PTCB STUDY — CHAPTER 30

Complementary & Alternative Medicine (CAM)

Alternative medicine

A range of therapies used instead of conventional Western medical treatments.

Complementary medicine

A range of non-orthodox therapies used together with conventional medicine.

Herb

A plant valued for its aromatic, medicinal, or flavorful properties.

Ayurveda

A treatment system originating in India that emphasizes spiritual self-awareness, lifestyle, diet, and disease prevention.

Traditional Chinese medicine (TCM)

A system of medicine that uses meridians, yin/yang balance, herbs, acupuncture, and other traditional techniques.

Homeopathy

A system based on the idea that very small, highly diluted doses of substances that cause symptoms can be used to treat those same symptoms.

Homeopath

A doctor or practitioner trained in using highly diluted substances under the “like cures like” principle.

Chiropractic medicine

Manual manipulation of joints and spine to relieve pain and improve function.

Biofeedback

Use of electronic monitoring to help a person gain voluntary control over involuntary body functions (e.g., heart rate, BP).

Prophylaxis

Treatment or measures taken to prevent disease.

Synthetic medicine

A medication made in a laboratory from chemical processes.

Diagnosis

The process of a physician recognizing a disease or condition, often based on signs, symptoms, and/or tests.

National Center for Complementary and Integrative Health (NCCIH)

List the three primary goals of the NCCIH:

a. Perform / support research on alternative and complementary treatments.

b. Train individuals / practitioners in CAM methods.

c. Provide information to consumers and health professionals about CAM therapies

Per the FDA, list five items that must appear on a dietary supplement label:

1.Product name

2. Clear statement that it is a “dietary supplement”

3. Name and place of manufacturer, packer, or distributor

4. Supplement Facts panel (serving size, servings per container, dietary ingredients, and amount per serving)

5. Net quantity of contents

6. Domestic address or phone number for reporting adverse events

What does DSHEA stand for?

Dietary Supplement Health and Education Act

Under DSHEA, must manufacturers prove effectiveness of an herbal product with the same rigorous clinical trials required for prescription drugs?

No

Dietary supplements cannot legally claim to treat, cure, or prevent a specific disease. Instead, what type of claim is allowed?

They may make structure/function or generalized health claims (e.g., “supports immune health”) and must include:

“This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”

According to the FDA, list the three key characteristics of a medical food:

a. Be administered enterally (orally or via feeding tube).

b. Be used under the supervision of a physician (though not all require a prescription).

c. Be intended to treat a condition with distinctive nutritional requirements.

Garlic

D. Allium sativum - Scientific Name

Echinacea

Echinacea purpurea (also E. angustifolia, E. pallida)

Saw palmetto

Serenoa repens

Ginkgo

Ginkgo biloba

Soy

Glycine max

Cranberry

Vaccinium macrocarpon

American ginseng

Panax quinquefolius

Black cohosh

Actaea racemosa

St. John’s wort

Hypericum perforatum

Milk thistle

Silybum marianum

Garlic (Allium sativum) is used for

Hypertension / hyperlipidemia (either is acceptable).

Echinacea is used as an immunostimulant and may help with ____

Common cold____________.

Saw palmetto is commonly used for

Benign prostatic hyperplasia (BPH).

Ginkgo biloba is often used for

circulation and Dementia / cognitive issues.

Soy (Glycine max) may help with ___________ and cardiovascular health.

Menopausal symptoms_(also hyperlipidemia or osteoporosis prevention;menopausal symptoms is ideal)________

Cranberry (Vaccinium macrocarpon) is widely used to help prevent or treat ___

UTIs_____.

American ginseng (Panax quinquefolius) may help with

Diabetes (also respiratory infections)_.

Black cohosh is often used to treat ________

Menopausal symptoms ____________________.

St. John’s wort (Hypericum perforatum) is most commonly used for

Depression______.

Milk thistle (Silybum marianum) is often used for ___

Liver protection / toxin-induced liver damage__________________.

Which herb can increase bleeding risk when taken with warfarin or NSAIDs?

A. Cranberry

B. Garlic

C. Milk thistle

D. Soy

B. Garlic

Which herb can decrease the effectiveness of oral contraceptives, warfarin, and some HIV medications?

A. Black cohosh

B. St. John’s wort

C. Echinacea

D. Ginkgo

B. St. John’s wort

Which herb may increase the risk of hypoglycemia when used with antidiabetic drugs like glimepiride?

A. Soy

B. Garlic

C. Ginseng

D. Milk thistle

C. Ginseng

A patient on warfarin is buying ginkgo and garlic supplements.

Why should this combination concern the pharmacy team?

Both garlic and ginkgo can increase bleeding risk when combined with warfarin and/or other antiplatelet agents (like aspirin).

This raises the risk of serious bleeding

List two types of prescription drugs whose effects may be decreased or altered by St. John’s wort:

o Oral contraceptives

o Warfarin

o Certain HIV antivirals (e.g., lamivudine and others)

o Antidepressants (SSRIs like fluoxetine, paroxetine)

(Any two of the above are acceptable.)

Garlic capsules

Natural

Cranberry juice for UTI prevention

Natural - N

St. John’s wort

Natural

Ayurvedic herbal and lifestyle plan

Natural or M/B = Mind–body medicine or both

Massage therapy

MAN = Manipulative / body-based practices

Chiropractic spinal adjustment

MAN = Manipulative / body-based practices

Yoga

M/B = Mind–body medicine

Acupuncture

M/B = Mind–body medicine

Biofeedback

M/B = Mind–body medicine

Meditation

M/B = Mind–body medicine

A 68-year-old patient taking warfarin and aspirin asks where the St. John’s wort is kept because they “heard it’s good for mood.”

a. Which two major concerns should the pharmacy technician recognize?

b. What should the technician do next (within technician scope)?

Increased bleeding risk (warfarin + aspirin + herbals like St. John’s wort may also interact; if they also use garlic/ginkgo, even more bleeding risk).

2. St. John’s wort can alter metabolism of many drugs (including warfarin, antidepressants, and others), possibly reducing effectiveness or causing toxicity

Do not recommend or counsel independently about starting St. John’s wort;

instead, notify and refer the patient to the pharmacist for clinical counseling and

possible prescriber contact.

A patient with chronic back pain says:

“I stopped all my prescription pain meds and now I only see my chiropractor.”

a. Is this complementary or alternative medicine?

This is alternative medicine (used instead of conventional treatment)

b. A different patient uses yoga and meditation plus their prescribed hypertension medications. Is this complementary or alternative?

This is complementary medicine (used in addition to conventional treatment)

A patient brings a bottle of an herbal supplement that claims on the front:

“Cures liver disease and reverses cirrhosis!”

a. Why is this claim not appropriate under DSHEA and FDA rules?

b. What kind of statement is allowed on a dietary supplement label?

Dietary supplements cannot claim to diagnose, treat, cure, or prevent disease.

That is a drug claim and violates DSHEA/FDA rules

Structure/function or general wellness claims (e.g., “supports liver health”), plus the statement:

“This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”