Any substance presented as having properties for treating or preventing disease in human beings
Medicines are divided into what 3 categories?
1) General Sales List (GSL) Medication
2) Pharmacy Only Medication
3) Prescription Only Medication
Give the definition of pharmacokinetics
How drugs are absorbed and moved around the body
Give the definition of pharmacodynamics
How drugs exert their effects on the body
What is the first site of drug metabolism?
The liver
What is the first pass effect?
If drugs are administered orally they are absorbed into the portal circulation and go directly to the liver.
This means drug concentration is often drastically reduced before it reaches general circulation - this is known as the first pass effect.
Another definition:
The intestinal and hepatic degradation or alteration of a drug or substance taken by mouth, after absorption, removing some of the active substance from the blood before it enters the general circulation.
What forms of medication can bypass the first pass effect?
Injections
Inhaled medications
Topical medications
Sublingual medications (*under the tongue)
Note these will all be metabolised by the liver eventually
What happens in Phase I liver detoxification for a drug?
the drug is made more lipophobic (water-soluble) to reduce chance of reabsorption by the kidneys
Primes a binding site on the drug using Cytochrome P450 enzymes
What happens in Phase II liver detoxification for a drug?
It is conjugated to reduce its effects and aid excretion
What is bile?
List 2 functions.
A bitter greenish-brown fluid which aids digestion and is secreted by the liver and stored in the gallbladder.
1) Acts as an emulsifier to break fat into smaller globules (makes it more hydrophilic) so that we can digest it.
2) Detoxifies bacterial endotoxins
Where is the main site of drug excretion?
The kidneys
What is the term "half-life"?
This is the time it takes for a drug's concentration in the body to fall by half.
What is an agonist?
Drugs that occupy receptors andactivate them!
What is an antagonist?
A drug that binds to a receptor and blocks the effect of an agonist is called an antagonist!
Which Cytochrome P450 enzyme is involved in the metabolism of over 50% of all drugs?
CYP 3A4 Enzyme
Define the two terms:
1. toxin
2. detoxification
1. the degree to which a substance is poisonous
2. the process of transforming the toxin from a harmful state to harmless
Give 4 common symptoms of suboptimal detoxification
Halitosis
Skin issues
Bloating
Food Allergies/Sensitivities
What systems in particular should we support for detoxification?
Liver
Bowel
Kidney
Lymph
*and also skin and lungs
Where does food absorption take place?
Small Intestine
Which part of the gut is responsible for digestion?
Jejunum
*however, digestion happens in all processes of the GIT and starts initially in the mouth
Where are fat soluble vitamins absorbed in the gut?
Ileum
What cells secrete HCL?
The PARIETAL cells
Give 4 risk factors for leaky gut
Alcohol
Stress
Intense exercise
GI infections
Give 4 symptoms of leaky gut
Fatigue
Food intolerance
Abdominal pain
Abdominal distension (bloating)
List 4 benefits of beneficial bacteria (microflora)
Promote healthy GI barrier
Digestion of carbohydrates
Supports GALT function (immunity)
Resists colonisation of pathogens
What are herbs?
A plant or plant part-valued for its medicinal, savoury or aromatic qualities.
*A seed-producing annual, biennial or perennial plant that does not develop persistent woody tissue but dies down at the end of a growing season.
What is a herbal infusion? * need to know for exam! *
Made by pouring just-boiled water over dry or fresh plant material and leaving it to steep (infuse) for 10-15 minutes. Used for 'delicate' plant parts such as flowers (chamomile), leaves (peppermint) and fruit (rose hips).
Usual dose is 1 heaped teaspoon (1 tea bag) per cup taken 3 times daily.
What is a decoction ?
Made by simmering plant material for 10-15 minutes. Used for harder woody parts like bark (wild cherry), seed (milk thistle) and roots (dandelion). Usual dose is 1 heaped tsp per cup x3 times daily.
What is a glycerine?
*Herbs*
Plant extract made by soaking herbs in glycerine.
This is ideal for children's medicines.
Usual dose is 5ml x3 times daily.
What is a herbaltincture?
Plant extract made by soaking herbs in a mixture of alcohol and water, usually for 30 days.
Usual dose is 5ml x3 times daily.
This is the most common form used by herbalists.
Any herb can be made into a tincture.
What is meant in the ratio of herbs?
for example, 1:2 and 25%
1:2 means 1 part herb to 2 parts liquid
25% means each litre contains 250ml alcohol and 75% (750ml) water
What would be the strongest form of herbal concoction?
Fluid extract
These are one kilo herb per litre (1:1)
Which herbal concoction are you most likely to get as an over the counter herbal product?
