Complementary, Alternative, and Integrated Therapies

Aloe

therapeutic uses: softens skin, heals, burns, and soothes pain, also acts as laxative

mechanism of action: inhibits the COX pathway and prostaglandin production, inhibits the release of histamine and leukotrienes from mast cells

adverse effects: hypersensitivity from skin formulation, fluid + electrolyte imbalances and abdominal cramping from oral formulation

nursing care: avoid giving the oral formulation to patients with kidneys disorders and cardiac disorders, the oral form interacts with many medications, including digoxin, diuretics, corticosteroids and antidysrhythmics

Black Cohosh

therapeutic uses: estrogen substitute, premenopausal and menopausal symptoms (cramps and hot flashes), to induce labor, hot flashes r/t cancer treatment

mechanism of action: unknown

adverse effects: GI distress, lightheadedness, headache, rash, weight gain, and liver damage

black and blue cohosh are different herbs and the latter has been found to cause HTN, hyperglycemia, chest pain, and infantile seizures during labor

nursing care: known to increase effects of anti-hypertensives, estrogen meds, and diabetes meds, no standard monitoring, ask pt if they could be pregnant or have liver disease

Echinacea

therapeutic uses: treats influenza, healing of skin disorders, wounds, and burns

mechanism of action: immunostimulant, inflammation suppressor

adverse effects: bitter tase, mild GI effects, fever, and allergic reactions (ragweed and daises)

nursing care: educate pt that chronic use can reduce effectiveness of some TB, HIV, and cancer medications

Feverfew

therapeutic uses: prevents migraines, analgesis, inhibiting free radical production, inhibition of growth and migration of cancer cells

mechanism of action: inhibits platelet-release serotonin, a factor associated with migraines, inhibits platelet aggregation, vascular smooth muscle relaxation, anti-inflammatory, inhibits prostaglandins —- analgesic effects

adverse effects: mild GI effects, post feverfew symptoms = agitation, tiredness, insomnia, headache, and joint discomfort when feverfew is abruptly stopped

allergic reactions in people with ragweed and echinacea

nursing care: educate patients not to take it if they are on drugs that affect platelet aggregation like NSAIDS, heparin, or warfarin, discontinue 2 weeks before elective surgery

Garlic

therapeutic uses: hypercholesterlemia and HTN

mechanism of action: releases allicin, suppresses liver enzymes involved in cholesterol synthesis, reduces LDL, increases nitric oxide —- vasodilation, suppresses platelet aggregation

adverse effects: GI manifestations, bad breath/body odor

nursing care: educate patients not to take it if they are on drugs that affect platelet aggregation like NSAIDS, heparin, warfarin, known to decrease blood levels of certain HIV meds and cyclosporine

Ginger Root

therapeutic uses: reduction of nausea during pregnancy, reduction of insulin resistance, pain + inflammation in knee arthritis, allergic rhinitis, relieves vertigo + nausea, increases intestinal motility, increases gastric mucous production, suppresses platelet aggregation

adverse effects: high doses can cause uterine contractions, potential CNS depression and cardiac dysrhythmias with excessive ingestion

nursing care: educate pt to not take if they are on drugs like NSAID, heparin, and warfarin, educate to not take with antidiabetic medications (increased hypoglycemia)

Gingko Biloba

therapeutic uses: decreases leg pain from occlusive disorders, improves memory and cognition in older patients with impaired cerebral circulation, decreases the risk of a stroke, decreases bronchospasms

mechanism of action: promotes vasodilation, increases blood flow to the brain, decreases platelet aggregation

adverse effects: mild GI upset, headache/lightheadedness

nursing care: educate pt with seizures to avoid it, can interact with multiple medications that lower the seizure threshold (antidepressants, antihistamines, and antipsychotics), educate pt not to take if use NSAIDS, heparin, or warfarin

Glucosamine ± Chondroitin

therapeutic uses: commonly used as a dietary supplement to manage osteoarthritis symptoms particularly in the knee

mechanism of action: reduces joint pain and slows cartilage breakdown

adverse effects: mild GI upset and shellfish related allergies

nursing care: educate patients not to take if using NSAID, heparin, warfarin

St. John’s Wort

therapeutic uses: depression, pain, inflammation

mechanism of action: increases serotonin levels

adverse effects: dry mouth, lightheadedness, Gi upset, skin rash with exposure to light, photosensitivity, allergic reactions, increased risk of serotonin syndrome,

nursing care: encourage patients using it to prevent long-term sun exposure and to use sunscreen

Saw Palmetto

therapeutic effect: benign prostatic hyperplasia, prostate cancer

mechanism of action: antiandrogenic effects —- decreased test levels, relaxes urinary tract to smooth muscle through antagonism of muscarinic receptors. anti-inflammatory effects through inhibition of lipoxygenase, COX, and leukotrienes

adverse effects: mild GI

nursing care: dont take if NSAIDs, heparin, and warfarin

Valerian

therapeutic uses: insomnia and other sleep disorders

mechanism of action: unclear

adverse effects: drowsiness, lightheadedness, depression, risk of physical dependence

nursing care: educate pt not to drive/use operational machinery

Cannabis

therapeutic uses: used to treat symptoms of cancer, RA, fibromyalgia, pain, neuropathies from HIV/AIDS, MS, and diabetes. Spasticity from MS or a spinal cord injuries reduced IOP

mechanism of action: brain and peripheral tissues harbor widespread cannabinoid receptors —- forms the endocannabinoid system

adverse effects: tachycardia, increased appetite, drowsiness/dizziness, hypotension, decreased urination, dry mouth + eyes, hallucinations, paranoia, anxiety, and impaired attention/memory, possible dependency

nursing care: do not give to pt unless local laws allow nurses to do so, determine if the patient has a MMP designated caregiver who can assist pt with use, be careful to not be judgmental, educate pt that there are no federal regulations regarding quality or purity

Epidiolex

contains a purified form of CBD for the treatment of seizures associated with lennox-gastaut syndrome or Dravet syndrome in pt older than 2 years

Marinol + Syndros

contain THC, FDA approved to treat nausea associated with cancer chemotherapy and for the treatment of anorexia associated with weight loss in AIDs patients

Cesamet

contains nabilone, a compound similar to THC and is synthetically derived, approved for nausea associated with cancer chemotherapy.