PC1- 4.1:Allergic Rhinitis, Cold and Cough Self-Care

True or False

There is limited evidence of dietary supplements in the treatment of common cold

True

Some dietary supplement only help in the _______________ not ________________

prevention

treatment

What are some supplements with limited evidence for possible effectiveness on common cold

Ginseng

Echinacea

Elderberry

Green Tea

What are some supplements with inconclusive or insufficient evidence for common cold

garlic

mistletoe

German Chamomile

Vitamin C

Zinc

Andrographs

mainly used to support immune system functions and prevent repeated cold infections, may reduce risk of respiratory tract infections in immunocompromised patients

American Ginseng

(Panax ginseng)

in combination with andrographis may reduce symptoms and shorten duration of symptoms

Siberian (Korean) Ginseng,

(Eleutherococcus senticosus)

True or False

American ginseng and Siberian Ginseng is the same and can be compared

FALSE

difference in extract composition!

Limitations for Ginseng in common cold

Pregnancy

(teratogenic effects)

What strength of Ginseng is safe for adults when using for common cold

100-3000 mg per day for 10 days

Should Ginseng be used short term or long term?

Short

American Ginseng standardization is _________ %of _____________ while Siberian Ginseng is _________ %of _____________

3-5%, ginsenosides

0.1-0.3%, eleutherosides

Ginseng interactions are moderate with ___________ active drugs

CNS

(alcohol, benzodiazepine)

DO NOT USE Ginseng in patients on what therapy as this is a MAJOR interaction

Warfarin

Moderate drug interactions with Ginseng

Antidiabetes

Antihypertensive

MAO inhibitors

3 species that Echinacea comes from

Echinacea pallida, Echinacea angustifolia, or Echinacea purpurea,

In clinical trials, Echinacea showed to prevent the common cold by reducing symptoms by

50-60%

Echinacea shows more evidence in the ____________ of common cold

prevention

Most preparations of Echinacea are liquid _____________ extracts and the dosing is usually _________ mL , __________ times daily

hydroalcoholic

5

2-6

Plant parts used for Echinacea are from

roots or herbs

Most common standardization of Echinacea root extracts is to _________ and _________

alkamides and polysaccharides

Above-ground Echinacea extracts are standardized to ________and __________

echinacosides and complex polysaccharides

True or False

Standardization may be linked with effectiveness in Echinacea

FALSE

Traditional uses for Echinacea

inflammations, fever, dizziness, blood purification, rattlesnake bites, colds, wound healing, general immune stimulant

Clinical use of Echinacea

treatment of the common cold ,anti-inflammatory effect after intravenous application

standardization of aerial parts of Echinacea purpurea

3.5% echinacoside

Dosing for Echinacea purpurea

900mg/day divided into 3 doses

MOA of Echinacea

inhibition of hyaluronidase

inhibition of prostaglandin synth

inhibition of COX-2

Root extracts of Echinacea exert what effects

antiviral and antifungal

leaf and aerial part extracts of Echinacea are linked to what effect

immunomodulatory

Proposed active ingredient of Echinacea

Echinacosides

only what part extract is standardized to Echinacosides

Echinacea purpurea aerial

true or false

Alkamides and polysaccharides in Echinacea are not usually standardized

true

Alkamides and polysacchardies are used as __________ substance substances for Echinacea

marker

Echinacea should not be given _________ due to potential allergic interactions and leukopenia

intravenously

Echinacea can cause counteractive effects on patients with on what drugs

immunosuppressants

True or False

Echinacea is contraindicated in pregnancy and lactation

FALSE it is actually not!

Clinical trials reported reduction in _________ of the common cold but it not significantly different compared to placebo

duration

Adverse effects of Echinacea are _______ with mostly just mild _______ upset

rare

GI

Patients with an __________ allergy should caution use of Echinacea and you should counsel them about using __________ or _________ instead

Asteraceae

Chamomile or calendula

Avoid use of ____________ agents and ___________ drugs with Echinacea

chemotherapeutic

immunosuppressant

Can Echinacea be used in children?

