Herbal Medications: An Evidence-Based Review
Course #58394 -
- Participation Instructions
- Review the course material online or in print.
- Complete the course evaluation.
- Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
Patients, and in some cases healthcare providers as well, are not fully aware of the health risks incurred by ingestion of herbal medications, either due to their potential adverse effects or pharmacologic interactions with other medications. This situation is further compounded by the fact that 40% to 70% of the patients taking herbal medications do not disclose this fact to their healthcare provider. This course provides the knowledge and tools required for clinicians to discuss natural health products with patients and other members of the healthcare team. It also discusses the need for physicians and nurses to actively inquire if the patient is taking herbal medications and take this information into account prior to prescribing new medications. A brief historical background and an overview of regulatory bodies responsible for overseeing herbal medications is provided. Relevant examples of widely used herbal compounds are presented. Clinically relevant information on commonly used herbal medications regarding therapeutic effectiveness, pharmacologic mechanism of action, adverse effects and drug interactions are reviewed based on scientific evidence.
- DEFINITIONS
- PREVALENCE OF HERBAL MEDICATION USE
- HISTORICAL OVERVIEW OF HERBAL MEDICATIONS IN NORTH AMERICA
- MEDICAL AND PATIENT PERCEPTIONS AND MISCONCEPTIONS ABOUT THE USE OF HERBAL MEDICATIONS
- DISCLOSURE AND CLINICAL NEED TO IDENTIFY THE USE OF HERBAL MEDICATIONS
- CLINICALLY RELEVANT PHARMACOLOGY AND TOXICOLOGY OF HERBAL MEDICATIONS
- HERBAL MEDICATIONS: REGULATORY ASPECTS
- SCIENTIFIC EVALUATION OF HERBAL MEDICATIONS
- EVIDENCE-BASED REVIEW OF THE MOST COMMONLY USED HERBAL MEDICATIONS
- CONCLUSION
- RESOURCES
- Works Cited
- Evidence-Based Practice Recommendations Citations
Considering the widespread availability and increased use of herbal medications, this course is designed for dental professionals who will benefit from the course.
Considering the pharmacologic interactions between herbal medications (HMs) and conventional medications, it is paramount to increase the awareness and knowledge of dental professionals about HMs. The purpose of this course is to increase dental professionals' awareness of the potential risks and benefits of HMs from an evidence-based perspective and promote the planned inclusion of HM use in patients' medical history. This course should allow dental professionals to discuss HMs in a knowledgeable and succinct manner with patients and colleagues.
Upon completion of this course, you should be able to:
- Discuss the prevalent current and historical use of HMs in North America.
- Explain the need to inquire about the use of HMs during preparation of a patient’s medical history, including components of a culturally sensitive assessment.
- Discuss the pharmacology (i.e., pharmacokinetics, pharmacodynamics, drug interactions, adverse drug reactions, toxicology) of HMs.
- Describe the differences between the process of development and approval of HMs versus conventional medications, and the implications of health claims and therapeutic efficacy of HMs.
- Outline the merits and limitations associated with the application of contemporary scientific principles and methodologies (i.e., evidence-based medicine) to assess the efficacy and safety of HMs.
- Discuss, based on scientific and conventional medical principles, the pharmacologic properties, efficacy, safety, toxicology, therapeutic indications, and recommended dosages of saw palmetto and St. John's wort.
- Describe the potential risks and benefits of ginkgo.
- Identify key characteristics of ginseng.
- Discuss the use of echinacea and kava, including potential adverse effects.
- Review the use of garlic and valerian as HMs.
- Outline the potential medical uses of andrographis and English ivy leaf.
- Analyze the available evidence for the use of peppermint, ginger, soy, and chamomile.
A. José Lança, MD, PhD, received his Medical Degree at the University of Coimbra in Coimbra, Portugal, and completed his internship at the University Hospital, Coimbra. He received his PhD in Neurosciences from a joint program between the Faculties of Medicine of the University of Coimbra, Portugal, and the University of Toronto, Toronto, Canada. He was a Gulbenkian Foundation Scholar and was awarded a Young Investigator Award by the American National Association for the Research of Schizophrenia and Depression (NARSAD).
Dr. Lança has participated in international courses and conferences on neurosciences. He has contributed to a better understanding of the mechanisms underlying the ontogenetic development of the brain opiatergic system. As a research scientist at the Addiction Research Foundation (ARF) in Toronto, he initiated research on the functional role played by dopaminergic cell transplants on alcohol consumption, leading to the publication of the first research reports on cell transplantation and modulation of an addictive behavior. Subsequently, he also investigated the role played by other neurotransmitter systems in the limbic system and mechanisms of reward, co-expression of classical neurotransmitters and neuropeptides and potential role in neuropsychiatric disorders.
He is an Assistant Professor in the Department of Pharmacology at the Faculty of Medicine and at the Faculty of Dentistry at the University of Toronto. He was the Program Director for Undergraduate Studies in the Department of Pharmacology of the University of Toronto. He has developed clinical pharmacology courses for the Radiation Sciences and Chiropody Programs of The Michener Institute for Health Sciences at the University of Toronto, where he also lectures both pharmacology courses and holds a Faculty position.
Dr. Lança's commitment to medical education started while a medical student, teaching in the Department of Histology and Embryology, where he became cross-appointed after graduation. In Toronto, he has contributed extensively to curriculum development and teaching of pharmacology to undergraduate, graduate and medical students. He has developed an integrated approach to clinical pharmacology, and has contributed to an evidence-based teaching of Herbal Medications in clinical pharmacology. He is also the author of six chapters in medical pharmacology textbooks.
Contributing faculty, A. José Lança, MD, PhD, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Mark J. Szarejko, DDS, FAGD
The division planner has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Sarah Campbell
The Director of Development and Academic Affairs has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.
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The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, professionals' attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients' trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages.
Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control-based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual's behaviors. These strategies include increasing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.