Natural Health Products

Question 1

How to identify natural health products in the Licensed Natural Health Products Database

Answer 1

• Eight-digit Natural Product Number (NPN)
• Homeopathic Medicine Number (DIN-HM)

Question 2

3 uses for cranberry

Answer 2

• Treatment and prevention of UTI
• Manage H. pylori infections leading to ulcers
• Prevent dental plaque

Question 3

2 effects of cranberry

Answer 3

• Decreased urinary pH (esp in large amounts)
• Theoretically can cause increased excretion of antibiotics and opiates (re: change in urinary pH)

NOTE: No other concerns for dentistry

Question 4

3 uses of chamomile

Answer 4

• Mild sedative effect
• Believed to have anti-inflammatory properties
• May be used as mouthwash for aphthous ulcers or mucosal ulceration secondary to chemo or radiotherapy

Question 5

2 concerns with chamomile

Answer 5

• Enhanced sedation possible with CNS depressants, sedatives
• Contains umbelliferone (coumarin-like substance) –> possible increased bleeding (avoid NSAID’s, ASA)
  
  • Stop administration 2 wks prior to invasive dental surgery

Question 6

2 uses of echinacea

Answer 6

• Believed to boost body’s autoimmune response, often taken at onset of cold
• May be used topically to treat mouth and pharyngeal inflammation

Question 7

2 concerns for echinacea

Answer 7

• Possible immunostimulant over short periods of time, but long time use (>8 weeks) may be associated w/ immunosuppression –> advise discontinuation 2 weeks before surgery
• Additive hepatoxocity –> avoid concurrent use of acetaminophen, NSAID’s, nacrolides ,azole antifungals in pts w/ compromised hepatic function

Question 8

5 uses of evening primrose

Answer 8

• PMS
• Hot flashes and night sweats assoc w/ menopause
• Atopic dermatitis
• Acne
• Rheumatoid arthritis

NOTE: Not much evidence exists that it is effective

Question 9

2 concerns about evening primrose

Answer 9

• Evidence for inhibition of platelet aggregation –> increased bleeding (avoid ASA, NSAID’s)
• Potential hypotensive effect –> monitor BP

Question 10

Use of garlic

Answer 10

Everything (i.e. acne, high cholesterol, high BP)

Question 11

5 possible effects of garlic

Answer 11

• Lower blood glucose
• Decrease incidence of thrombosis
• Boost immune system
• Fight bacteria
• Fight free radicals

Question 12

3 concerns about garlic

Answer 12

• Irreversible platelet aggregation inhibitor & potentiates effect of other platelet inhibitors (i.e. prostacyclin) –> avoid NSAID’s, ASA
  
  • Discontinue at least 7 days prior to invasive dental surgery
• Additive effect with CNS depressants (sedatives, opiates)
• Potential to lower BP – monitor for orthostatic hypotension

Question 13

3 uses of ginger

Answer 13

• Soothe upset stomach and digestive problems
• Relieve toothache (fresh ginger)
• Arthritis and muscle & joint pain (effectiveness unclear)

Question 14

3 concerns about ginger

Answer 14

• May inhibit platelet activating factor –> possible bleeding w/ NSAID’s, ASA
• May lower BP –> monitor orthostatic hypotension
• Additive effects with CNS depressants (benzodiazepines and opiates)

Question 15

5 uses of ginkgo biloba

Answer 15

• Natural enhancement for brain function and memory
• Treatment for:
  
  • Peripheral vascular disease
  • Cerebral vascular disease
  • Mild dementia
  • Alzheimer’s dementia

Question 16

Concern about gingko bilob

Answer 16

Inhibitor of platelet activating factor –> possible bleeding with NSAID’s and ASA. Discontinue 2 weeks prior to invasive surgery

Question 17

3 uses for ginseng

Answer 17

• Used regularly to help boost immune system (little evidence)
• Enhance physical & mental performance
• Protect against stress

Question 18

4 concerns about ginseng

Answer 18

• Inhibits clotting (inhibition of thromboxane formation)
• Irreversible platelet inhibition:
  
  • Avoid ASA, NSAID’s
  • Discontinue 7 days prior to invasive surgery
• May lower BP – monitor orthostatic hypotension
• Additie effects with benzodiazepines, opiates (caution)

Question 19

4 uses of red yeast rice

Answer 19

• Traditional chinese remedy for:
  
  • Poor circulation
  • Indigestion
  • Diarrhea
• Natural product to lower cholesterol (contains lovastatin)

Question 20

2 concerns about red yeast rice

Answer 20

• Same interactions as other statins (i.e. erythromycin, azole antifungals - esp. itraconazole) –> risk of rhabdomyolysis by inhibition of CYP3A4
• Additive hepatoxicity (avoid NSAID’s and acetaminophen)

Question 21

4 uses for St. John’s Wort

Answer 21

• Mild to moderate depression
• Melancholia
• Anxiety
• Topically for minor wounds, bruises, infections, sprains

Question 22

2 concerns about St. John’s Wort

Answer 22

• Adverse effects = drowsiness, GI complaints, photosensitivity
• Possibly elevation of CYP450 levels –> rapid metabolism of many drugs (i.e. benzodiazepines and NSAIDs)
  
  • Discontinue at least 5 days prior to surgery

Question 23

6 uses for turmeric

Answer 23

• Ayuvedic and Chinese medicine as anti-inflammatory for problems with:
  
  • Liver
  • Digestion
  • Skin diseases
  • Wounds
• Reduction of pain and improvement of function in osteoarthritis
• Antioxidant – fights free radicals

Question 24

2 concerns about turmeric

Answer 24

• May lower BP – orthostatic hypotension
• Inhibitor of platelet aggregation - risk of increased bleeding –> avoid NSAIDs, ASA

Question 25

2 uses for valerian

Answer 25

• Natural sedative
  
  • Sleep disorders
  • Mild anxiety
• NOTE: appears to increase GABA

Question 26

2 concerns about valerian

Answer 26

• Enhanced sedation with CNS depressants (sedatives, opiates)
• May inhibit CYP3A4 (avoid with azole antifungals and macrolides)