Adulteration: its various meanings.
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Biological Factors↗
Biomedical subjects
J S Cauffield
Publications and source records attributed to J S Cauffield.
Phytoestrogens as therapeutic alternatives to traditional hormone replacement in postmenopausal women.
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Aged↗
The psychosocial aspects of complementary and alternative medicine.
Approximately one in four persons in the United States uses complementary and alternative medicine (CAM). Out-of-pocket costs of CAM rival medical treatment at $21.2-32.7 billion versus $29.3 billion, respectively. Users of CAM tend to have high incomes and high levels of education. They also have medical conditions not easily treated by modern medicine such as chronic pain, poor mental health, human immunodeficiency virus infection, and cancer. The most common therapies are noninvasive (acupuncture, chiropractic, massage), however, consumption of dietary supplements has grown dramatically. Patients often use CAM in addition to modern medicine and are reluctant to discuss CAM with their physicians. Pharmacists' professional approach to science may bias them against CAM therapies. Complementary and alternative medicine use should be included in visit histories and discussed in an objective, nonjudgmental manner to encourage patient disclosure.
Adult↗
White paper on herbal products. American College of Clinical Pharmacy.
Individuals increasingly are taking a more active role in their health care, and herbal products have emerged as a common choice among self-care therapies. Pharmacists are active participants in the care of patients who are taking herbal products. Currently, most pharmacists are not educated adequately about herbal products and other types of alternative medicine. Furthermore, good information about many of these products is not available. These combined factors present a challenge for pharmacists as they seek to provide optimal care and counseling to patients who use herbs or supplements. We recommend the following actions to place pharmacists in better positions as effective agents protecting public safety: Regulations should be implemented at a federal level to require basic levels of standardization and quality control in the manufacture of herbal products. Indexing terms in medical bibliographic systems should be expanded to target herbal products. Funding should be increased for scientific research evaluating herbal products. Pharmacy schools should include a competency statement in their curricula regarding herbal medicines. Continuing education in herbal products should be available and encouraged for all pharmacists. Pharmacists should approach the use of all therapeutic interventions with scientific rigor, whether they are traditional or complementary in nature. Patients will benefit as more information is known and widely disseminated. By actively embracing the responsibility for counseling individuals on the appropriate use of herbal products, pharmacists will become a recognized source of expert information in this rapidly growing area, yielding important improvements in the quality of care.
Humans↗
The serum digoxin concentration: ten questions to ask.
Although the role of digoxin therapy has been the subject of debate, the drug is generally accepted as effective in the treatment of heart failure due to systolic dysfunction and as therapy for atrial fibrillation and supraventricular tachyarrhythmias. Serum digoxin concentrations are commonly used to gauge patient response to digoxin. Digoxin pharmacokinetics are complex, and many factors can confound the interpretation of digoxin concentrations. The exact therapeutic range of serum digoxin varies in the literature but should be considered to be from 0.8 to 2.0 ng per mL, on the basis of population data regarding therapeutic response and toxicity. Renal function plays a major role in digoxin pharmacokinetics and is an important factor in determining digoxin doses. Many medications, including quinidine, amiodarone and verapamil, alter digoxin pharmacokinetics and can result in two- to three-fold increases in the serum digoxin concentration. Effective interpretation of the digoxin concentration requires consideration of the patient's renal function and clinical status, possible drug interactions, time of the assay and other variables.
Algorithms↗
Alpha blockers: a reassessment of their role in therapy.
Intended for the treatment of hypertension, alpha blockers offer advantages in treating patients who also have other risk factors for coronary artery disease. Alpha blockers lower blood pressure by decreasing vascular resistance and are effective for the treatment of mild to moderate hypertension. In addition, alpha blockers have beneficial effects on lipid levels; they increase high-density lipoprotein levels and decrease total cholesterol, low-density lipoprotein and triglyceride levels. Alpha blockers do not induce glucose intolerance or hyperinsulinemia. Although they appear to decrease left ventricular mass, the clinical significance of this action is unknown. Alpha blockers are also effective for improving the symptoms of benign prostatic hypertrophy, although surgery is recommended for patients with severe symptoms.
Adrenergic alpha-Antagonists↗
Dietary supplements used in the treatment of depression, anxiety, and sleep disorders.
Dietary supplement use has increased during the past decade. Epidemiologic studies suggest that patients turn to dietary supplements because of a reluctance to take prescription medications or a lack of satisfaction with the results. They often perceive dietary supplements to be a safer or more natural alternative. Patients with mental health conditions, including depression, anxiety, and sleep disorders, are among those who use dietary supplements. St. John's Wort is used to treat depression. Clinical studies comparing dietary supplements with low-dose antidepressants (maprotiline, amitriptyline, or imipramine at 75 mg/day) or high-dose antidepressants (imipramine at 150 mg/day) find no significant difference between treatments. Kava kava is used to treat anxiety. Clinical trials demonstrate it to be superior to placebo, and roughly equivalent to oxazepam 15 mg/day or bromazepam 9 mg/day. Agents discussed for use in sleep disorders include melatonin, valerian, 5-hydroxytryptamine, catnip, chamomile, gotu kola, hops, L-tryptophan, lavender, passionflower, skullcap, and valerian. Familiarity with the evidence for use and the possible resulting risks can help health professionals to guide patient decisions regarding use of dietary supplements.
Anxiety↗