hepatic DOSING toxicity Adults: 200 – 400 mg Q6 – 8 Renal toxicity including acute hours PO to a maximum of renal failure if dehydration 1200 mg/d occurs Onset of action: 30 – 60 minutes Duration of action: 4- 6 hours Acetaminophen - Little effect on COX-1 or COX-2 DOSING - A third isoform, COX- Adults: 325 – 650 mg Q4H 3, recently discovered PO or PR for acute pain 325 and acetaminophen – 1000 mg Q4-6 hours PO for has affinity for COX-3 osteoarthritis Maximum daily - May explain analgesic dose: 4 g/d and antipyretic effect Onset of action: under 1 hour - Little anti- Duration of action: 4 – 6 inflammatory effect as hours it is rapidly inactivated by peroxides produced in inflamed tissue  Risks rapidly absorbed from the gut Minimal plasma protein binding Widely distributed to peripheral tissue and the CNS Toxic intermediate formed with CYP1A2, 2E1, 3A isoenzymes Normally conjugated with glutathione and renally excreted Glutathione depletion can lead to hepatic necrosis CELECOXIB - Selective COX-2 DOSING Inhibitor - 100 mg BID PO or - Potent anti- 200 mg daily PO for inflammatory activity osteoarthritis without significant GI - toxicity - Increased risk of cardiovascular disease and mortality Does not inhibit platelet aggregation GASTROPROTECTION - Risk of major GI Strategies: bleeding: - Using COX-2 - Increased age selective NSAIDs - Concomitant use of - Using prostaglandin systemic analogues: corticosteroids or misoprostol Using warfarin History of GI proton pump bleeding or peptic inhibitors: omeprazole ulcer disease - - 1 - 2% of people who use NSAIDs will develop GI complications, an annual rate 3 to 5 times higher than among those who do not use NSAIDs Homeopathy Bryonia alba Affinities: acts on (white bryony) tendons, ligaments, or  connective tissue Causes inflammation and dryness, - Worse with motion - Better with rest and strong pressure - Strong thirst for water Rhus tox Affinities : (Poison ivy) 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 - Restless mind Ledum - Acute gouty pain pf (Marsh tea) ankle and knee - Worse with heat, in bed at night, motion - Better with cold, soaking in cold water Week 5 Low back pain Bot med Same potanicals as joint pain (chart above), with exceptions of, Corydalis yanhusuo Corydalis yanhusuo Actions: analgesic, hepatic, warming (yan hou so) calminative Constituents: alkaloids, volatile oils Part used: root Indications: any pain Safety: do not use in pregnancy, Tincture dose: 3-12ml (1:5 in drowsiness with high dose, 40%) Nutrition Focuses Vitamin C Magnesium Proteolytic enzymes Vitamin D Vitamin C - Increases calcium absorption = strong bones/healing Risk of deficiency: fractures/wounds o Children < 1 yr - % absorbed decreases with o The elderly, especially those in higher intake (must intravenous to nursing homes achieve a high absorption or be in o Low fruit and vegetable intake acute state of illness) , bacteria in o Cigarette smokers gut can absorb extra not used o People with gastro-esophageal reflux disease Sources: Fruits: kiwi, papaya, strawberry, citrus fruits, etc. Veggies: red peppers, parsley, broccoli, brussels' sprouts, asparagus, kale, etc. - The Upper tolerable intake level (UL) for vitamin C is 2 g/d Results in: gastric gramping, diarrhea, gac, bloating , tooth erosion - Risk oxalate stone formation - Iron metabolism diseases -above 2 grams contradicted in pregnancy Magnesium Deficiency is one of main causes of low back pain - magnesium supports muscle and Sources: nerve function, a deficiency is Nuts and seeds directly related to impaired muscle o Legumes and whole grains, and nerve function that can affect especially oats, the back. barley, and brown rice o Most vegetables, especially MAGNESIUM DEFICIENCY green leafies, corn, Muscle tremor, spasms, cramps, and and carrots tetany o Seafood and dairy products Chest tightness and shortness of breath o Coffee and tea, cocoa and Palpitations and cardiac arrhythmias chocolate Anxiety, depression, fatigue, insomnia Loss of appetite, nausea and vomiting CONTRAINDICATIONS End-stage renal disease Myasthenia gravis Urinary tract infection with elevated urinary phosphates Kidney stones Hyperparathyroidism Proteolytic Enzymes - are effective at reducing (digestive enzymes) inflammation and symptoms  related to inflammatory conditions Food sources of digestive (chronic pain/ osteo arthiririts) enzymes Types: Protein ‘s - protease, bromelain, papain, nattokinase Lipids: Lipase Carbs : Amylase, lactase, Alpha- galactosidase, cellulase Vitamin D - improves absorption of calcium (good for bones/lower back pain) - Deficiency seen in LBP patients VITAMIN D Skin production depends on: o Length of exposure to the sun o Amount of bare skin exposed o Season and time of day o Level of latitude o Degree of pigmentation o Age SUMMARY 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 Pharm PHARMACOLOGIC OPTIONS Acetaminophen and NSAIDs GABA derivatives Muscle relaxants Opioids GABA derivatives - Pregabalin and Gabapentin - Typically reserved for soft tissue INDICATIONS and hyperalgesic pain Act Typically reserved for neuropathic centrally pain - Not fully understood mod of action - Similar structure to GABA but DO ADVERSE EFFECTS NOT actually interact with GABA -Most common: sedation, ataxia, tremor, dizziness, dry mouth, Modes of Actions weight gain - Bind α2δ1 receptors of voltage- -May also cause GI upset, gated calcium channels