STANDARDISED EXTRACTS
Topical application finely chopped, wet plant material usually wrapped in a fine woven cloth and held in place by bandage.
What is this?
Herbal poultice
Volatile Oils... what are these?
Also called ESSENTIAL OILS.
Aromatic chemicals extracted from plants by distillation. External use in creams, massage oils e.g. tea tree oil.
Macerated Oils.. what are these?
Herb material is soaked in a carrier oil (e.g. almond or olive) for external application
What is the herbal action of a Bitter herb?
Stimulates appetite and digestion (e.g. gentian)
What is the herbal action of an astringent herb?
Contracts proteins and reduces discharges (green tea)
What is the herbal action of a Carminative herb?
Relaxes digestive smooth muscles, reduces gas and bloating (fennel)
What is the herbal action of a Demulcent herb?
Soothes mucous membrane inflammation
What is the herbal action of a Tonic herb?
Increases strength and vitality (ashwaganda)
What is the herbal action of an Analgesic herb?
Relieves pain
What is a neurotransmitter?
Brain chemicals that communicate information throughout the our brain and body.
They relay signal between nerve cells (neutrons).
There are two types of neurotransmitter:
-Excitatory (stimulates the brain)
-Inhibitory (calms the brain and creates balance - these balance mood and are easily depleted when excitatory NTs are overactive)
5 - hydroxytryptamine is another term for ______ ?
Serotonin
TRUE OR FALSE:
Serotonin is an important signalling molecule in the gut
TRUE
Give 3 precurors of serotonin:
5-HTP
Tryptophan
Hypericum Perforatum (St John's Wort)
Give 3 food sources of tryptophan
TURKEY
RED MEAT
DAIRY PRODUCTS
*also nuts, seeds, bananas, soy products
What is GABA? (Gamma Aminobutyric Acid)
An INHIBITORY neurotransmitter that is responsible for calming the nervous system.
Low levels of GABA associated with anxiety, panic attacks, palpitations.
True or false:
Serotonin is an INHIBITORY neurotransmitter
TRUE
What is a catecholamine?
A hormone produced by the adrenal glands
The 3 main ones are:
- noradrenalin
- adrenalin
- dopamine
This neurotransmitter plays a role in cognitive arousal, emotional status, reward-seeking behaviour, mood, fine motor function.
Imbalances are linked to ADHD, schizophrenia, tourette's syndrome, and autism.
DOPAMINE
This neurotransmitter plays a role in sleep, mood and brain activity.
Serotonin
This neurotransmitter plays a role in sleep and anxiety.
GABA
This neurotransmitter plays a role in memory and cognitive function
Acetylcholine
The neurotransmitter plays a role in arousal and stress
Adrenaline
This neurotransmitter plays a role in mood, fine motor function, emotions, cognitive function
Noradrenaline
Glutamate - is this an excitatory or inhibitory neurotransmitter?
EXCITATORY
What is the HPA Axis?
Hypothalamic Pituitary Adrenal Axis
What is the major methyl donor in the human body?
SAMe
(Methionine also known as s-adenosylmethionine)
Give 4 therapeutic recommendations for depression
Exercise (for endorphin production)
Sleep hygiene
Stress management techniques
Reduce all stimulants (alcohol, caffeine, sugar, drugs)
What supplements would you give someone with insomnia?
Folic Acid (this is a cofactor for melatonin)
Tryptophan (this is a cofactor for melatonin and serotonin)
5 HTP (cofactor for melatonin and serotonin)
What is phase III detoxification?
Antiporter activity - an energy-dependent efflux pump and transporter proteins which pump the toxin (e.g. xenobiotics) out of the cell therefore reducing intracellular concentration and mobilising processed toxins for excretion.
Give 2 phase I detoxification supoort nutrients
Cysteine, glycine, glutamine, vitamin C - precursors to glutathione production
Magnesium
Give 2 examples of phase II nutrient support
Cysteine, glycine, glutamin, vit C - precusor to glutathione
Magnesium
Give 2 phase I detox inhibitors
Garlic
Echinacea
Give 2 phase I inducers
Alcohol
Nicotine
phase III detoxification requires which antioxidant?
GLUTATHIONE
The 4 R Protocol involves what....?
REMOVE - remove pathogenic bacteria, pathogens
REPLACE - replenish digestive enzymes and other digestive factors that may be lacking
REINOCULATE - reintroduction of beneficial bacteria (probiotics)
REPAIR - support the structure and function of the gut wall (heal the leaky gut!)
What is the weed, seed and feed programme?
Step 1 (prepare + weed) - exclude food and drink other than purified water for 24 hrs.
