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Appendix T: use of epi and Benadryl Discontinue suspected drug causing rxn Maintain airway, aminophylline or other bronchodilators may be requiredAdminister epi Adults: IM, Sub Q Adults: .3-.5 mg q 5-15 min IV adults: .1 mg over 5 min OR 1-4 mcg/min infusion Children: IM, Sub Q: .01 mg/kg or .1 mg q 5-15 min IV: .01 mg/kg/dose or .1-.2 mg over 5 min, may repeat q 30 min OR .1-1.5 mcg/kg/min infusion Administer antihistamines: to prevent recurrence/decrease intensity of reaction Adults: diphendyradmine IM, IV: 50-100 mg single dose, may follow w/ 50 mg q 6 hr for 1-2 days Children: diphenhydramine IM,IV: 5mg/kg/day in divided doses q 6-8hr; may follow w/ oral therapy for 1-2 days Support BPAdminister corticosteroids (hydrocortisone: 100-1000 mg, may follow w/ 7 mg/kg/day IV or oral therapy for 1-2 days) Documentation Bee pollen: enhance athletic performance Decreases effects of analgesics and NSAIDSAdditive blood thinner effect Increases risk of hepatotoxicity CAN Be contaminated w/ fungus-> risk of infection Creatine: muscle building Increased risk of nephrotoxicity when taken w/ NSAIDS Alteration of liver function CoQ10 Recommended concurrent use w/ -statins Spontaneous abortionIncreased clotting risk Hypotension, hypoglycemia Antioxidant effect Ephedra: believed to be used to lose weight Can cause seizures in otherwise healthy adults Banned in US in 2004 Glucosamine: take for osteoarthritis, TMJ arthritis, glaucoma Potentiates effects of warfarin (increased risk for bleeding/bruising) Can decrease efficiency of insulin and interfere w/ antidabietic drugs Saw palmetto: BPH Evidence states does not reduce/relieve symptoms of BPH Believed to have antiplatelet actions (contraindicated w/ anticoagulants)Unknown mechanism can have effects on other medications Soy: believed to relieve hot flashes Binds to synthetic thyroid hormones (levothyroxine), exacerbating thyroid conditions Kava: anxiety, stress, restlessness, insomnia, benzo withdrawl, muscle aches and pains, PMS Taking w/ alprazolam (Xanax) increases SE: resp, confusion, drowsiness Increased LIVER TOXICITY; can affect metabolism of other drugs SHOULD NOT BE CONSUMED INTERNALLY Melatonin: taken for sleep aid Can increase BS, BP, and increase risk for seizures Flaxseed: relief of constipation, dyslipidemias Indirect soure of lignans which alter estrogen metabolism to produce less active estrogen metabolites (concern w/ hormonal b.c.) Some effectiveness in reducing LDL and total cholesterol, but does not impact triglycerides or HDL Echinacea: prophylaxis of cold Does have ability to stimulate immune system Contraindicated in pts w/ autoimmune disorder Works w/in first 12 hrs of cold BUT not useful as prophylactic Can trigger allergic response in pts w/ allergy to ragweed/daisy flowers Impacts Cytochrome P450 systemPotentiates warfarin, caffeine CONCERN OF OTHER ADDATIVES IN PRODUCTS St. John’s Wart: relief of s/sx of depression Risk of Serotonin Syndrome (life threating) when combined w/ SSRI’s Can reduce effectiveness of oral contraceptives Elderberry: thought to shorten length of infection Shown to possibly be effective in reducing symptoms/duration of influenza if taken w/in 48 hrs. Child’s dose should be limited to 15 mL/twice daily Extract=medicine, wine and jelly used for culinaryContains cyanide producing chemicals, poisoning may occur when ingested in large quantities when not cooked Chromium: may be helpful in controlling blood sugar levels, assisting insulin to work better, and reversing effects of neuropathyReduces effectiveness of levothyroxine (synthroid)NSAIDS can increase levels to toxic values Use w/ cinnamon could result in kidney damage Evening primrose oil: used as substitute for HT Evidence suggests not effective Does not reduce hot flashes or night sweats caused by menopauseOne specific product did reduce menopausal symptoms Drug-drug interactions with anticoagulatns, phenothiazines, and anesthetics Black cohash: believed to relieve menopause symptoms Studies results are mixed May cause liver damage Drug-drug interactions: alcohol containing perpetrations may react w/ disulfiram May precipitate hypotension when used w/ anti hypertensives Used to treat snakebites Milkthistle: protection from liver damage Mixed evidence on efficacy Has been used in tx of cirrhosis b/c shown to be hepatoprotective in addition to having hepatocyte regenerative Allergy in ppl w/ rxns to daisy/ragweed Zinc: taken at the beginning