Yes, but short term

Echinacea effectiveness depends on

extract formulation

dosing

Moderate drug int with Echinacea

Caffeine

CYP 1A2 substrates

CYP 3A4 substrates

Immunosuppresants

Minor drug Interaction with Echinacea

Midazolam

Sambucus nigra, Caprifoliaceae

Elderberry

Traditional uses for Elderberry

flavoring agent

diuretic

laxative

astringent

Clinical uses of Elderberry

treatment of influenza, potential immune system activation, anti-hepatotoxi

Most preparations of Elderberry contain

100-150 mg of anthocyanins or flavonoids,

Daily doses of Elderberry in clinical trials range from

400 mg to 2 g dried berry extract

MOA of Elderberry

prevention of hemagglutination of release of viral particles for influenza A and B strains

reduction in HIV and herpes simplex replication through antigen production stimulation

Active ingredients in Elderberry

anthocyanins

sambunigrin

plant lectins

Which ingredient in elderberry is responsible for hemagglutination

plant lectins

Elderberry has moderate interaction with

immunosuppressant drugs

Is pregnancy contraindicated in Elderberry use?

No

Green tea latin name

Camellia sinensis, Theaceae

Traditional uses of Green Tea

appetite suppressant

increase sexual drive,

malaria,

dysentery,

diuretic,

stimulant,

immune modulator

Clinical uses of Green Tea

ergogenic,

neuroprotective, & nootropic effects, cardiovascular protection,

antimicrobial

Pure caffeine green tea can be taken in doses of _____________ but no more than _____________a day

100-200 mg

500 mg

Polyphenol-rich extracts in green tea may contain up to ____________ mg of epigallocatechin-gallate

800

What is responsible for stimulant and nootropic effects in green tea

Caffeine

What ingredient in green tea is responsible for calming and anxiolytic effects through action on central GABAA receptor

L-theanine

What has strong antioxidant and antiviral effect in green tea

Epigallocatechin-gallate (EGCG)

Green tea ____________-rich extracts exert antiviral effects,

polyphenol

FDA approved green tea extract marketed as __________ and _______________ ointment is used for genital warts, special formulation of sinecatechins

Veregen

Polyphenon E

Due to the caffeine content in green tea, there are moderate drug interactions with

diuretics

antihypertensive drugs

Minor interactions with Green Tea

Alcohol

antidiabetes

contraceptives

Fluconazole

Mexiletine

Terbinafine

Major interaction with Green tea

Ephedra

Vitamin C (ascorbic acid) showed modest effects of reducing common cold duration by _________ days but is inconsistent between studies

1-1.5

Higher doses of Vitamin C are needed to achieve potential benefit of more than _______

2g

Doses above 2g may results in adverse effects such as

kidney stones

GI upset

No relationship between vitamin C ______________ and reduced risk of contracting common cold in adults or children alike

supplementation

Only route of Vit C supplementation is ________; any other route is not a dietary supplement but _____ administration is FDA-approved drug

oral

IV

________ is a micronutrient electrolyte that is essential in enzymatic processes and cellular processes including immune regulation and response

Zinc

Upper daily limit of Zinc intake is _______ mg, should not be exceeded through supplementation

40

Oral supplementation with zinc lozenges can contain between _________ mg of elemental zinc as its sulfate or acetate salt

9-34

Zinc May reduce ______ and __________ of common cold if taken at symptom onset although clinical studies are limited and show only marginal improvement

severity

duration

Zinc ______ __________ remains controversial since it may lead to high absorption with subsequent copper deficiency

nasal spray

___________ was associated with certain Zicam products, since been withdrawn from US market

Loss of smell

Zinc lozenges can be taken every____ hours until symptom improvement, do not exceed more than ____ lozenges per day in adults, ______ in children (also consider upper daily limit 40mg!)

2

6

4

______-term Zinc use is regarded as safe, adverse effects are limited to potential ______ and ___________

short

constipation

N/V

Do not recommend supplement use in immunocompromised patients, including ________ or_______

toddlers

elderly