peripheral edema, and vision - This specific subtype is present in changes the brain, skeletal, cardiac, and -Cannot be abruptly discontinued smooth muscle – dose should be tapered over a - Most important area is the dorsal minimum of 1 week to avoid horn of the spinal column These withdrawal effects receptors are upregulated as a response to pain Modifies calcium entry and reduces neurotransmitter release Gabapentin Initial dose is 300 – 400 mg/day PO (GABA derivative) 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 is 50 – 150 mg daily PO (GABA derivative) 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 - 2 types 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 (Benzodiazepines or non- associated with pain benzodiazepines) - reduce muscle rigidity/spasticity that interferes with therapy or function (as in cerebral palsy, for example METHOCARBAMOL - no effect on the contraction of (non-benzodiazepine muscle fibers, motor end plates, antispasmodic) or nerve fibers - Mechanism of action thought to be DOSING dependent on its CNS depressant 1 g QID PO 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 - A GABA receptor agonist specific for the beta subunit which is DOSING primarily expressed on pre- and Initial dose: 5 mg TID PO post-synaptic neurons Increase gradually to a maximum - Binding causes an influx of of 20 mg TID potassium into the neuron causing hyperpolarization and decreased calcium influx at presynaptic nerve terminals - Results in the reduced rate of action potentials and reduced activation of post-synaptic motor neurons that innervate muscle spindles ADVERSE EFFECTS sedation, muscle weakness, nausea, dizziness In rare cases can cause hepatotoxicity Potential additive CNS depression with  other drugs like opioids and benzodiazepines Homeopathy Colocynthis - Contains cucurbitacin glycosides (bitter cucumber) Affinity: - smooth muscles of GI - Diarreia - Peripheral nervous system and cranial nerves sensations : violent cramping (feels like muscle being pulled followed by numbness). Anger! - Strong pressure - Better with heat/flexing thigh toward pelvis Kalium Carbonicum Affinities: articular system, CNS, (potassium carbonate) (K2CO3) circulatory system Sensations: anxiety in epigastric pit (Solar plexus) - Wekanes - Worse between 2-4am - Better with heat, when sitting -craving for sweets, thick secretions 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 Bot Med Key action Warming Adaptogen, Hepatic/Alterative Physical activity is the most effective treatment for depression. Don’t be afraid to consider herbs that act as stimulants. Expect to use stronger herbs at bigger doses. - Key Botanicals (but already covered in above charts): - st. johns wart - Ginseng’s - Cayenne - Chi hu Psilocybin mushrooms - Euphoric (shrooms) - Adaptogen Piper methysticum Primary Actions: Nervine, (Kava kava) mild euphoric, analgesic, antispasmodic, antifungal Part: root Constituents: Kavalactones, resins Indications: Anxiety, insomnia, nervous tension, depression Cautions/Contraindications:, long-term consumption (210 mg Kavalactones qd) shows elevated GGT. A characteristic ichthyosiform skin rash (dry, scaling) has been observed in high-dose Rhodiola rosea Primary Actions: Adaptogen, (Rhodiola) vascular tonic Part: root Constituents: Polyphenols (rosavin, salidroside),  Indications: Fatigue from overwork, lowered libido, ongoing physical or mental stress, altitude sickness, ischemic heart disease Cautions/Contraindications: Though not considered toxic, like Panax ginseng, rhodiola may be too stimulating for individuals showing signs of restlessness, insomnia, dizziness, or anxiety. Smilax officinalis (Sarsaparilla) Primary Actions: Adaptogen, alterative, anti-inflammatory Part: root/rhizome Constituents: Saponins based on the aglycone sarsapogenin, sterols, volatile oils Indications: Eczema, psoriasis, BPH, waning libido, RA, gout Saftey: generally safe Theobroma cacao (Chocolate bean) Primary Actions: Mild stimulant, adaptogen, nutritive Constituents: Methylxanthines, theobromine, flavonoids, fatty acids Indications: Asthma, COPD, low mood, stress, convalescence Cautions/Contraindications: Considered safe and tasty. Lowers tone of lower esophageal sphincter, so avoided in GERD. Safety rating during pregnancy and lactation not established. 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. Nutrition Main focus Diet, spices, microbiome SAM-E Omega 3 FA 5 HTP B vitamins Magnesium Vitamin D Also notable; - Anti oxidants - Saffron - Turmeric - Mediterranean diet (lowers risk by 33%) - Pro biotics and non- probiotic treatments Diet and mood regulation - Blood sugar balance - Weight management - Stimulants - Food sensitivities Omega 3 60% at a dosage of ≤1 g/d would have 1-4 G EPA+DHA/Day beneficial effects on depression. 5 HTP Tryptophan can be found in turkey, 200 - 400 mg/day 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 andcatabolic cellular processes that are essential for brain function.  - may reduce anxiety and depression and benefit at-risk populations for stress Magnesium - Deficiency common among depressed 200 - 600 mg/day pateints Vitamin D - Reduce risk of depression but non 1000- 2500 IU/day strong enough evidence Homeopathy Arsenicum Album - Intense burning - Significant weakness - Extreme sensitivity to cold - Worse Between 12 - 3am from cold - Better with heat - Cannot rest until house is in order