of a cold to stop all symptoms Tightens leaky gut in chrons, Too much can be immunosuppressive Can block rhinovirus from binding which can decrease duration of cold Vegetarians run risk of deficiency Taken w/ food to decrease gastric irritationTake zinc within first 12 hrs to treat a coldTaken around the clock will not work Lavender oil (aromatherapy): treat nervousness and restlessness, also mosquito repellentIndicated in insomnia, depression, and alopeciaPotentiates effects of barbiturates Weak repellantCan cause dermatitis and stimulate hair growth Can cause gynecomastia Should not be used in pregnant/breastfeeding women Redbull: excessive caffine One 8.4 fl oz can contains 80 mg of caffineMild/moderate symptoms of overdose occur 250-500 mg Jitters/restlessness/nervousness Increased HR N/VAnxiety Palpitations Insomnia Dizziness Sweating Cardiac arrest Garlic: claims made that can reduce high BP and atherosclerosis FRESH CLOVES, CAPSULES, OR TABLETS may have effects in lowering cholesterol (but less effective than statins) and slowing development of atherosclerosis Potential for bleeding Stop garlic 2 weeks prior to surgery Ginger: prevention and tx of n/v associated w/ motion sickness, loss of appetite, pregnancy, surgery , and chemotherapy May act at serotonin receptors (unclear) Good evidence but may take up to 3 days to be effective HUGELY EXCESSIVE DOSES (> 5gm/day) may result in CNS depression and cardiac dysrhythmias Can supress platelet aggregation (risk of bleeding), lower blood sugar Green tea: mental alertness Effective, but b/c of caffine Concerns for caffeine dependency, high blood pressure Ginkgo trees: improve thinking Effective to improve thinking and possibly sharp thinking skills of younger ppl, help normal memory loss in older ppl ABSOLUTELY NO EFFECT IN DIMENTIA Concerns: increased clotting times (interactions w/ anticoagulants), increased risk of liver and thyroid cancer Capsaicin: topical analgesic, stimulates TRPV1 receptors on on receptive nerve fibers; pain relief thought to be b/c of reduction in TRPV1 expresssing nociceptive nerve endings Relief of discomfort assoc w/ painful peripheral syndromes Muscle, joint pain, arthritis, strains, and sprains Wash hands and don’t get into eyesDon’t use with open wounds/damaged skin Can increase BP Feverfew: Migraine headaches Uterine contraction: spontaneous abortion (contraindicated in pregnancy) Risk of bleeding (inhibition of coagulation) No better than placebo Sassafras: used for skin conditions, RA, diuretic, increased sweating, leprosy, syphilis, performance enhancing, analgesic, anesthetic Adverse effects: stomach irritation, tachycardia, increased BP, anxiety, shaking Used in making ecstasy Vitamin B12: anti-aging remedy No evidence it is an effective remedy (no independent effect on cognition) Excess could result in polycythemia (use cautiously in pts w/ hx of cancer), restenosis, and can exacerbate hypokalemia Airborne: dietary supplement generally used for immune booster (spec vitamin C) No conclusive evidence that it prevents/shortens cold duration (not backed by FDA) Excess intake may cause gas, bloating, N/V/D, bleeding Unknown drug interactions Valerian root: potential anxiolytic to improve sleep Safe w/ short term use. Effects of long term use unkown Drowsiness in morning after taking (don’t operate heavy machinery) Sedative effects: d/c 2 weeks before surgery Benzo like withdrawl after long term use so TAPER OFF Potential for HA, uneasiness, insomnia Contraindication in pregnancy/ breastfeeding Green coffee beans: weight lossUnkown, not recommended for weight loss until more research done Contains about as much caffine as normal coffee; but contains chlorogenic acids and other antioxidants (may be responsible for weight loss?) Effects bad for pts w/ HTN Possible SETachycardia, restlessness, n/v, agitation, anxiety, calcium deficiencies, arrhythmias, MG depleation (K depletion to follow), ringing ears, worsening bleeding disorders, muscle tension Cranberry: prevention of frequent UTIs Some chemicals keep bacteria from sticking, but no effect on bacteria already latched to urinary tract: bottom line, possibly effective NO effect on bacterial growth Contraindicated in pts w/ allergy to ASA (contains salicylic acid) Can cause oxalate kidney stones High sugar content Aloe vera: burns Small minor burns will help speed up healing time, may cause skin irritation Topically no major risks ................
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