Eradicate symbiotic organisms using garlic
Step 2 (seed + feed) - provide prebiotics to feed the bowel with F.O.S. and resistant starch rich foods (e.g. slippery elm)
Inhibit growth of pathogenic flora through antimicrobials e.g. grape seed extract
Probiotics can be introduced to help restore beneficial bacteria colonies and reduce pathogenic strains
What is the definition of cross - reactivity?
Give an example.
Cross reactivity is when an antibody reacts with more than one antigen.
Klebsiella + Ankylosing Spondylitis
What is the role of T regulatory cells?
To shut down T cell reaction at the end of an immune response
What are the two types of immunity
Innate (non-specific) = this is immediate
Adapative (specific / acquired) = this is not as fast
What antibody is involved in secretions?
Secretory igA
What is NFKB?
Nuclear Factor Kappa B - This is a transcription factor.
When an inflammatory response is required to defend a cell, the appropriate genes are transcribed by a molecule called transcription factor. NF-KB is a major one of these factors.
What would an anti-inflammatory diet include?
Avoid:
- Trans fats
- Processed meats
- Artificial colourings, MSG
- Large fish (mercury)
Include:
- Organic fruits and veg
- Olive and coconut oil to cook
- Omega 3 fats - flax seed oil, salmon, walnuts
Define autoimmune disease
Conditions caused by an immune response against the body's own tissues.
The immune system mistakes its own cells for antigens.
What is the cross reactive antigen theory?
Antigens on certain pathogens may have determinants which cross react with self antigens and an immune response against these determinants may lead to antibodies against tissue antigens.
It is when an antibody reacts with more than one antigen (typically self-antigens)
What is Th1 ?
T helper cell 1 - involved in immune response
What is stress?
The non-specific response of the body to any demand
A stressor is that which produces stress
What is aldosterone?
A corticosteroid hormone which stimulates absorption of sodium (Na) by the kidneys and so regulates water and salt balance.
What are the functions of cortisol?
Increases glucose production and mobilisation
Reinforces autonomic NS response
Decreases inflammatory response
- Suppresses immunity
- Enhances lipolysis
What happens to the HPA axis in a period of chronic stress?
Becomes Hypoactive
Give 4 risks of stress
1. Suppresses thyroid function
2. Suppresses reproductive function
3. Suppresses immunity
4. Increases risk of autoimmunity
What is DHEA?
Dehydroepiandrosterone - a steroid hormone produced by the adrenals.
What are adaptogens?
Herbal adaptogens are natural herbs that have a non-specific, normalising effect on physiology - they encourage non-specific resistance to stressors e.g. ashwaganda, rhodiola, cordyceps, ginko biloba
What are two other terms for the Tricarboxylic acid (TCA) cycle?
Krebs Cycle or Citric Acid Cycle
*all the same thing
Energy production is the result of which 2 metabolic processes?
Krebs Cycle
Electron Transport Chain
Why is ALA important in energy production?
It forms a component of complex V (ATP synthase) which produces ATP within the electron transport chain!
So its important structurally and functionally.
what is the role of Nitric Oxide (NO)?
plays an important role in regulating vascular tone, inhibiting platelet aggregation, and suppression of smooth muscle cell proliferation
What is RAAS?
Renin-Angiotensin- Aldosterone System
A hormone system involved in the regulation of the plasma sodium (Na) concentration and arterial blood pressure
What is leptin?
Leptin is a satiety hormone that regulates appetite and energy balance of the body.
It is produced by adipocytes.
It can cause decreased hunger, increased activity and thermogenesis.
What is leptin resistance?
Desensitisation for the leptin signal - hormone not working as effectively
What is Grehlin? *think hungry gremlin*
Where is it produced?
Plays a role in long term regulation of energy metabolism and the short term regulation of feeding - increasing food intake and body weight.
*produced in the fundus of the stomach - which is the uppermost section of the stomach
Plasma ghrelin levels increase twofold before a meal is consumed and they decrease within 1 hour of eating.
To lose fat.... what would we recommend?
DECREASE LIPOGENESIS AND ENHANCE LIPOLYSIS
What is a SNP?
Single Nucleotide Polymorphism
Chromosomes contain one copy of the same gene from each parent. A change to one single letter e.g. ATCG to ATCC is called a Single Nucleotide Polymorphism (SNP)
A change in at least one DNA base within a gene
What is polymorphism?
The inheritance of genes in different forms.
What is methylation?
Uses the process of donating a methyl group to a substrate.
1 carbon bound to 3 hydrogen.
Methylation helps with gene regulation (turns genes on/off), processes hormones, builds neurotransmitters, builds immune cells and produces energy etc.
