NUR318 Chapter 19 Alternative Preparations and Over-the-Counter Drugs

Alternative Preparations and OTC objective

Explain the role of the nurse in assessment and intervention with patients using alternative preparations or over-the-counter drugs

What is integrative medicine?

the combined use of conventional therapies and evidence-based complementary alternative medicine (CAM)

What are the 4 OTC drugs?

nicotine and nicotine cessation products, caffeine, omeprazole, NSAIDs

Nicotine and nicotine cessation products

increases clearance of many psychotropics

Caffeine

causes elevated BP and HR

Omeprazole

More than doubles life of diazepam and raises concentrations of citalopram, sertraline, and escitalopram

NSAIDs

Concomitant use of SSRIs and NSAIDs increases the risk of gastric bleeding

What are the first 4 reasons people choose herbals?

desire for empowerment, belief in enhanced health with concomitant use, desire to try a novel therapy, belief that conventional medicine will not help

What are the second 3 reasons people choose herbals?

on advice from a health care professional, costs of conventional treatments, assumption that “natural” implies better tolerance

Common Herbs used to treat psychiatric illness

angelica, chamomile, ginkgo, kava, melatonin, St.john’s wort, valerian, SAM-e

What is St.John’s wort used for?

mild to moderate depression

What are important interactions of St.John’s wort?

increased risk of serotonin syndrome with SSRIs, interferes with protease inhibitors, reduces effectiveness of oral contraceptives

Common herbal therapy for anxiety

valerian

What is valerian used for?

Anxiolytic; helps with sleep disorders

Valerian is used with what?

Effective anxiolytic used with St. John’s wort

What drug interactions does valerian have?

May reduce effects of: MAOIs, Warfarin, Phenytoin

What is a risk of valerian?

Potential for dependence

What herbal is used for memory and dementia?

Ginkgo

What is ginkgo used for?

May help antidepressant-related erectile dysfunction, may slow cognitive decline if started early

What are the cautions with ginkgo?

Increases effects of anticoagulants (bleeding risk); Interacts with several drugs

What is a key safety concern with ginkgo?

Use cautiously in patients with bleeding problems

What is melatonin?

Endogenous biomolecule and antioxidant that helps regulate the sleep-wake (circadian) rhythm

How can melatonin improve sleep?

may reduce sleep onset latency, duration and quality, and the number of nocturnal awakenings

How should nurses obtain information about a patient's use of CAM/herbals?

Be proactive in asking about it

What attitude should nurses use when discussing CAM/herbal use?

Respect, openness, and interest

What are the first 6 additional integrative choices?

AI- therapy app, magnesium, cannabis/synthetic THC, aroma therapy, AI-wearables, acupuncture/acupressure

What are the second 5 additional integrative choices?

light therapy, nutrition-what foods, animal-assisted therapy, behavioral sleep interventions including guided imagery, music/art/dance/movement/play